[[alternative]]Effects of Tai-Chi Chuan Training on Physical Functioning and Quality of Life in Patients with Hemodialysis

[[abstract]] 背景及目的：文獻顯示血液透析患者身體功能表現及生活品質滿意度偏低，而身體功能狀態不但影響生活品質，亦是預測患者住院率與死亡率之重要因子。研究證實太極拳運動可增進慢性疾病患者之體能平衡、肌耐力及心肺功能，對改善焦慮、壓力、失眠及生活品質等方面亦有助益，對於太極拳運動是否可以改善血液透析患者之身體功能與生活品質，相關文獻尚不足，故本研究目的為評估十二週太極拳訓練對改善血液透析患者身體功能及生活品質之成效。 方法：本研究為類實驗設計，研究場所為中部某一區域教學醫院之血液透析室，研究對象為門診的血液透析病患，採立意取樣，將符合篩選條件者，依個案意願分為太極拳運動訓練（實驗組）或維持平日之生活活動（對照組）二組，實驗組需每週練習三次太極拳運動，持續十二週。研究工具包含身體功能之測量、柯氏功能狀態評估量表與腎臟疾病生活品質量表 (KDQOL-36TM)；評估時間點為運動訓練介入前及介入後第四週、八週及十二週。數據資料以SPSS 18.0 統計軟體進行統計分析。 結果：本研究共有太極拳組21人及對照組25人，太極拳運動訓練十二週訓練後，五項身體功能測試結果皆呈顯著改善 (p < 0.001)，而對照組身體功能僅在坐-站次數及時間有變化；身體功能五項測試組間相比，兩組之間呈顯著差異 (p < 0.01)。太極拳組在十二週後其KDQOL-36TM 生活品質評量在各項次皆較未介入前明顯改善；兩組相比之結果，在症狀/問題及腎臟疾病負荷兩個項次，組間比皆呈顯著性差異，顯示太極拳運動確實改善了血液透析患者之生活品質。 結論：本研究結果確立此太極拳運動對血液透析患者之實證效益，故可推論太極拳運動可協助血液透析患者改善身體功能及提昇生活品質。本研究成果可提供臨床透析醫療相關醫護人員，作為臨床診療照護血液透析病患之參考。[[abstract]] Background and Aims: Many previous studies have confirmed that physical function and quality of life in patients with hemodialysis are both low and physical function status not only affects the quality of life, but also plays an important role of predicting the hospitalization rate and mortality. Accumulated evidences suggested that the integration of Tai Chi improves the functional capacity of patients, thereby offering them a better quality of life in a variety of patient populations. To date, there are little data regarding the effect of Tai Chi on the physical function and quality of life in patients with hemodialysis. Thus, the purpose of this study was to evaluate the beneficial effects of Tai Chi integration on hemodialysis patients in terms of their physical functioning and quality of life. Methods: This was a quasi-experimental study in which data was collected from hemodialysis units at a medical center in middle Taiwan. Purposive sampling was used to recruit regular follow-up outpatient participants who were assigned to an experimental group (participating in Tai Chi (TC) exercise sessions lasting from 50 to 60 minutes, three times per week for 12 weeks) and a comparison group (who continued with existing medical care and life style) according to their individual preferences. Outcome indicators included time to complete 5 sit-to-stand cycles (STS-5), time to complete 10 sit-to-stand cycles (STS-10), repetition of sit-to-stand cycles in one minute (STS-60), 6-minute walk distance (6-MW), gait speed, Karnofsky Performance Status and the quality of life for kidney disease scale (Kidney Disease Quality of Life; KDQOL-36TM). Tests were performed at four time points: baseline, fourth, eighth and twelfth weeks after the intervention. The analyses were performed using the Statistical Package for the Social Science (SPSS 18.0). Results: 21 participants in the TC exercise group and 25 in the comparison group. The two groups were homogeneous in basic characteristics. In terms of STS-5, STS-10, STS-60, 6-MW and gait speed, the TC group showed significant reductions with time, along with increases in repetitions, distance and speed at the end of the intervention. Slight improvements were seen in the comparison group in duration (STS-5) and repetitions. Comparing TC group with comparison group, all physical functioning indicators significantly improved. In addition to physical functioning, the TC exercise resulted in significant improvements in the quality of life for the participants in every dimension of KDQOL-36TM at the end of the intervention. In a comparison of the measurements taken between TC group and comparison group, improvements were seen in symptom/ problem list and burden of kidney disease of quality of life (p < 0.05). Conclusion: The results of the present study confirm the effectiveness of Tai Chi exercise as an intervention modality. It may suggest that Tai Chi exercise training can help patients with hemodialysis to strengthen physical functioning and enhance their quality of life. The results of the present study can be used as a reference for domestic health organizations and medical hospitals when formulating policies for dialysis treatment and guides for clinical therapy and care