奥塔戈运动对膝关节置换术后老年患者平衡能力和害怕跌倒的影响
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摘要
目的 :分析奥塔戈运动对膝关节置换术老年患者平衡能力和害怕跌倒的影响。方法 :纳入符合标准的65例膝关节置换术后出院老年患者作为研究对象,按入院时间分为观察组33例,对照组32例。对照组患者接受常规功能锻炼指导,观察组患者在此基础上接受奥塔戈运动锻炼。采用Berg平衡量表、单条目问题法和修订版跌倒效能量表比较两组干预效果,并记录两组患者跌倒发生情况。结果:干预1个月后,观察组患者平衡能力得分、跌倒效能得分均高于对照组(P<0.01),观察组患者害怕跌倒发生率低于对照组(P<0.01),差异均有统计学意义;两组患者均未发生跌倒。结论 :奥塔戈运动可以提高膝关节置换术后老年患者的平衡能力和跌倒效能水平,降低害怕跌倒发生率及跌倒发生风险。
Objective: To explore the effect of Otago exercise programme on balance ability and Fear of Falling in elderly patients with knee arthroplasty. Methods: Sixty-five discharged elderly patients after knee replacement were included and divided into the observation group(33 cases) and the control group(32 cases) according to the time of admission. The routine functional exercise instruction and the flow Otago exercise programme were implemented in the control group and intervention group, respectively. The Berg balance scale, single item about falling fear and modified falls efficacy scale were used to evaluate the balance ability and fear of falling after the intervention, and the occurrence of falls in two groups was recorded. Results: The patients' balance ability and the fall efficacy in the intervention group were higher(P<0.01), and the rate of falling fear was lower than that in the control group(P<0.01) after 1 month of intervention. No fall occurred in both groups. Conclusion: Otago exercise programme can improve the balance ability and fall efficacy of elderly patients after knee arthroplasty, and reduce the incidence of falling fear and the risk of fall.
Objective: To explore the effect of Otago exercise programme on balance ability and Fear of Falling in elderly patients with knee arthroplasty. Methods: Sixty-five discharged elderly patients after knee replacement were included and divided into the observation group(33 cases) and the control group(32 cases) according to the time of admission. The routine functional exercise instruction and the flow Otago exercise programme were implemented in the control group and intervention group, respectively. The Berg balance scale, single item about falling fear and modified falls efficacy scale were used to evaluate the balance ability and fear of falling after the intervention, and the occurrence of falls in two groups was recorded. Results: The patients' balance ability and the fall efficacy in the intervention group were higher(P<0.01), and the rate of falling fear was lower than that in the control group(P<0.01) after 1 month of intervention. No fall occurred in both groups. Conclusion: Otago exercise programme can improve the balance ability and fall efficacy of elderly patients after knee arthroplasty, and reduce the incidence of falling fear and the risk of fall.
引文
[1]Bruyère O,Ethgen O,Neuprez A,et al.Health-related quality of life after total knee or hip replacement for osteoarthritis:a 7-year prospective study.Archives of Orthopaedic&Trauma Surgery,2012,132(11):1583-1587.
[2]Beswick AD,Wylde V,Goobermanhill R,et al.What proportion of patients report longterm pain after total hip or knee replacement for osteoarthritis?A systematic review of prospective studies in unselected patients.BMJ Open,2012,2(1):e000435.
[3]Wada M,Kawahara H,Shimada S,et al.Joint proprioception before and after total knee arthroplasty.Clinical Orthopaedics&Related Research,2002(403):161-167.
[4]Sharaf AY,Ibrahim HS.Physical and psychosocial correlates of fear of falling:among older adults in assisted living facilities.Journal of Gerontological Nursing,2008,34(12):27-35.
[5]Tsonga T,Michalopoulou M,Kapetanakis S,et al.Risk factors for fear of falling in elderly patients with severe knee osteoarthritis before and one year after total knee arthroplasty.Journal of Orthopaedic Surgery,2016,24(3):302-306.
