老人打太極是否可以改善認知能力Practicing Tai Chi Quan may improve cognitive ability of elderly people

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2020-11-12 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

徐翊瑄* 賴櫟婷 盧郁濘 張琬舒

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

老年醫學 Geriatrics

科別

  • 老化 Ageing
  • 神經學護理 Neuroscience Nursing
  • 長期照護 Long Term Care

中文關鍵詞

老人 太極 認知功能

英文關鍵詞

older adult Tai Chi Tai ji Tai Chi Quan cognitive function

機構名稱

佛教慈濟醫療財團法人花蓮慈濟醫院

申請單位

護理部

中文摘要

形成臨床提問:
目前台灣已邁入高齡化社會,失智症為常見的老人問題,根據國際失智症協會 (Alzheimer's Disease International [ADI], 2017) 指出每3秒即新增一位失智者。目前常見西醫藥物或懷舊治療等,作者在門診常見失智症患者引發的行為,如:走失、憂鬱症、跌倒等,最常見為認知障礙,連帶造成照顧者的壓力及身心俱疲。在搜尋太極的相關文獻中,發現許多文獻說明太極拳可以訓練肌肉的平衡度,卻鮮少看到有關認知功能的結果,故引發作者想藉由文獻搜尋,設定相關PICO問題,探討老人打太極拳是否能夠改善認知功能。以利將太極拳推廣於老年人預防認知功能障礙的發生。
文獻搜尋的方法與分析:
本文確立臨床問題,根據PICO的關鍵字、同義字,以MeSH term及布林邏輯聯集與交集,搜尋Cochrane Library、PubMed、Ovid Embase、臺灣碩博士論文系統資料庫及華藝線上圖書館等資料庫,限制近 5 年內中英文之系統性文獻回顧或隨機控制試驗文獻,搜尋出共201篇,刪除內容及結果不符,最後選定兩篇隨機對照試驗研究評讀,進行評析。
文獻的品質評讀:
使用Joanna Briggs Institute (2014)證據等級系統評讀證據等級,兩篇為Level 1D。並使用2018 年 Critical Appraisal Skill Program(CASP)為工具,進行有效性、重要性及應用性之評析。兩篇文獻研究目的皆研究老年人在接受打太極拳後其認知功能分數,並以簡易智能測試(Mini-Mental Status Examination, MMSE)、魏氏記憶量表評估( The Wechsler Memory Scale-III, WMS-III),測量受試者接受介入措施前後的分數變化。 在重要性的評讀部份,一篇隨機對照試驗研究結果顯示老年人打太極拳活動MMSE分數有進步(p<0.01)、甚至進步分數>控制組(p=0.001),另一篇也在魏氏記憶量表中的記憶力、建構力分數明顯增加(p=0.006,p=0.01),發現可顯著改善認知功能;另發現文獻中也提到打太極拳可以增加平衡度、預防跌倒的機會,促進人際關係。在應用性部分,由於打太極拳不需藥物、難度低並且無副作用、不具侵入性,也可以增加與家人、社會中的相處機會,其利益大於傷害。
結論與建議:
綜合評讀結果,發現打太極拳可以改善老年人認知功能,太極拳相對臨床上的治療有更多的效益且安全。在門診或臨床上,可以拍攝教學影片指導門診等候區、病房區的病患或是家屬,或是在護理教育裡面,可以將太極拳融入課程,讓護理人員走入社區時也可以將此安全又不需花費的活動推廣於大眾,更可以配合長照2.0政策在各社區據點設計太極拳團體課程,增加老人的健康體能與認知功能也提升老人的社會參與度或社區推廣,讓太極拳生活化,不僅可預防失智,也可增進老年人的社會參與度。

英文摘要

Ask an answerable question (PICO):
Taiwan has entered an aging society, and dementia is a common elderly problem. According to the International Dementia Association (ADI), number of dementia patient is added one every three seconds. Currently, western medicine or reminiscence therapy is the standard of management for the dementia. Dementia patients in the outpatient clinic have some abnormal behaviors, such as cognitive impairment, getting lost, depression, falls, and so on. The most commonly found is cognitive impairment, which causes caregiver stress and physical fatigue. In the literature, we found that doing Tai Chi Quan could train the balance of muscles, but was rarely reported its effect on the cognitive functions. Therefore, we wanted to evaluate whether the elderly people who had been doing Tai Chi Quan could improve their cognitive function. If these elderly people can improve their cognitive function, we can promote the Tai Chi Quan to the elderly.
The Method and Analysis of Literature Review:
This article established clinical issues, based on PICO keywords and synonyms. Using the MeSH Term and Bollinger logic union and intersection, we searched databases, including Cochrane Library, PubMed, Ovid Databases, Embase, Airiti Library and Nation Digital Library of Theses and Dissertations in Taiwan as well as Huayi Online Library (in Chinese). We searched for systematic reviews or random controlled trials in Chinese or English literature in the past five years. A total of 201 articles were preliminarily extracted. Finally, by screening the content to match the topic, a total of two articles of random controlled trials were selected and analyzed.
Critical Appraisal:
Evaluation of the two articles with the Joanna Briggs Institute (JBI, 2014) Evidence Rating System revealed two of them are Level 1D. The effectiveness, importance, and applicability were evaluated with the Critical Appraisal Skill Program (CASP, 2018). The purpose of the two articles was to examine the cognitive function scores of elderly patients after practicing Tai Chi Quan. The Mini-Mental Status Examination (MMSE) and the Wechsler Memory Scale-III (WMS) -III) were used to measure the change of scores for subjects before and after intervention of measures. In the evaluation section of importance, the results of one randomized controlled trials showed that the MMSE scores of elderly people doing Tai Chi Quan have improved (p<0.01), and even the improvement score was greater than that of control group (p=0.001). Evaluation in the memory scale with Wei’s showed that the memory and constructiveness scores increased significantly (p=0.006, p=0.01), indicating doing Tai Chi Quan can significantly improve cognitive function increase muscular balance, reduce the chance of falling, and promote interpersonal relationship. In the applicability part, playing Tai Chi Quan does not require drugs, is not complicated, has no side effects, and is not invasive. Furthermore, it can also increase the chance of getting along with family members and society. Therefore, its benefits outweigh the harm.
Conclusions and Recommendations:
The overall evaluation result revealed that playing Tai Chi Quan improved the cognitive function to the elderly, and was more freedom in clinical treatment. In the clinic or clinical care, we can use the videos to teach and guide patients or their families in the waiting area. In nursing education, we can integrate Tai Chi Quan into the nursing course so that when the nursing staff enters the community, it can be taught safely. The activities do not need to spend money and can be promoted to the public, and the Tai Chi group courses can be designed for the community bases in conjunction with the Long-Term Care 2.0 policy to increase the elder ’s physical fitness and cognitive function. It can prevent not only dementia but also increase the social participation of the elderly