[[alternative]]Exploring the effectiveness of music therapy activities in improving the physical fitness, activity and depression in the frailty of the community elderly

[[abstract]]目的:探討以音樂治療活動於社區衰弱老人體適能、活動力及憂鬱情緒改善成效，並建構一套適合長者使用的音樂治療活動促進方案。背景:台灣於2018年3月老人人口增加到14.05%，已正式晉升為高齡社會，家中長輩無可避免自然老化或是慢性病數的增加，導致體能衰退及憂鬱情緒產生，成為社區老人最常見的健康問題，也增加醫療成本及照顧人力的需求，形成社會、家庭重大負擔。因此治本之道，唯有從老人的身心健康促進著手。音樂治療活動可視老人能力、喜好及需求做靈活變化，採多元團體活動，是普遍受老人歡迎、能力可及、成本低，全方位健康促進，對於老人的體適能、活動力及憂鬱情緒的改善，更是具有顯著的效果。方法:本研究在四個社區關懷據點實施，採隨機實驗(RCT)性研究，單盲設計，立意取樣，雙組前後測試驗，研究樣本須年滿65歲以上，前測以BMI、30秒坐站、2分鐘屈膝抬腿、2.44公尺坐走、慣用手握力等項目篩檢衰弱指標，國際身體活動量表中文短版(IPAQ-SF)探討老人的活動力，並以自覺健康狀態及台灣老人憂鬱量表(TGDS-30)篩檢有憂鬱傾向的長輩。收案條件以Fried衰弱症五個指標≧1項以上或TGDS-30指數≧15分以上者參與研究。四個關懷據點以隨機方式決定二個實驗組及二個對照組，實驗組介入音樂治療活動及關懷據點常規活動，對照組只有關懷據點常規活動，音樂治療活動介入十二週，每週一次，每次90分鐘，第十三週第一次後測，因應研究對象有情緒問題，第十六週，再第二次後測，收集三次測量數據以IBM SPSS 22.0 版及SAS統計軟體進行資料建檔及分析，統計方式以描述性統計百分比、平均數、標準差，以t test分析兩組同質性，皮爾森積差相關性及Linear Mix Model分析兩組成效指標與時間點交互作用。結果:本研究共收案55人，實驗組30人，對照組25人，十二週音樂治療課程後，在衰弱指標上，30秒坐站平均數實驗組由前測14.77次，後測一進步至16.17次，後測二再進步至17.70次，共進步2.93次，對照組只進步1.24次；2分鐘屈膝抬腿平均數實驗組由77.53次，後測一進步至86.20次，後測二再進步至86.53次，共進步9次，對照組只進步0.08次；2.44公尺坐走平均數實驗組由前測10.60秒，後測一進步至9.54秒，後測二再進步至9.18秒，共進步1.42秒，對照組只進步1.06秒；握力平均數實驗組由20.37公斤，後測一進步至22.02公斤，後測二再進步至22.87公斤，共進步2.5公斤，對照組只進步0.32公斤。兩組在後測一，2分鐘屈膝抬腿達到顯著交互作用，介入效益估計值10.29(p=.02)，其他成效指標都有進步，但未達顯著；在後測二，兩組達到顯著交互作用的項目有四項: 2分鐘屈膝抬腿，介入效益估計值為12.86 (p=.00)；握力，介入效益估計值為0.95 (p=.03)；憂鬱指數(TGDS-30)，介入效益估計值為-1.59(p=.03)；及身體活動量(IPAQ-SF)，介入效益估計值為1098.47(p=.00)。另外四個成效指標未達顯著交互作用，有30秒坐站，介入效益估計值1.42(p=.22)、2.44公尺坐走，介入效益估計值-0.22(p=.67)、自覺健康狀態，效益估計值0.27(p=.49)、BMI，介入效益估計值0.78(p=.39)。 結論:音樂治療活動能增加社區衰弱老人上肢肌力及下肢活動力、心肺功能等，並改善老人憂鬱情緒問題及日常身體活動量。本研究還發現音樂治療活動有延遲效應，即使在課程停止後四週，老人體適能、活動量及憂鬱情緒仍持續進步。[[abstract]]Objective: To investigate the effectiveness of music therapy activities in improving the physical fitness and mobility and reducing the depressive emotions in the frailty of community elderly, in addition to constructing a suitable proposal for promoting the use of music therapy activities. Background: In March 2018, Taiwan officially became an aging society as the elderly accounted for 14.05% of the country’s total population. The aging process and increase in chronic diseases that the elderly experience have led to physical decline and depression, which are not only the most common health problems among community elderly but also great burdens for society and families as they increase medical costs and labor requirements for providing care. Hence, the only way to address this issue is to improve the physical and mental health of the elderly. Flexible adjustments can be made in music therapy activities according to the strengths, preferences, and requirements of the participating elderly individuals. Hence, music therapy programs that involve various group activities are well received among the elderly as they are a practical and low-cost approach to promote the overall health of the elderly, in addition to significantly improving their physical fitness and mobility while reducing their depressive emotions.Method: A single-blind randomized controlled trial (RCT) approach was used in this study. Purposive sampling was conducted at four community care centers where elderly individuals aged 65 and above were subjected to a pre-intervention test that aimed to check if they met any frailty criteria. The test was completed by measuring the elderly’s BMI and dominant hand grip strength and assessing their performances in the 30-second sit-to-stand test, 2-minute leg raise test, and 2.44 m up-and-go test. The Chinese version of the International Physical Activity Questionnaire - Short Form (IPAQ-SF) was used to assess the mobility of the elderly, while the Taiwan Geriatric Depression Scale (TGDS-30) and each elderly individual’s self-perceived health were used to check if the given elderly individual had depressive tendencies. Participants were selected if they had at least one of the five frailty criteria proposed by Fried, or if their TGDS-30 score was at least 15 or higher. Then, participants from the four community care centers were randomly divided into two control groups and two experimental