影響中高齡與高齡者體能活動參與因素探討之前驅研究 - 以新北市某地區醫院復健科為例

Abstract

研究背景：65歲以上高齡長者隨著年齡漸長面臨老化與衰弱問題，加上醫藥衛生進步使得國民平均餘命延長，若不重視身體功能退化問題，將對個人與社會帶來極大的照護壓力。45至65歲的中高齡者逐步邁入高齡的過程中，亦會面臨肌肉流失、衰弱等健康挑戰。多個研究證實，要改善或預防這些退化、衰老問題，體能促進、體能活動參與是很重要的。然而，實務上無論是醫院復健科或是復健科診所、骨科診所，常見到中高齡及高齡族群因肌肉骨骼或關節退化產生的痠痛、慢性疼痛而來進行儀器治療，使用儀器治療僅能短暫改善疼痛、痠痛情形，最有效的方法仍是主動的體能參與、針對患部做訓練，儘管醫師與治療師多次的衛教，大多數病人僅願選擇儀器治療而缺乏主動參與體能活動意願，而這樣的行為無非是浪費健保資源。 研究目的：本研究為前驅研究，旨在初步探討影響復健科中高齡與高齡族群體能活動參與之因素與動機，並進一步探討可能的改善對策。 研究方法：本研究發展半結構式問卷，並針對新北市某地區醫院45歲以上至醫院復健科接受慢性疼痛、痠痛相關治療的中高齡與高齡病患進行調查，總收案數為37人。由於本研究樣本數有限，研究結果以描述性統計呈現。期望本研究結果能協助復健科臨床人員與政策制定者，理解中高齡與高齡者體能活動參與的初步趨勢，進而改善健康促進策略，減少門診復健資源浪費及實際改善中高齡及高齡族群的健康行為。 研究結果：高齡者較中高齡者體能參與比例較高，而不論中高齡或高齡，若自覺健康狀況越好，體能參與比例也越高。然而，對體能活動能改善疼痛痠痛的認知程度越高，反而體能參與比例越低。影響受試者體能活動參與的主要影響因素包括「天氣不佳(環境因素)」、「不想動(心理因素)」與「身體疼痛痠痛(生理因素)」，其中天氣因素佔比最高(43.24%)，反映出環境與心理因素對行為的實質影響力。影響受試者最主要的參與動機是「為了身體健康」、「離家近／交通方便」、「可改善慢性疼痛」。 研究結論：本研究針對復健科病患的體能活動參與進行探討，故政策需要著重在如何改善現有復健制度、給付制度以及利用制度改變進而影響復健科病患的門診復健資源使用行為，並加強復健科病患與政府資源的連結與應用。

Background As seniors aged 65 and older grow older, they experience aging and frailty. With advancements in medical and health care, the average life expectancy of the population has increased. However, if degenerative issues are not addressed, they may result in substantial caregiving burdens for both individuals and society. Adults aged 45 to 65, in the process of transitioning into older age, also face health challenges such as muscle loss and frailty. Numerous studies have confirmed that to prevent and mitigate these degenerative and aging issues, participation in physical fitness and physical activities is crucial. In clinical practice, however, middle-aged and older adults often seek instrument-based treatments at hospital rehabilitation departments, rehabilitation clinics, or orthopedic clinics due to musculoskeletal or joint degeneration that causes chronic pain and discomfort. While such treatments may provide temporary relief, active participation in physical activity and region-specific physical training remain the most effective approach. Despite repeated health education from physicians and therapists, most patients are more inclined to undergo passive treatments and show low motivation for engaging in physical activity, which leads to inefficient use of healthcare resources. Objectives This pilot study aims to preliminarily explore the factors and motivations influencing physical activity participation among middle-aged and older adults in a rehabilitation department setting. Furthermore, it seeks to identify potential strategies to enhance such participation. Methods A semi-structured questionnaire was administered to patients aged 45 and above who were receiving treatment for pain-related conditions in the rehabilitation department of a district hospital in New Taipei City. A total of 37 valid responses were collected. Given the limited sample size, the results are presented using descriptive statistics. This study intends to provide preliminary insights for clinical rehabilitation professionals and policymakers, helping them to better understand trends in physical activity participation and to optimize health promotion strategies, reduce unnecessary outpatient rehabilitation utilization, and ultimately improve the health behaviors of this population. Results The participation rate in physical activity was higher among older adults than among middle-aged adults, and individuals with better self-rated health were more likely to engage in physical activity. Paradoxically, those with better objective health conditions or greater awareness that physical activity can alleviate pain were less likely to participate in physical activity. The most commonly cited barriers were: "unfavorable weather" (environmental factor), "lack of motivation" (psychological factor), and "pain and discomfort" (physiological factor), with weather conditions being the most frequently mentioned (43.24%). The main motivations for participating in physical activity included: "to improve personal health" , "proximity and transportation convenience" , and "to alleviate chronic pain". Conclusion This study focuses on the physical activity behaviors of rehabilitation patients. The findings suggest that future policies should focus on improving the current rehabilitation system and reimbursement mechanisms, in order to influence patients’ health behavior and utilization of rehabilitation resources. Moreover, better integration and promotion of government-supported physical activity programs within clinical rehabilitation settings is essential to enhancing patient engagement and achieving more sustainable health outcomes.