نوع مقاله : مقاله پژوهشی

نویسندگان

1 استادیار دانشگاه اراک

2 استادیار دانشگاه تهران

3 استاد دانشگاه تربیت مدرس

چکیده

هدف این پژوهش ارزیابی همبستگی بین تغییرات در اندازه‌های روان‌شناختی و عملکردی مرتبط‌ با افتادن مردان سالمند متعاقب یک برنامه‌ی تمرینی - ترکیبی و مقایسه‌ی میزان تأثیر تمرین بر این متغیرها بود. نمونه‌ی آماری، 31 سالمند بالای 60 سال بودند که به‌طور تصادفی به دو گروه مداخله (با میانگین سنی 39/4±08/66) و کنترل (با میانگین سنی 33/7±14/70) تقسیم شدند. برای اندازه‌گیری متغیرها از پرسش‌نامه مشخصات فردی، آزمون نشستن ‌و برخاستن 30 ثانیه، بنشین‌ و برسان، تعادل روی ‌یک ‌پا، بلندشدن ‌و رفتن، 10متر راه‌رفتن، مقیاس اعتماد به ‌تعادل ویژه‌ی فعالیت‌ها و کارآمدی افتادن – بین‌المللی استفاده ‌شد. تجزیه‌ و ‌تحلیل ‌آماری با آزمون t مستقل، محاسبه‌ی درصد تغییر، ضریب همبستگی پیرسون و اندازه‌ی اثر انجام‌ شد. میانگین نمره‌ی آزمون‌های قدرت‌ عضلانی اندام ‌تحتانی، انعطاف‌پذیری، چابکی‌ و تعادل ‌پویا، سرعت ‌حرکت، تعادل ایستا، مقیاس ترس ‌از افتادن و اعتماد به ‌تعادل در گروه مداخله نسبت ‌به گروه کنترل، به‌طور معناداری بهبود یافت (P≤0.05). تأثیر برنامه‌ی مداخله‌ی ‌تمرینی بر اندازه‌های عملکردی ‌و ‌روان‌شناختی یکسان ‌نبود. بیشترین اندازه‌ی اثر به‌ترتیب در قدرت اندام ‌تحتانی و اعتماد به ‌تعادل و کمترین اندازه‌ی اثر در انعطاف‌پذیری و ترس‌ از افتادن مشاهده ‌شد. تغییرات قدرت عضلانی با تغییرات سرعت و تغییرات انعطاف‌پذیری با تغییر چابکی و سرعت به‌طور معناداری همبسته بود (P≤0.05). بین تغییرات در اندازه‌های عملکردی و روان‌شناختی، همبستگی معناداری وجود نداشت (P≤0.05). هم‌چنین بین میزان تغییرات در ترس‌ از افتادن و اعتماد به ‌تعادل، همبستگی معناداری مشاهده‌شد (P≤0.05, r=-0.66). بنابراین، برنامه‌ی تمرینی به اضافه‌ی برنامه‌ی آموزش درباره‌ی افتادن، بر بهبود عوامل روان‌شناختی و عملکردی مرتبط با تعادل و افتادن مردان سالمند مؤثر بود.

کلیدواژه‌ها

عنوان مقاله [English]

Correlation between changes in balance and fall-related psychological and functional measures of men older adults after a combined training program

نویسندگان [English]

  • Darush Khajavi 1
  • Ali Akbar Jaberi Moghadam 2
  • Anooshirvan Kazem Nejad 3

چکیده [English]

The study examined correlation between balance-and-fall-related psychological and functional measures of men older adults after a combined training program. Sample include 31 healthy older adults over 60-year assigned randomly to intervention (mean age=66.08±4.39) or control groups (mean age=70.14±7.33) that 2 subjects dropped out from each group. Variables measured by 30-s Chair-Stand Test, Seat and Reach, Up and Go, ABC, FES-I. Data was analyzed by t-student, Percent change, Pearson Correlation Coefficient, and Effect Size. Mean scores of lower extremity strength, flexibility, agility and dynamic balance, speed, static balance, fear of falling, and balance confidence improved significantly in intervention group than control group (p<0.05). Effect of the intervention program on functional and psychological measures was not equal. Largest effect size observed in lower extremity strength, balance confidence, and static balance, respectively. The smallest effect size was observed in flexibility, fear of falling, and agility/dynamic balance. Change in lower extremity strength was significantly correlated with changed in speed (-0.66) and change in flexibility was correlated with change in agility and speed significantly. But not significant correlations observed between functional and psychological measures changes (p≤0.05). Correlation between changes in fear of falling and balance confidence was significant (r=-0.66, p≤0.05). The training program with education program was effective to improve balance-and-fall-related psychological and functional measures in men older adults.