groups. The experimental group participated in music therapy activities in addition to routine activities in the care center, while the control group only participated in routine activities in the care center. The music therapy activities were held once every week for 12 weeks, with each session lasting 90 minutes. The first post-intervention test was conducted in the 13th week, while the second post-intervention test was conducted in the 16th week in response to emotional problems experienced by some participants. The pre-intervention and the two post-intervention test results were analyzed and filed using IBM SPSS 22 and SAS statistical software. Descriptive statistics were obtained, such as the percentage, mean, and standard deviation. The t-test was used to analyze the homogeneity of the two groups; the Pearson correlation and the Linear Mix Model were used to analyze the interactions between the timing of the tests and the performance indicators of the two groups.Results: There were 55 participants in this study: 30 were in the experimental group while 25 were in the control group. After 12 weeks of participating in the music therapy activities, the pre-test, first-post-test, and second post-test results of the experimental group for the 30-second sit-to-stand test, were 14.77, 16.17, and 17.70 times, respectively, indicating an overall improvement of 2.93 times, whereas the overall improvement of the control group was 1.24 times. In the 2-minute leg raise test, the three test results of the experimental group were 77.53, 86.20, and 86.53 times, respectively, indicating an overall improvement of 9 times, whereas the overall improvement of the control group was 0.08 times. In the 2.44 m up-and-go test, the three test results of the experimental group were 10.60, 9.54, and 9.18 seconds, respectively, indicating an overall improvement of 1.42 seconds, whereas the overall improvement of the control group was 1.06 seconds. In terms of grip strength, the three test results of the experimental group were 20.37, 22.02, and 22.87 kg, respectively, indicating an overall improvement of 2.5 kg, whereas the overall improvement of the control group was 0.32 kg. In the first post-test, a statistically significant interaction was observed in both groups for the 2-minute leg raise test, in which the estimated intervention effect size was 10.29 (p = .02). Meanwhile, improvements were observed in the other performance indicators, but they were not statistically significant. In the second post-test, statistically significant interactions were observed in both groups for four performance indicators, namely, the 2-minute leg raise test results, for which the estimated intervention effect size was 12.86 (p = .00); the grip strength results, for which the estimated intervention effect size was 0.95 (p = .03); the TGDS-30 scores, for which the estimated intervention effect size was -1.59 (p = .03); and the mobility results (in terms of the IPAQ-SF), for which the estimated intervention effect size was 1098.47 (p = .00). In contrast, statistically significant interactions were not observed in either group for four other performance indicators, namely, the 30-second sit-to-stand test results, for which the estimated intervention effect size was 1.42 (p = .22); the 2.44 m up-and-go test results, for which the estimated intervention effect size was -0.22 (p = .67); the self-perceived health results, for which the estimated intervention effect size was 0.27 (p = .49); and the BMI results, for which the estimated intervention effect size was 0.78 (p = .39).Conclusion: Music therapy can improve the cardiovascular functions, upper body muscle strength, and lower body mobility of community elderly, in addition to reducing their depressive emotions and increasing their daily level of physical activity. Moreover, the findings from this study suggest that music therapy activities have a prolonged effect, as the physical fitness and mobility levels of the elderly still showed improvement and their depressive emotions were still reduced even after the activities had stopped for four weeks