睡前足浴是否能改善老人睡眠品質?A footbath before bedtime can improve the sleep quality to the elderly?

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2020-04-26 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

黃紹宇* 楊麗瓊

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

睡眠醫學 Sleep Medicine

科別

  • 老化 Ageing
  • 臨床指引/實證照護成效 Clinical Guidelines/Evidence Based Outcomes

中文關鍵詞

老年人 足浴 睡眠品質

英文關鍵詞

elderly footbath sleep quality

機構名稱

臺北榮民總醫院

申請單位

護理部

中文摘要

形成臨床提問:
失眠在International Classification of Sleep Disorders-Third Edition(ICSD-3)中定義為包含難以入睡、難以維持睡眠以及睡眠品質差(Darien, IL,2014),在2017年台灣睡眠醫學學會的調查「台灣常見睡眠問題盛行率的變化趨勢:一個十年的橫斷性重覆調查」 結果顯示,全台慢性失眠症盛行率為 11.3%,而資料中顯示高齡者失眠比率增加,50-59歲慢性失眠有16.7%,60-69歲更有22.7%慢性失眠比率(台灣睡眠醫學會,2017),而失眠容易致使白天精神不佳、嗜睡、易怒、或是抑鬱等症狀(Cho & Duffy,2018),而睡前足浴對於老人長期慢性失眠問題在多篇文獻中被證實是有效的。 在臨床接觸許多老年病患,除了需要忍受疾病帶來的痛苦之外,還有長期慢性失眠所導致的疲憊,而有些患者更因肝腎功能不佳而無法使用安眠藥物,故促使筆者決定找尋非藥物的方式用以緩解老人失眠問題,以睡前足浴是否能改善老人睡眠品質為題,並藉由實證的方式找出合適之方法,用以幫助臨床失眠之老人,以提升其生活品質為目標。
文獻搜尋的方法與分析:
本研究以「睡前足浴是否能改善老人睡眠品質?」為題,設定 PICO 關鍵字:老人Elderly、Old people、Aging;睡眠品質不良Poor sleep;足浴Footbath、soak;睡眠品質Sleep quality,將關鍵字以布林邏輯 AND及 OR 的方式做聯集及交集,搜尋 Cochrane、PubMed、Clinical Key等資料庫,適當調整搜尋設定,並選擇文章等級較高、年代較新,且符合 PICO 之文章進行嚴格評讀。本文採用JBI 之「Checklist for Randomized Controlled Trials以及Checklist for Quasi-Experimental Studies (non-randomized experimental studies)」進行四篇研究文章之嚴格評讀。
文獻的品質評讀:
依照 PICO 問題類型選擇合適的文獻,因此次 PICO 乃為治療型問題,故最後選出年代最新、等級最高的四篇研究文章進行嚴格評讀,以JBI 2014 levels of evidence 將文章做分級,評析文章中一篇屬於 Level 1、三篇屬於Level 2。評讀的四篇文獻中有三篇所使用的睡眠品質評估方法均為PSQI(Pittsburgh Sleep Quality Index),一篇使用腕動計及睡眠困擾調查表進行評估。
結論與建議:
睡前足浴對老年人睡眠品質提升是可行且易完成的,臨床應用上建議採用10cm深的塑膠泡盆並維持水溫在41-42℃,並在睡前一小時內取20分鐘進行,並在首次進行此項活動時先由訓練過的專人進行足浴教學以及監控實施正確性及完整性,之後再持續由專人監控睡眠品質的改善程度來完成此措施最為有效。

英文摘要

Ask an answerable question (PICO):
Insomnia is defined as the problems comprising the difficulty of sleep initiation, duration, consolidation, or poor quality by International Classification of Sleep Disorders-Third Edition (ICSD-3). In a survey by the Taiwan Society of Sleep Medicine, "The Trend of the Prevalence of Common Sleep Problems in Taiwan: A 10-year Cross-sectional Repeating Survey" The results showed that the prevalence of chronic insomnia in Taiwan was 11.3%, and the data showed that the rate of insomnia increased to the elderly, 16.7% people in the age 50-59 years old with chronic insomnia, and 22.7% people in the age 60-69 years old with chronic insomnia. Insomnia can easily lead to symptoms of poor mental health during the day, drowsiness, irritability, or depression (Cho & Duffy, 2018), and a foot bath before bedtime has been proven is effective to resolve the long-term chronic insomnia to the elderly. In clinical practice, many elderly patients need to not only tolerating the pain caused by the disease but also fatigue caused by long-term chronic insomnia. Some patients are even unable to use sleeping drugs due to poor liver and kidney functions. To resolve the problems, the author decides to look for the methods without medicine to alleviate the insomnia problem to the elderly. The title is whether the foot bath before bedtime can improve the sleep quality to the elderly. Hoping find out the appropriate method to help the elderly with clinical insomnia to improve their life quality.
The Method and Analysis of Literature Review:
This study is titled as "A footbath before bedtime can improve the sleep quality to the elderly?" And set PICO keywords: Elderly, Old people, Aging; Poor sleep; Footbath, soak; Sleep quality. Searching keywords by connecting them using “AND” and “OR” in the form of Boolean Logic in the databases of Cochrane, PubMed and Clinical Key. Selecting articles with higher grades and latest publication date which meet PICO to study. In this article we use JBI's "Checklist for Randomized Controlled Trials and Checklist for Quasi-Experimental Studies (non-randomized experimental studies)" to evaluate four literatures.
Critical Appraisal:
We select the proper literature according to the PICO. Since the questions from PICO are therapeutic issues, so we choose the latest and the highest graded four research articles to evaluate. We further grading four articles by standard of “JBI 2014 levels of evidence”. Results show that one article belongs to Level 1 and the others belong to Level 2. Three of them use assessment method of the sleep quality by Pittsburgh Sleep Quality Index. One of them uses the actigraphy and a sleep disorder inventory for evaluation.
Conclusions and Recommendations:
Footbath before bedtime is feasible and easy to improve the sleep quality to the elderly. In clinical application, it is recommended to soaking in 10 cm deep in the water with temperature at 41-42 ℃, and maintaining 20 minutes before bedtime. Before the first time footbath, one should be taught by a trained person the footbath skills and checked the correctness and completeness of the activity. Finally, one should checked the improvement of sleep quality by a trained person which is the most effective way to do the activity.