کلیدواژه‌ها [English]

  • Fall
  • Balance
  • Psychological and functional measures
  • Effect Size
1) Curtin A, Prevention of falls in older adults. Medicine and Health. 88 (1):22-5.
2) Cumming R, Salkeld G, Thomas M, Szonyi G. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. The Journals of Gerontology; 2005, 55A, 5; Health Module pg. 299
3) Hatch J, Gill-Body. K, Portney, L. Determinants of Balance Confidence in Community-Dwelling Elderly People, Physical Therapy. 2003. 83:1072-9.
4) Bandura A. Self-efficacy: The exercise of control. 1997. New York: Freeman
5) Powell L., Myers A. The Activities-specific Balance Confidence (ABC) Scale. Journal of Gerontology: Medicine Sciences. 1995, 50, 28-34.
6) Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. Journal of Gerontology: Psychological Sciences. 1990, 45 (6):239-43.
7) Wijlhuizen GJ, de Jong R, Hopman-Rock M. Older persons afraid of falling reduce physical activity to prevent outdoor falls. Preventive Medicine.2007, 44:260-4.
8) Filiatrault J, Gauvin L, Richard L, Robitaille Y, Laforest S, Fournier M, Corriveau H. Impact of a multifaceted community-based falls prevention program on balance-related psychologic factors. Archives of Physical Medicine Rehabilitation. 2008, 89 (10):1948-57.
9) Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age and Ageing. 2005, 34 (6): 614–9
10) Zijlstra et al. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age and Ageing. 2007, 36: 304–9.
11) Arfken C.L., Lach H.W., Birge S.J., & Miller P.J. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health. 1994, 84 (4): 565–70.
12) Shumway-Cook A and Woollacott MH. Motor Control: Translating Research into Clinical Practice. 2007, Third Edition. Philadelphia: Lippincott, Williams, and Wilkins.
13) Simpson J, Worsfold C, Fisher K, Valentine J. The CONFbal scale: a measure of balance confidence-a key outcome of rehabilitation. Physiotherapy. 2009, 95; 103–9
14) Kulmala J, Sihvonen S, Kallinen M, Alen M, et al. Balance confidence and functional balance in relation to falls in older persons with hip fracture history. Journal of Geriatric Physical Therapy. 2007, 30 (3):114-20.
15) Binda s, Culham E, Brouwer B. Balance, Muscle Strength, and Fear of Falling in Older Adults. Experimental Aging Research. 2003, 29 (2) , 205-19 .
16) Mann R, Birks Y, Hall J, Torgerson D, Watt I. Exploring the relationship between fear of falling and neuroticism: a cross-sectional study in community-dwelling women over 70. Age and Ageing. 2006, 35 (2) , 143-7.
17) Evitt C, Quigley P. Fear of Falling in Older Adults: A Guide to Its Prevalence, Risk Factors, and consequences. Rehabilitation Nursing; 2004, 29, 6. 207.
18) Cyarto EV, Brown WJ, Marshall AL, Trost SG. Comparative effects of home- and group-based exercise on balance confidence and balance ability in older adults: cluster randomized trial. Gerontology. 2008, 54 (5):272-80.
19) Connors KA, Galea MP, Said CM. Feldenkrais Method Balance Classes Improve Balance in Older Adults: A Controlled Trial. Evidence-based Complementary and Alternative Medicine. 2009, Jun 24.
20) Ullmann G, Williams HG, Hussey J, Durstine JL, McClenaghan BA. Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older. Journal of Alternative and Complementary Medicine. 2010, 16 (1):97-105.
21) Robertson A, Janice J, Eng J, Hung C. The Effect of Functional Electrical Stimulation on Balance Function and Balance Confidence in Community-Dwelling Individuals with Stroke. Physiotherapy Canada. 2010, 62:114–9.
22) Liu-Ambrose T, Khan M, Eng J, Lord. R McKay. A. Balance Confidence Improves with Resistance or Agility Training. Gerontology; 2004, 50, 6, 373.
