Fall prevention for the elderly in a long-term care institution : Development of an exercise program based on EBN

我们的目的是开发一个基于循证护理（EBN）的预防跌倒的运动项目，不仅可以增加下肢肌肉力量、平衡和机动性，还可以减少对跌倒的恐惧，提高长期护理机构中老年人预防跌倒的自我效能。我们制定了一个运动计划，包括热身，静态拉伸运动，下肢肌肉强化，平衡训练（脚趾训练和本体感觉神经肌肉促进），以及基于EBN的冷却。研究设计为临床试验。我们通过两次试验开发了一个程序。在第一次试验中，30名同意我们研究的老年人被分为16人的干预组和14人的对照组。这个项目的长度是三个月，我们测量了肌肉力量，平衡，活动能力，对摔倒的恐惧，对摔倒的自我效能，以及摔倒的次数来评估项目的有效性。结果，干预组平衡性和活动能力增强，跌倒次数减少，但肌肉力量和跌倒自我效能没有增加，手臂力量明显下降。没有发生与培训有关的医疗问题。我们修改了程序，以增加下肢的肌肉力量，以增加或维持手臂力量和跌倒的自我效能。在第二次试验中，40名老年人被分为21人的干预组和19人的对照组。结果显示，手臂力量和跌倒的自我效能感保持不变，但下肢肌肉力量没有增加。总之，长期机构的老年人预防跌倒的运动计划可能是有用的。

Our aim was to develop an exercise program for fall prevention, based on evidence-based nursing (EBN), to not only increase muscle strength in the lower extremities, balance, and mobility, but also to decrease fear of falling and to increase self-efficacy for fall prevention in the elderly in a long-term care institution. We developed an exercise program which consisted of a warm-up, static stretching exercise, muscle strengthening in the lower extremities, balance training (toe training and proprioceptive neuromuscular facilitation), and a cool-down, based on EBN. The study design was a clinical trial. We developed a program through two trials. In the first trial, the 30 elderly participants who agreed to our study were divided into an intervention group of 16 people and a control group of 14 people. The length of the program was three months, and we measured muscle strength, balance, mobility, fear of falling, self efficacy for fall, and the number of falls to evaluate the effectiveness of the program. As a result, the intervention group showed increased balance and mobility and a decreased number of falls, although muscle strength and self-efficacy for fall did not increase and arm strength decreased significantly. No training-related medical problems occurred. We modified the program to increase muscle strength in the lower extremities, to increase or maintain arm strength and self efficacy for fall. In the second trial, 40 elderly participants were divided into an intervention group of 21 people and a control group of 19 people. The results showed a maintaining of arm strength and an increase of self-efficacy for fall but no increase of muscle strength in the lower extremities. In conclusion, an exercise program for fall prevention in the elderly in a long-term institution may be useful.