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系統識別號 U0026-3001201213415600
論文名稱(中文) 探討活動介入於預防住院老人功能衰退之成效:前驅性研究
論文名稱(英文) Effects of activity program in prevention of functional decline among hospitalized elderly: a pilot study
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 100
學期 1
出版年 100
研究生(中文) 黃楷雯
研究生(英文) Kai-Wen Hung
學號 t2697106
學位類別 碩士
語文別 中文
論文頁數 65頁
口試委員 指導教授-陳清惠
口試委員-張家銘
口試委員-林桑伊
中文關鍵字 住院老人  步行活動介入  功能衰退 
英文關鍵字 elderly patient  walking intervention  functional decline 
學科別分類
中文摘要 老人住院會因活動受限或其他住院引起的合併症,使住院天數延長,增加身體功能衰退的機會。研究顯示40%的老人住院期間有功能衰退的現象,其中28.6%的住院老人無法回復原有功能。故本研究主要為探究步行活動介入對預防住院老人身體功能衰退成效的前驅性研究。採實驗性研究設計,以南部某醫學中心,65歲以上之住院病人為對象,以隨機分派方式分為實驗組及控制組,實驗組8人,控制組7人。控制組接受病房常規照護。實驗組的介入措施為在確認病人可下床活動後,依病人個人身體狀況每日走路10~60分鐘,持續至出院後返家後1個月。成效評量為比較兩組的巴氏量表、起立行走測驗、握力、健康生活品質、出院目的地、住院天數及28天再入院比率。
研究結果顯示:(1)日常生活功能方面,實驗組出院1個月的巴氏量表分數已高於出院前2週的分數,(2)握力方面,實驗組出院和住院的握力平均差高於控制組(3.0±3.13公斤 vs0.3±3.6公斤),(3)起立行走測驗方面,實驗組在出院和住院的完成時間平均差較控制組多(-4.0±8.0秒 vs-1.3±1.3秒)。整體而言,住院中步行活動介入對於住院老人預防功能衰呈現改善趨勢,建議未來可運用於臨床護理。
英文摘要 Limited motion and related complications of elderly might cause prolonged length of stay and risk of functional decline during hospitalization. Previous research demonstrated that 40% of elderly has functional declines during hospitalization and 28.6% of them are unable to regain the original function. This pilot study was aimed to explore the effect of intervention to prevet functional decline in hospitalized elderly.A total of 15 elderly who were enrolled and randomized allocated into the control group (n=7) and the experimental group (n=8). Admitted in one of the medical center at southern Taiwan. Patients in the experimental group were intervented by accumulated 10~60 minutes walking daily from admission to one month after discharge. The walking plan was designed according to individual physical tolerance and personal perference. The outcome measures included activities of daily function measured by Modified Barthel index, hand grip strength, time up and go test, quality of life,discharge destination,hospital length of stay,28-day readmission rate.
The improvement in Modified Barthel index at one month after discharge was greater than 2 weeks before admittance in experimental group. The hand grip strength at discharge was greater in experimental group than in control group. The improvement in respect to timed up and go test in experimental group was better than in control group (-4.0±8.0second vs-1.3±1.3second).In conclusion, the walking intervention is shown to be feasible and effective in preventing functional decline in elderly. We suggested that the walking intervention may implant into in clinical nursing care in the future.
論文目次 目錄
中文摘要 …………………………………………………………………………Ⅰ
英文摘要 …………………………………………………………………………Ⅱ
致謝 ………………………………………………………………………………Ⅲ
目錄 ………………………………………………………………………………Ⅳ
圖目錄 ……………………………………………………………………………Ⅶ
表目錄 ……………………………………………………………………………Ⅶ
附件目錄 …………………………………………………………………………Ⅷ

