運動治療對於改善長照機構中老年人身體功能表現的成效之系統性文獻回顧

The Effects of Therapeutic Exercise on Physical Function of Older Residents in Long Term Care Facilities-A Systematic Review

劉守莊(Shou-Chuang Liu) ； 林佩欣(Pay-Shin Lin) ； 唐翔威(Shang-Wei Tang)

《物理治療》 33卷5期 (2008/10) Pp. 302-313

摘要

背景與目的：在人口快速老化且長期照護高齡化的情況下，提供高齡者一個最完善的長期照護服務顯得格外的重要，而運動治療(therapeutic exercise)是常被用來做為提昇老人身體功能的介入方式之一。本文的目的為探討運動治療對於改善長照機構老年人身體功能的成效，並希望提供臨床工作者在給予此類個案運動治療時之參考。方法：以系統性文獻回顧(systematic review)搜尋自西元1990年迄2007年8月間Medline、PubMed、CINAHL、Cochrane library、Scopus、CEPS和全國碩博士論文網資料庫中，有關運動治療對於長照機構老年人身體功能成效的中、英文文獻。本文也使用皮卓量表(PEDro Scale)針對所有收錄文獻之研究品質予以評值(appraisal)。結果：總共納入27篇相關文獻，各文獻之皮卓分數由3~8分不等，表示中等到良好品質。這些文獻依不同身體功能表現分為七類呈現，其中9篇探討對於上肢肌力的成效，14篇探討對於下肢肌力的成效，7篇探討對於心肺耐力的成效，11篇探討對於日常生活功能的成效，14篇探討對於活動力的成效，18篇探討對於行走能力的成效，13篇探討對於平衡的成效，3篇探討對於關節活動度的成效。在每類身體功能表現中，依整理正、負向結果的篇數計算歸納結論。結論：多數的文獻顯示，運動治療介入對於提昇長照機構老人的下肢肌力、心肺耐力、活動能力和行走能力等身體功能上具有正面的成效，但對於改善上肢肌力、日常生活功能、關節活動度和平衡能力的成效上則不一致。臨床建議：長照機構中老年人的各方面情況不盡相同，因此臨床應用時需針對個別的能力和需求來選擇合適的介入計劃和評估工具。

關鍵字

長期照護 ； 運動治療 ； 身體功能 ； 老年人 ； 治療成效 ； 系統性文獻回顧

並列摘要

Background and purpose: As the number of older adults increases sharply, the needs of long term care (LTC) for them escalates. It is important to find effective interventions for improving their physical function. Therapeutic exercise is one of the programs to maintain and improve physical function. The purposes of this systematic review were to investigate the effects of therapeutic exercise on physical function of older residents living in the LTC facilities and to provide the suggestions for clinical practice. Method: A systematic search of literature published between 1990 and Aug. 2007 in Medline, PubMed, CINAHL, Cochrane library, Scopus, CEPS and Center for Chinese Studies electronic databases were performed. PEDro scale was applied for research quality appraisal. Results: A total of 27 studies has been included in this review. The PEDro scores of the included studies ranged from 3 to 8, that is, moderate to good quality. All of the articles were discussed by being grouped into 7 categories according to the measurement outcomes. In each category, there were some articles showed significantly positive effects of the therapeutic exercise, but others were not. The conclusions were made basically by study count. Discussion and conclusion: This review showed that therapeutic exercise had positive effects on lower extremity muscle strength, cardiopulmonary endurance, mobility and ambulatory ability in the LTC elderly. However, the effects on upper extremity muscle strength, activity of daily living, range of motion and balance were inconsistent. Suggestion: In view of the heterogeneous characteristics of the LTC elderly residents, it is important to consider the baseline functional capacities and individual needs in implementing proper intervention programs and assessment tools.

並列關鍵字

Long term care ； Therapeutic exercise ； Physical function ； Older adults ； Effects ； Systematic review