中醫保健課程對於改善長者步態穩定成效之評估-以臺北市為例

Abstract

背景：臺北市老年人口比例全台最高，跌倒恐懼與行走步態被廣泛認為是導致老人跌倒的重要風險因子，但關於社區老年人步態參數的研究在臺灣相對有限。目的：本研究旨在瞭解臺北市社區老年人的跌倒恐懼與步態參數現況，並評估融入健康信念模式的中醫保健課程對其之影響。方法：本研究採準實驗設計，以方便抽樣在臺北市招募65歲至85歲社區老人，設計以健康信念模式融入之提升下肢功能中醫保健課程，介入為期一個月，課程包括數種中醫身體活動、穴位按摩、藥膳及茶飲。研究區分介入課程A組、介入課程B組及對照組，B組差異為減少特定的中醫身體活動。研究工具使用可攜式慣性傳感器進行15公尺折返步態量測，及跌倒自覺風險量表(FES-I)進行評估。結果：參與者對跌倒存在高程度恐懼，在步速、步頻、步幅長度、腳趾最小離地高度等步態參數有良好的表現，為活動力較為活躍族群。A組介入組內對步速、步幅長度、步距、雙支撐以及腳跟最大離地高度具顯著改善效果；課程B組介入於對腳跟最大離地高度具組間顯著改善效果，但該課程對跌倒恐懼及步距有負向的影響。結論：以提升下肢功能為目的之中醫保健課程，短期即能有效改善社區老年人步態表現，比一般身體活動更對老人行動推進能力有幫助。Background: In Taiwan, Taipei City has the highest proportion of elderly residents nationwide. Fear of falling and gait disturbances are widely acknowledged as significant risk factors for falls. However, research on gait parameters among community-dwelling elderly individuals in Taiwan remains relatively sparse.Objective: This study aims to assess the current state of fear of falling and gait parameters among elderly residents of Taipei City and to evaluate the effects of a Traditional Chinese Medicine (TCM) healthcare program that incorporates the Health Belief Model.Methods: A quasi-experimental design, this study recruited community-dwelling elderly individuals aged 65 and above from Taipei City through convenience sampling. The TCM healthcare program was designed to enhance lower limb functionality and included components such as TCM physical activities, acupressure, medical cuisine, and herbal teas. Participants were assigned to intervention group A, intervention group B, or a control group, with Group B receiving reduced TCM physical activities. The program spanned one month, with sessions lasting 120 minutes weekly. Measurements were conducted using a portable inertial sensor for a 15-meter return gait test, and assessments were carried out using the Fear of Falling Scale (FES-I).Results: The findings revealed a widespread prevalence of fear of falling among participants, alongside positive outcomes in gait parameters such as walking speed, cadence, stride length, and minimum toe clearance. Group A showed significant improvements in walking speed, cadence, stride length, step length, double support, and maximum heel height following the intervention. Although Group B demonstrated significant enhancements in maximum heel height exceeding those of the control group, it negatively impacted fear of falling and step length.Conclusion: The TCM healthcare program, integrated with the Health Belief Model, was effective in improving gait parameters among the elderly population in the community. These results offer valuable insights for the development of future health policies and program designs, aiming to enhance the quality of life and physical health of community-dwelling seniors.