[6]Tinetti ME,Powell L.Fear of falling and low self-efficacy:a case of dependence in elderly persons.Journal of Gerontology,1993,48(Special Issue):35-38.
[7]刘娜,宋圆圆,谷岩梅,等.跌倒效能对社区老年人日常活动能力的影响.中华现代护理杂志,2017,23(19):2466-2468.Liu N,Song YY,Gu YM,et al.Effects of fall efficiency on activities of daily living for community elderly people.Chin J Mod Nurs,2017,23(19):2466-2468.
[8]王田田,郭爱敏.老年人跌倒恐惧的研究进展.中国护理管理,2017,17(9):1217-1221.Wang TT,Guo AM.Fear of falling in older adults:a review.Chinese Nursing Management,2017,17(9):1217-1221.
[9]Choi K,Ko Y.Characteristics associated with fear of falling and activity restriction in south Korean older adults.Journal of Aging&Health,2015,27(6):1066-1083.
[10]柏敏,郭芝廷,方萍萍,等.奥塔戈运动项目对老年人跌倒干预效果的Meta分析.中国实用护理杂志,2018,34(4):309-314.Bo M,Guo ZT,Fang PP,et al.Effect of Otago exercise program on the elderly′s falls:a metaanalysis.Chin J Prac Nurs,2018,34(4):309-314.
[11]El-Khoury F,Cassou B,Charles M,et al.The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults:systematic review and meta-analysis of randomised controlled trials.British Journal of Sports Medicine,2013,347:f6234.
[12]Thomas S,Mackintosh S,Halbert J.Does the'Otago exercise programme'reduce mortality and falls in older adults:a systematic review and metaanalysis.Age and Ageing,2010,39(6):681-687.
[13]宫伟.奥塔戈运动项目对社区老年人跌倒效能影响的研究.长春:吉林大学,2011.Gong W.Study of Otago exercise programme on fall-efficacy of the elderly in the community.Changchun:Jilin University,2011.
[14]Dadgari A,Hamid TA,Hakim MN,et al.Randomized control trials on Otago exercise program(OEP)to reduce falls among elderly community dwellers in Shahroud,Iran.Iranian Red Crescent Medical Journal,2016,18(5):e26340.
[15]Benavent CV,Rosado CP,Segura OE,et al.The effectiveness of a video-supported groupbased Otago exercise programme on physical performance in community-dwelling older adults:a preliminary study.Physiotherapy,2016,102(3):280-286.
[16]Park Y,Chang M.Effects of the Otago exercise program on fall efficacy,activities of daily living and quality of life in elderly stroke patients.J Phys Ther Sci,2016,28(1):190-193.
[17]李莺,程云,赵丽蓉,等.奥塔戈运动对老年脑卒中患者害怕跌倒的影响.中华护理杂志,2014,49(12):1442-1447.Li Y,Cheng Y,Zhao LR,et al.Effect of Otago exercise programme on fear of falling in elderly patients with stroke.Chinese Journal of Nursing,2014,49(12):1442-1447.
[18]Mat S,Ng CT,Tan PJ,et al.Effect of modified Otago exercises on postural balance,fear of falling,and fall risk in older fallers with knee osteoarthritis and impaired gait and balance:a secondary analysis.Pm&R,2018,10(3):254-262.
[19]Robertson MC.Otago exercise programme to prevent falls in older adult:a home-based,individually tailored strength and balance retraining programme.New Zealand:Otago Medical School,University of Otago,2003.
[20]李莺.运动锻炼对老年脑卒中患者害怕跌倒的影响.上海:复旦大学,2014.Li Y.Effect of exercise on fear of falling in elderly patients with Stroke.Shanghai:Fudan University,2014.
[21]Berg K.Measuring balance in the elderly preliminary developmentof an instrument.Physiotherapy Canada,1989,41(6):304-311.
