某精神專科醫院慢性精神病人拉筋伸展操效果之世代研究

The Outcomes of Stretch Exercise Programs for Chronic Psychiatric Inpatients: A Non-Randomized Control Trial Study

10.29827/YBYJZZ.202209_6(1).0001

蔡欣芸(Hsin-Yun Tsai)；許涴淇(Wan-Chi Hsu)；王沛云(Pei-Yun Wang)；陳姿聿(Tzu-Yu Chen)

柔軟度 ； 拉筋伸展操 ； 慢性精神病 ； psychiatric care ； patients with chronic psychiatric disorders ； physical fitness

醫保研究雜誌

6卷1期（2022 / 09 / 01）

1 - 11

繁體中文

目的：本研究目的為比較拉筋伸展操訓練加毛巾操訓練與毛巾操訓練間對慢性精神病人的下肢柔軟度及上肢柔軟度四個月後改變情形之差異。方法：以立意取樣68名在慢性精神科病房的病友，分為實驗組34人與對照組34人。實驗組接受拉筋伸展操訓練加毛巾操訓練，對照組接受毛巾操訓練，為期4個月。兩組皆在實驗前後進行檢測，測驗包含坐姿體前彎（下肢柔軟度）及抓背測驗（上肢柔軟度），以GEE廣意估計模式分析實驗組與對照組下肢柔軟度及上肢柔軟度改變情形之差異。結果：經過16週後，在控制罹病年數後，拉筋伸展操組與毛巾伸展操組皆無法有效提升慢性住院病人之下肢柔軟度（坐姿體前彎）與上肢柔軟度（抓背測驗）。究其原因有二；（1）兩組伸展操各有六組動作，針對上下肢柔軟度的活動過少：在下肢柔軟度方面，需使用大腿及小腿後側肌肉群，拉筋伸展操組六個動作中僅有兩個與該等肌肉群有關，毛巾伸展操組六個動作亦僅有一個有關。在上肢柔軟度方面，需使用手臂及背部肌肉，拉筋伸展操組的六個動作中僅有一個有關與該等肌肉群有關，毛巾伸展操組六個動作亦僅有一個有關，（2）落實度不足：個案進行兩組伸展操的各種動作時，均有落實度不足的限制，拉筋伸展操由治療師帶領，但因治療師需專注示範動作，難以確保所有個案落實拉筋動作、毛巾伸展操以影片示範，無專業人員在旁教導，亦無法確認個案的動作正確性及落實度。結論：拉筋伸展操組與毛巾伸展操組皆無法改善上下肢柔軟度不良之狀態。建議未來進行體適能介入研究時，須先針對小族群進行試驗（pilot），以確保拉筋伸展操及毛巾伸展操組六個動作所伸展肌群與改善上下肢柔軟度所需使用肌群有關。

Purpose. The study aimed to compare the outcomes of lower extremity flexibility (LEF) and upper extremity flexibility (UEF) between two stretch exercise programs designed for chronic psychiatric inpatients. Methods. Sixty-eight participants were recruited through purposive sampling. The treatment group (n=34) performed a combined stretch exercise program (freehand stretch exercise and towel stretch exercise) and the control group preformed the towel stretch exercise only. Both exercise programs lasted for 4 months. Pre- and post-tests included Sit-and-Reach Flexibility Test (for LEF) and Apley's Scratch Test (for UEF). A generalized estimating equation (GEE) was conducted to analyze the results. Results. With the disease duration adjusted, both groups did not demonstrate significant changes in LEF and UEF at the conclusion of the programs. We attributed the insignificant results to the following two limitations. First, very few of the six movement components in each of the two stretch exercises did work out for LEF and UEF. The LEF involves mostly the posterior muscle groups of thighs and legs. There are only two out of the six movement components in the freehand stretch exercise that work out for those muscle groups; likewise, there is only one movement component in the towel stretch exercise that works out for the muscle groups. In turn, the UEF involves muscle groups of the arms and the back. Both freehand and towel stretch exercises include only one movement component that works out for those muscle groups. Second, we speculated upon the accuracy and the range of movements demonstrated by the participants during the exercises. While leading the freehand stretch exercise, the therapist might have difficulty monitoring the quality of each participant's movements simultaneously. Similarly, the participants watched the video demonstration to perform the towel stretch exercise alone without professional's supervision, which might also jeopardize their compliance with the movement requirements. Conclusion. Both freehand and towel stretch exercise programs did not improve LEF and UEF for the client population. Future exercise programs aiming to improve LEF and UEF should be pilot-tested prior to their implementation to ensure the anticipated outcome.