第一章 緒論 ………………………………………………………………………1
第一節 背景與重要性 …………………………………………………………1
第二節 研究目的 ……………………………………………………………2
第二章 文獻查證 ………………………………………………………………3
第一節 身體功能衰退的定義 …………………………………………………3
第二節 日常活動功能的評估工具 ……………………………………………3
第三節 影響住院老人功能衰退的危險因子 …………………………………5
第四節 預防住院老人功能衰退的運動介入措施 ……………………………7
第五節 預防住院老人功能衰退的活動設計注意事項………………………11
第三章 研究架構與研究問題…………………………………………………12
第一節 研究架構………………………………………………………………12
第二節 研究問題………………………………………………………………13
第三節 名詞界定………………………………………………………………14
第四章 研究方法與過程………………………………………………………15
第一節 研究設計………………………………………………………………15
第二節 研究場所與對象………………………………………………………16
第三節 活動介入措施…………………………………………………………17
第四節 研究過程………………………………………………………………18
第五節 研究工具………………………………………………………………21
第六節 倫理考量………………………………………………………………24
第七節 資料分析理……………………………………………………………24
第五章 研究結果 ………………………………………………………………25
第一節 研究對象人口學屬性………………………………………………25
第二節 兩組個案活動狀況…………………………………………………28
第三節 兩組日常生活功能比較……………………………………………33
第四節 兩組握力比較………………………………………………………36
第五節 兩組起立行走測驗比較……………………………………………37
第六節 兩組健康生活品質比較……………………………………………39
第七節 兩組住院天數、28天再入院、住院滿意度、出院目的地………41
第六章 討論 ………………………………………………………………………43
第一節 活動狀況的探討……………………………………………………43
第二節 日常生活功能的成效………………………………………………44
第三節 肌肉力量和行走功能的成效………………………………………44
第四節 健康生活品質的成效………………………………………………45
第五節 其它成效……………………………………………………………45
第七章 結論、限制與建議 ………………………………………………………47
第一節 結論…………………………………………………………………47
第二節 研究結果之應用與建議……………………………………………48
參考文獻 …………………………………………………………………………49
中文部分 ………………………………………………………………………49
英文部分 ………………………………………………………………………51

圖目錄
圖3-1 運用活動介入措施防止住院老人身體功能衰退之研究架構圖………12
圖4-1 收案流程圖………………………………………………………………17
圖4-2 資料收集流程……………………………………………………………20
圖5-1 2組住院前2週到出院後3個月的巴氏量表變化 ……………………35
圖5-2 2組住院到出院後1個月的握力變化 ………………………………37
圖5-3 2組住院到出院後1個月的起立行走測驗完成時間變化 ……………39
圖5-4 2組EQ-5D index出院到出院後1個月的變化 ………………………40
圖5-5 2組EQ-VAS出院到出院後1個月的變化 ……………………………41

表目錄
表2-1預防住院老人功能衰退之運動介入措施文獻彙整 ……………………10
表4-1 研究設計 ………………………………………………………………15
表 5-1人口學變項(等比變項)………………………………………………25
表 5-2人口學變項(類別變項)………………………………………………27
表5-3 2組住院前活動情形……………………………………………………29
表5-4 2組住院中活動情形……………………………………………………30
表5-5 實驗組出院後1個月和3個月的活動情形 ……………………………31
表5-6 控制組出院後1個月和3個月的活動情形 ……………………………32
表5-7 2組巴氏量表獨立項目從住院前2週到出院後3個月的變化…………34
表5-8 2組住院前2週到出院後3個月的日常生活功能變化…………………35
表5-9 2組住院到出院握力的比較 …………………………………………36
表5-10 2組住院到出院1個月握力的比較 …………………………………36
表5-11 2組住院到出院起立行走測驗的比較 ………………………………37
表5-12 2組住院到出院1個月起立行走測驗完成的比較 …………………38
表5-13 2組住院到出院1個月起立行走測驗的比較 …………………………38
表5-14 2組住院住院到出院1個月的EQ-5D比較 ………………………40
表5-15 2組住院住院到出院1個月的EQ-VAS比較 …………………………40
表5-16 兩組住院天數比較的比較 …………………………………………41
表5-17 兩組28天再入院的比較 ………………………………………………42
表5-18 兩組出院後轉送長期照護機構的比較 ………………………………42

附件目錄
附件一 個案資料登錄表………………………………………………………56
附件二 活動計畫執行登錄表…………………………………………………63
附件三 Charlson comobidity index(CCI) …………………………………………65
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