[22]金冬梅,燕铁斌,曾海辉.Berg平衡量表的效度和信度研究.中国康复医学杂志,2003,18(1):25-27.Jin DM,Yan TB,Zeng HH.Validity and reliability of Berg balance scale on assessing balance function.Chinese Journal of Rehabilitation Medicine,2003,18(1):25-27.
[23]郝燕萍,刘雪琴.修订版跌倒效能量表在我国老年人群中的测试研究.中华护理杂志,2007,42(1):19-21.Hao YP,Liu XQ.Research of application of the modified fall efficacy scale of Chinese version in the aged in China.Chinese Journal of Nursing,2007,42(1):19-21.
[24]刘建平.随机对照试验的依从性和意向性治疗分析.中国中西医结合杂志,2003,23(12):884-886.Liu JP.Analysis of compliance and intentionality in randomized controlled trials.Chinese Journal of Integrated Chinese and Western Medicine,2003,23(12):884-886.
[25]徐丹,陶陶,张继荣,等.本体感觉训练对全膝关节置换术患者关节功能恢复的荟萃分析.中华老年医学杂志,2018,37(3):339-343.Xu D,Tao T,Zhang JR,et al.The effect of proprioceptive training on knee joint recovery among patients with total knee replacement:a meta-analysis of randomized controlled trials.Chin J Geriatr,2018,37(3):339-343.
[26]Venema DM,Karst GM.Individuals with total knee arthroplasty demonstrate altered anticipatory postural adjustments compared with healthy control subjects.Journal of Geriatric Physical Therapy,2012,35(2):62-71.
[27]Schwartz I,Kandel L,Sajina A,et al.Balance is an important predictive factor for quality of life and function after primary total knee replacement.Journal of Bone and Joint Surgery,2012,94B(6):782-786.
[28]Moutzouri M,Gleeson N,Billis E,et al.The effect of total knee arthroplasty on patients'balance and incidence of falls:a systematic review.Knee Surgery Sports Traumatology Arthroscopy,2017,25(11):3439-3451.
[29]Tinetti ME,Richman D,Powell L.Falls efficacy as a measure of fear of falling.Journal of Gerontology,1990,45(6):239-243.
[30]Delbaere K,Crombez G,Vanderstraeten G,et al.Fear-related avoidance of activities,falls and physical frailty:a prospective community-based cohort study.Age&Ageing,2004,33(4):368-373.
[31]Pua Y,Ong P,Lee AY,et al.Preliminary prediction model for fear-induced activity limitation after total knee arthroplasty in people60 years and older:prospective cohort study.Archives of Physical Medicine and Rehabilitation,2013,94(3):503-509.
[32]李莺,程云,赵丽蓉.老年脑卒中患者跌倒自我效能的现状及影响因素分析.中国实用护理杂志,2014,30(23):12-16.Li Y,Cheng Y,Zhao LR.The current status and influencing factors of falls self-efficacy among the stroke elderly patients.Chin J Prac Nurs,2014,30(23):12-16.
[33]郭红,李红云,杨雅威,等.住院脑血管病老年患者跌倒效能影响因素的研究.中华护理杂志,2013,48(2):147-150.Guo H,Li HY,Yang YW,et al.The in fluencing factors of falls eficacy among hospitalized older patients with cerebrovascular disease.Chinese Journal of Nursing,2013,48(2):147-150.
[34]Bade MJ,Kittelson JM,Kohrt WM,et al.Predicting functional performance and range of motion outcomes after total knee arthroplasty.American Journal of Physical Medicine&Rehabilitation,2014,93(7):579-585.
[2]Beswick AD,Wylde V,Goobermanhill R,et al.What proportion of patients report longterm pain after total hip or knee replacement for osteoarthritis?A systematic review of prospective studies in unselected patients.BMJ Open,2012,2(1):e000435.
[3]Wada M,Kawahara H,Shimada S,et al.Joint proprioception before and after total knee arthroplasty.Clinical Orthopaedics&Related Research,2002(403):161-167.
