太極拳社區介入對老人跌倒之成效
Effectiveness of Community Base Tai Chi
中文摘要
目的：針對台中縣新社鄉65 歲以上的老人，執行一年的太極拳社區介入，觀察
太極村跌傷發生率，有無顯著改變，及太極村跌傷發生率的改變量與對照村跌 傷發生率的改變量有無差異，並探討各組的平衡能力、步態與害怕跌倒程度，於 介入後的改變。方法：本研究設計採前後（before and after）與同步對照
（simultaneous controls）混合，利用立意取樣選取六個村，將其分為太極村與 對照村，從2002 年 8 月到 2003 年 7 月，以楊氏太極拳十三式進行介入，並在六 村張貼預防跌倒海報。資料收集包括：(1)基線測量：於 2001 年 8 月採用結構式 問卷進行第一次面對面訪視。(2)追蹤訪視：分別在 2002 年與 2003 年 8 月進行第 二次及第三次的面對面訪視。(3)跌倒電話追蹤：自 2001 年 8 月至 2003 年 8 月，
每位老人共8 次電話追蹤。(4)跌倒就醫記錄：從新社鄉及鄰近地區之醫療院所
收集2001 年 8 月至 2003 年 8 月新社鄉老人跌傷的就醫記錄。(5)太極拳參與狀況 於每次團體練習後記錄練習者出席狀況。本研究利用波以松回歸（Poisson regression）來評估太極拳社區介入對跌傷發生率的效應，並以概括估計法
（generalized estimating equations, GEE）調整同一位老人重複測量的非獨立性；
另外，利用一般線性混合模式（general linear mixed model）分析平衡能力、步態 及害怕跌倒程度等於介入後的改變。結果：太極村及對照村的跌傷發生率均有顯 著下降，但發生率的改變量，並無統計上的顯著差異。太極村及對照村的平衡能 力、步態及害怕跌倒程度均不受社區介入影響，但介入後，太極拳練習者的平衡 與步態較對照村明顯進步。結論：太極拳的社區介入並不足以有效降低未練習太 極拳老人的跌傷發生率及害怕跌倒程度，也無法提升未練習者的平衡能力與步 態，但對練習者的平衡能力與步態是有益處的。
英文摘要
Purposes: This study was to observe whether the incidence rate of injurious falls in tai chi village was significantly change or not, and whether the changes of the incidence rates of injurious falls between tai chi village and control village were significant different or not after a one-year Tai Chi community intervention trial was conducted among people aged 65 years or older in Shin-Sher Township, Taichung County, Taiwan. Evaluate the effects of time and intervention in fear of falling, balance, and mobility function. Methods: The study design was a combination of before and after and simultaneous controls. We conducted Tai Chi 13 postures of Yang style from August 2002 to July 2003. The data collections include: (1) baseline interview:
personal face to face interview in August 2001. (2) follow-up interview: two times personal face to face interview separately in August 2002 and 2003. (3) follow-up
with telephone: 8 times per order person in total from August 2001 to August 2003.
(4) records of fall-related medical treatments: collected in clinics and hospitals around Shin-Sher Township from August 2001 to August 2003. (5)Attendance for Tai Chi practice: took down the attendance after group practicing. The Poisson regression model with GEE (generalized estimating equations) approach was used to investigate the effects associated with Tai Chi Chuan. The general linear mixed model was used to investigate the effects of time and intervention in fear of falling, balance and gaits.
Result: Both of the incidence rates of injurious falls in Tai Chi village and control village were significantly decreased. The changes of the incidence rates of falls between Tai Chi village and control village were not significant different. There were no effects of intervention in fear of falling, balance and gaits in tai chi village or control village. But, the balance and gaits of tai chi practitioners were significantly improved. Conclusion: The Tai Chi community intervention may not effectively reduce the incidence rate of injurious falls and fear of falling, but, it improved the balance and gait among tai chi practitioners.
