團體式Otago運動對日間照顧中心長者下肢肌力與平衡之成效

Group-Based Otago Exercise Program on Lower Extremity Strength and Balance in the Elderly at a Daycare Center

探討團體式Otago運動對日間照顧中心長者下肢肌力與平衡功能改善之成效。本研究為多中心、單組、重複測量之設計。研究對象由物理治療師帶領團體式Otago 運動訓練，每週進行3次，持續6個月，共78次，並依參與次數，將參與至少52次者（出席率達2／3）訂為高出席率組，反之為低出席率組。量測指標包含下肢肌力及平衡能力，共3個測量時間，分別為Otago運動介入前（T1）、介入後3個月（T2）及6個月（T3）。共收案48位長者。從T2到T3，高出席率組參與者的膝肌群與腳踝肌群肌力，皆持續顯著增加（膝伸直肌：13.11 kgf至14.22 kgf，p＝0.007；膝彎曲肌：7.57 kgf至8.23 kgf，p＝0.021；腳踝蹠屈：10.50 kgf至12.40 kgf，p＜0.001，腳踝背屈：10.40 kgf至12.92 kgf，p＜0.001），而低出席率組之變化未有顯著差異。在平衡功能方面，介入措施後，高出席率組長者起身行走測試（TUG）秒數顯著較短（T3-T1，估計值：-3.58，SE：1.51，p＝0.02），且隨時間進展，高出席率組長者TUG秒數持續降低（20.84秒 vs. 19.95秒 vs. 17.01秒），而T2到T3時，低出席率組長者TUG秒數不僅未降低，且微幅升高（16.57秒 vs. 16.88秒），表示平衡能力呈現退化。為期6個月的Otago運動能有效提高老年長者下肢力量和平衡能力，建議應將Otago運動作為防跌主要運動計劃，並加以推廣。

The purpose of this study is to evaluate the effects of a group-based Otago Exercise Program (OEP) on the lower extremity strength and balance ability in elderly population in the daycare center. This was a multi-center, single-group pretest-posttest design. All participants were enrolled in group OEP led by a physiotherapist. Sessions were conducted three times per week over a 6-month period. A total of 78 sessions were performed during the 6-month intervention. According to the participation, those who participated at least 52 times (attendance rate reached 2/3) were defined as the high attendance group, otherwise the low attendance group. Lower extremity muscle strength and balance ability were collected at baseline (T1), after 3 months (T2) and 6 months (T3) of the OEP, respectively Forty-eight participants aged over 65 who attended the elderly daycare center were recruited. From T2 to T3, the knee and ankle muscle strength of participants in the higher attendance group continued to increase significantly (knee extensor: 13.11 kgf to 14.22 kgf, p=0.007; knee flexor: 7.57 kgf to 8.23 kgf, p=0.021, ankle plantar flexors: 10.50 kgf to 12.40 kgf, p<0.001; ankle dorsiflexors: 10.40 kgf to 12.92 kgf, p<0.001), but there was no significant difference in the lower attendance group. The TUG time of the elderly in the higher attendance group was shorter than that of those in the lower attendance group (T3-T1, estimated value:-3.58, SE: 1.51, p=0.02). As time progressed, the TUG time of the elderly in the higher attendance group improved significantly from T1 to T3 (20.84s vs. 19.95s vs. 17.01s), whereas from T2 to T3, the TUG values in the lower attendance group worsened (16.57s vs. 16.88s). Participating in a group-based OEP over 6 months may improve the lower extremity strength and balance ability in elderly population. It is recommended that the OEP should be promoted for preventing falls in elders in clinical practice.