[4]Sharaf AY,Ibrahim HS.Physical and psychosocial correlates of fear of falling:among older adults in assisted living facilities.Journal of Gerontological Nursing,2008,34(12):27-35.
[5]Tsonga T,Michalopoulou M,Kapetanakis S,et al.Risk factors for fear of falling in elderly patients with severe knee osteoarthritis before and one year after total knee arthroplasty.Journal of Orthopaedic Surgery,2016,24(3):302-306.
[6]Tinetti ME,Powell L.Fear of falling and low self-efficacy:a case of dependence in elderly persons.Journal of Gerontology,1993,48(Special Issue):35-38.
[7]刘娜,宋圆圆,谷岩梅,等.跌倒效能对社区老年人日常活动能力的影响.中华现代护理杂志,2017,23(19):2466-2468.Liu N,Song YY,Gu YM,et al.Effects of fall efficiency on activities of daily living for community elderly people.Chin J Mod Nurs,2017,23(19):2466-2468.
[8]王田田,郭爱敏.老年人跌倒恐惧的研究进展.中国护理管理,2017,17(9):1217-1221.Wang TT,Guo AM.Fear of falling in older adults:a review.Chinese Nursing Management,2017,17(9):1217-1221.
[9]Choi K,Ko Y.Characteristics associated with fear of falling and activity restriction in south Korean older adults.Journal of Aging&Health,2015,27(6):1066-1083.
[10]柏敏,郭芝廷,方萍萍,等.奥塔戈运动项目对老年人跌倒干预效果的Meta分析.中国实用护理杂志,2018,34(4):309-314.Bo M,Guo ZT,Fang PP,et al.Effect of Otago exercise program on the elderly′s falls:a metaanalysis.Chin J Prac Nurs,2018,34(4):309-314.
[11]El-Khoury F,Cassou B,Charles M,et al.The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults:systematic review and meta-analysis of randomised controlled trials.British Journal of Sports Medicine,2013,347:f6234.
[12]Thomas S,Mackintosh S,Halbert J.Does the'Otago exercise programme'reduce mortality and falls in older adults:a systematic review and metaanalysis.Age and Ageing,2010,39(6):681-687.
[13]宫伟.奥塔戈运动项目对社区老年人跌倒效能影响的研究.长春:吉林大学,2011.Gong W.Study of Otago exercise programme on fall-efficacy of the elderly in the community.Changchun:Jilin University,2011.
[14]Dadgari A,Hamid TA,Hakim MN,et al.Randomized control trials on Otago exercise program(OEP)to reduce falls among elderly community dwellers in Shahroud,Iran.Iranian Red Crescent Medical Journal,2016,18(5):e26340.
[15]Benavent CV,Rosado CP,Segura OE,et al.The effectiveness of a video-supported groupbased Otago exercise programme on physical performance in community-dwelling older adults:a preliminary study.Physiotherapy,2016,102(3):280-286.
[16]Park Y,Chang M.Effects of the Otago exercise program on fall efficacy,activities of daily living and quality of life in elderly stroke patients.J Phys Ther Sci,2016,28(1):190-193.
[17]李莺,程云,赵丽蓉,等.奥塔戈运动对老年脑卒中患者害怕跌倒的影响.中华护理杂志,2014,49(12):1442-1447.Li Y,Cheng Y,Zhao LR,et al.Effect of Otago exercise programme on fear of falling in elderly patients with stroke.Chinese Journal of Nursing,2014,49(12):1442-1447.
[18]Mat S,Ng CT,Tan PJ,et al.Effect of modified Otago exercises on postural balance,fear of falling,and fall risk in older fallers with knee osteoarthritis and impaired gait and balance:a secondary analysis.Pm&R,2018,10(3):254-262.
[19]Robertson MC.Otago exercise programme to prevent falls in older adult:a home-based,individually tailored strength and balance retraining programme.New Zealand:Otago Medical School,University of Otago,2003.