23) Iglesias C, Manca A, Torgerson D. The health-related quality of life and cost implications of falls in elderly women. Osteoporoses Int. 2009, 20: 869–78
24) Murphy S. Dubin J. and Gill T. The development of fear of falling among community-living older women: Predis... The Journals of Gerontology; 2003; 58, 10; Health Module,943
25) Rikli RE, Jones CJ. Development and Validation of a function fitness test for community- residing older adults. J Aging Phys Act, 1999, (7):129-61.
26) Cao, Z-B et al. The Effect of a 12-week Combined Exercise Intervention Program on Physical Performance and Gait Kinematics in Community-dwelling Elderly Women. J Physiol Anthropol. 2007. 26. 325–32.
27) خواجوی داریوش. رواسازی و تعیین پایایی "مقیاس کارآمدی در افتادن، فرم بین‌المللی" در سالمندان: نسخة فارسی. مجله سالمندی ایران.1392، 8 (2) :47-39.
28) سیّدیان مازیار، فلاح مهتاب، نوروزیان مریم، نجات سحرناز، دلاور علی، قاسم‌زاده حبیب‌الله. تهیه و تعیین اعتبار نسخه فارسی آزمون کوتاه وضعیت ذهنی، مجله علمی سازمان نظام پزشکی جمهوری اسلامی ایران، 1386، 25 (4):    14-408
29) DiBrezzo et al. Exercise Intervention Designed to Improve Strength and Dynamic Balance Among Community-Dwelling Older Adults. Journal of Aging and Physical Activity, 2005, 13, 198-209.
30) خواجوی، داریوش. تأثیر یک برنامه مداخله تمرینی بر عملکرد حرکتی، عواملِ روان‌شناختی مرتبط با افتادن و کیفیّت زندگی مردان سالمند، 1391، دانشگاه تهران، دانشکده تربیت‌بدنی و علوم ورزشی، رساله دکتری، منتشر نشده.
31) American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001, 49 (5):664-72.
32) Shumway-Cook A, Silver IF, LeMier M, York S, Cummings P, Koepsell TD. Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2007, 62 (12):1420-7.
33) Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, Wilson NL. Tai Chi and fall reductions in older adults: a randomized controlled trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2005, 60 (2):187-94.
34) Nemmers TM, Miller JW. Factors influencing balance in healthy community-‐dwelling women age 60 and older. Journal of Geriatrics Physical Therapy. 2008, 31 (3):93-100.
35) Hess J, Woollacott M. Effect of high-intensity strength-training on functional measures of balance ability in balance-impaired older adults. Journal of Motor Behavior. 2005, 37: 404-16.
36) Islam MM, Nasu E, Rogers ME, Koizumi D, Rogers NL, Takeshima N. Effects of combined sensory and muscular training on balance in Japanese older adults. Preventive Medicine. 2004, 39: 1148-55.
37) Liubbicich ME, Magistro D, Candela F, Rabaglietti E, Ciairano S. Physical activity and mobility function in elderly people living in residential care facilities. Act on Aging: A pilot study. Advances in Physical education. 2012, 2 (2): 54-60.
38) Shin K. R., Kang Y., Park H. J. and Heitkemper M. Effects of exercise program on physical fitness, depression, and self-efficacy of low-income elderly women in South Korea. Public Health Nursing. 2009, 26 (6):523-31.
39) Shigematsu R, Chang M, Yabushita N, Sakai T, Nakagaichi M, Nho H, Kiyoji T. Dance-based aerobic exercise may improve indices of falling risk in older women. Age and Ageing. 2002, 31: 261-6.
40) Barnett A, Smith B, Lord SR, Williams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age and Ageing. 2003, 32 (4):407-14.
41) Yates T, Dunnagan T. Evaluating the effectiveness of a home-based fall risk reduction program for rural community-dwelling older adults. Journal of Gerontology: Medical Sciences. 2001, 56 (4): 226- 30.
42) Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 1977, 84, 191-215.
43) Bandura A. Self-efficacy mechanism in human agency. American Psychologist, 1982, 33, 344-58.
44) پورافکاری نصرت الله. فرهنگ جامع روانشناسی و روانپزشکی و زمینه‌های وابسته انگلیسی-فارسی. 1385. انتشارات معاصر، ص852.