[[alternative]]The effect of reablement training on improving mobility, physical function and activities of daily living of residents in long-term care facility

[[abstract]]背景：進住機構的老人為失能人口，行動功能障礙並需依賴他人協助日常生活活動。而復能對日常生活功能受限的人就是賦能，聚焦於個案的優勢能力而非缺損，強調復原而非殘補代勞。故復能訓練對提升老人長照機構中長者功能之成效如何，是值得深入探討的議題。目的：本研究旨在探討12週、每週3次、每次30分鐘復能訓練，對提升機構老年長者行動功能、身體功能及日常生活活動功能之成效。期望研究結果提供實證，有助於機構管理者及政策制定者在擬定納入給付對象時，作為參考。方法：本研究為分層隨機對照試驗，以北區某長照機構16位住民為研究對象，依「行動能力」分為輪椅不能主動活動(n = 8)、輪椅可主動活動(n = 4)、行走需輔具(n = 4)，再進行分層隨機分配為復能組(n = 8)及控制組(n = 8)。成效評量包括：行動功能以De Morton Mobility Index (DEMMI)量表，身體功能以The Short Physical Performance Battery (SPPB)量表、日常生活活動(ADL)以巴氏量表(BI)進行評估，並以加拿大職能表現量表(Canadian Occupational Performance Measure, COPM)測量復能成效。復能組介入12週復能訓練，控制組則維持原有的生活型態，在介入前及介入期滿七天內分別完成前、後測，評估者與介入者為不同治療師（單盲）。以魏克生符號檢定(Wilcoxon Signed Rank Test)及曼─惠特尼U檢定(Mann-Whitney U Test)進行組內與組間之差異統計檢定，設定統計顯著水準α= 0.05。結果：16名受試者的年齡範圍60-92歲；認知功能MMSE平均24.4 ± 3.7分；行動輔具大多使用輪椅(81.3%)，多數居住於機構兩年以上(62.5%)，診斷為心血管疾病(75.0%)最多、腦神經疾病(62.5%)次之。復能組接受五大類功能性復能計畫處遇：行走功能處方訓練(n=7)、站立坐站功能處方訓練(n=7)、坐姿功能處方訓練(n=5)、其他個別化生活處方訓練(n=8)，統計分析結果顯示復能組在後測行動功能DEMMI量表中坐站能力顯著優於控制組(p = 0.038)；在職能表現操作滿意度(p = 0.042)以及日常生活活動功能(p = 0.041)能力上的進步皆有顯著差異，其中移位功能的進步達邊緣顯著差異(p = 0.059)。依「行動能力」次分組比較復能組及控制組兩組前後測功能進步情形，結果顯示輪椅不能主動活動組(n = 8)：復能組在DEMMI總分、COPM-P與COPM-S及BI總分（尤以移位）進步優於控制組；輪椅可主動活動組(n = 4)：復能組在DEMMI總分、SPPB總分、COPM-P與COPM-S及BI總分（尤以平地上走動) 進步皆優於控制組；行走需輔具組(n = 4)：復能組在COPM-S及BI總分（包含上下樓梯及大小便控制）平均分數進步優於控制組。結論：本研究初步驗證復能訓練可提升長照機構長者之行動功能、身體功能及日常生活活動功能，增進自立能力並延緩失能。關鍵詞：復能訓練、行動功能、身體功能、日常生活活動功能、長照機構[[abstract]]Background: The elderly residents in long-term care facilities (LTCFs) are disabled population who have mobility dysfunction that impacts their performances of activities of daily living (ADL). Reablement is one approach for maintaining and improving the functional independence. There is limited evidence on the effectiveness of reablement training on enhancing the functions of the elderly residents in LTCFs.Purpose: The purpose of this study was to explore the effectiveness of a reablement training program on enhancing the mobility, physical function and ADL of the elderly residents in the LTCF. A 30-minute reablement training session was completed 3 times a week for a total of 12 weeks. It is hoped that the research results will provide empirical evidence for institutional managers and policymakers to consider reablement as payment objects.Methods: This is a stratified randomized control trial. A total of 16 residents participated in the study, and were categorized into three groups, namely, wheelchair use without active activities group (n = 8), wheelchair use with active activities group (n = 4), and walking aids use group (n = 4) respectively. Then the stratified samples were randomly assigned to the reablement group (n = 8) or the control group (n = 8). The outcome measures included the De Morton Mobility Index (DEMMI) for mobility function, the Short Physical Performance Battery (SPPB) for physical function, the Barthel Index (BI) for ADL, and the Canadian Occupational Performance Measure (COPM). The reablement group received reablement training, while the control group maintained the original lifestyle. Both groups completed the pre-test and post-test within seven days before and after the intervention period. Assessment and intervention was conducted by different therapists (single blind). The Wilcoxon Signed Rank Test and the Mann-Whitney U Test were used for statistical testing of differences within and between groups. The alpha level of statistical significance was 0.05.Results: The 16 residents aged 60-92 years old with an average MMSE score of 24.4 ± 3.7. Most of them used wheelchairs (81.3%), and lived in the institution for more than two years (62.5%). Cardiovascular disease (75.0%) is the most common diagnosis, followed by central nervous disease (62.5%). The reablement group received walking training (n=7), standing and sit-to-stand training (n=7), sitting training (n=5), and individualized ADL training (n=8) prescriptions. Results showed that the reablement group showed an advantage over the control group in terms of DEMMI-chair (p = 0.038). In addition, the reablement group showed significant improvements in the COPM-S (p = 0.042) and BI (p = 0.041).Conclusions: The research results show that reablement training for elderly residents in LTCF can enhance their mobility, physical functions, and ADL.Keywords: Reablement, mobility, physical function, activities of daily living, long-term care facility