[20]李莺.运动锻炼对老年脑卒中患者害怕跌倒的影响.上海:复旦大学,2014.Li Y.Effect of exercise on fear of falling in elderly patients with Stroke.Shanghai:Fudan University,2014.
[21]Berg K.Measuring balance in the elderly preliminary developmentof an instrument.Physiotherapy Canada,1989,41(6):304-311.
[22]金冬梅,燕铁斌,曾海辉.Berg平衡量表的效度和信度研究.中国康复医学杂志,2003,18(1):25-27.Jin DM,Yan TB,Zeng HH.Validity and reliability of Berg balance scale on assessing balance function.Chinese Journal of Rehabilitation Medicine,2003,18(1):25-27.
[23]郝燕萍,刘雪琴.修订版跌倒效能量表在我国老年人群中的测试研究.中华护理杂志,2007,42(1):19-21.Hao YP,Liu XQ.Research of application of the modified fall efficacy scale of Chinese version in the aged in China.Chinese Journal of Nursing,2007,42(1):19-21.
[24]刘建平.随机对照试验的依从性和意向性治疗分析.中国中西医结合杂志,2003,23(12):884-886.Liu JP.Analysis of compliance and intentionality in randomized controlled trials.Chinese Journal of Integrated Chinese and Western Medicine,2003,23(12):884-886.
[25]徐丹,陶陶,张继荣,等.本体感觉训练对全膝关节置换术患者关节功能恢复的荟萃分析.中华老年医学杂志,2018,37(3):339-343.Xu D,Tao T,Zhang JR,et al.The effect of proprioceptive training on knee joint recovery among patients with total knee replacement:a meta-analysis of randomized controlled trials.Chin J Geriatr,2018,37(3):339-343.
[26]Venema DM,Karst GM.Individuals with total knee arthroplasty demonstrate altered anticipatory postural adjustments compared with healthy control subjects.Journal of Geriatric Physical Therapy,2012,35(2):62-71.
[27]Schwartz I,Kandel L,Sajina A,et al.Balance is an important predictive factor for quality of life and function after primary total knee replacement.Journal of Bone and Joint Surgery,2012,94B(6):782-786.
[28]Moutzouri M,Gleeson N,Billis E,et al.The effect of total knee arthroplasty on patients'balance and incidence of falls:a systematic review.Knee Surgery Sports Traumatology Arthroscopy,2017,25(11):3439-3451.
[29]Tinetti ME,Richman D,Powell L.Falls efficacy as a measure of fear of falling.Journal of Gerontology,1990,45(6):239-243.
[30]Delbaere K,Crombez G,Vanderstraeten G,et al.Fear-related avoidance of activities,falls and physical frailty:a prospective community-based cohort study.Age&Ageing,2004,33(4):368-373.
[31]Pua Y,Ong P,Lee AY,et al.Preliminary prediction model for fear-induced activity limitation after total knee arthroplasty in people60 years and older:prospective cohort study.Archives of Physical Medicine and Rehabilitation,2013,94(3):503-509.
[32]李莺,程云,赵丽蓉.老年脑卒中患者跌倒自我效能的现状及影响因素分析.中国实用护理杂志,2014,30(23):12-16.Li Y,Cheng Y,Zhao LR.The current status and influencing factors of falls self-efficacy among the stroke elderly patients.Chin J Prac Nurs,2014,30(23):12-16.
[33]郭红,李红云,杨雅威,等.住院脑血管病老年患者跌倒效能影响因素的研究.中华护理杂志,2013,48(2):147-150.Guo H,Li HY,Yang YW,et al.The in fluencing factors of falls eficacy among hospitalized older patients with cerebrovascular disease.Chinese Journal of Nursing,2013,48(2):147-150.
[34]Bade MJ,Kittelson JM,Kohrt WM,et al.Predicting functional performance and range of motion outcomes after total knee arthroplasty.American Journal of Physical Medicine&Rehabilitation,2014,93(7):579-585.
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