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Ikääntyneiden on tärkeää olla fyysisesti aktiivisia, sillä se on yhteydessä parempaan toimintakykyyn ja itsenäisyyteen. Sairaalahoidon jälkeen moni ikääntynyt ei saavuta sitä edeltänyttä tasoa toimintakyvyssä. Kustannusten hillitsemiseksi ikääntyneiden kotona pärjäämiseen ja kuntoutukseen tulee panostaa. Aikaisempi tutkimustieto on puutteellista kotikuntoutuksen vaikuttavuudesta sairaalasta kotiutuvilla ikääntyneillä. Tässä Pro Gradu-tutkielmassa selvitettiin, onko tehostetulla kuuden kuukauden mittaisella kotikuntoutuksella vaikutusta ikääntyneiden fyysiseen aktiivisuuteen ja toimintakykyyn sairaalajakson jälkeen.
Tutkimus oli satunnaistettu kontrolloitu tutkimus, jonka kohdejoukkona olivat Jyväskylän seudulla asuvat yli 60-vuotiaat henkilöt, jotka olivat olleet sairaalahoidossa alaraajan tai selän leikkauksen tai tapaturman vuoksi (n=106). Koeryhmäläiset osallistuivat sairaalasta kotiuduttuaan kuusi kuukautta kestävään kuntoutusinterventioon, joka sisälsi seitsemän fysioterapeutin kotikäyntiä ja kolme puhelinohjausta. Kontrolliryhmä sai vallitsevan hoitokäytännön mukaista hoitoa, johon sisältyy yleensä fysioterapeutin osastolla antama ohjeistus kotiharjoitteista. Mittaukset tehtiin pian sairaalasta kotiutumisen jälkeen sekä kolmen ja kuuden kuukauden kuluttua alkumittauksista. Fyysistä aktiivisuutta mitattiin kuutena peräkkäisenä päivänä reiteen kiinnitettävällä Hookie AM 20 -kiihtyvyysmittarilla. Fyysistä toimintakykyä mitattiin lyhyellä fyysisen suorituskyvyn testistöllä (Short physical performance-battery, SPPB-testi). Aineisto analysoitiin SPSS 18 -ohjelmalla toistomittausten varianssianalyysi-menetelmällä.
Tutkimusryhmät eivät eronneet alkutilanteessa merkitsevästi toisistaan. Interventioryhmän (IR) ja kontrolliryhmän (KR) fyysisen aktiivisuuden ja fyysisen toimintakyvyn muutos eivät eronneet tilastollisesti merkitsevästi kuuden kuukauden tutkimuksen aikana. Passiivisesti vietetty aika lisääntyi interventioryhmällä (IR) 15%, mutta myös kontrolliryhmällä (KR) 11,7% (ryhmä-aika-yhdysvaikutus p=0,934). Kevyt fyysinen aktiivisuus väheni IR:llä 0,1% ja lisääntyi KR:llä 1,2% (p=0,273). Keskiraskas fyysinen aktiivisuus lisääntyi IR:llä 1,9% ja KR:llä 4,5% (p=0,680). Fyysistä toimintakykyä mittaavassa SPPB-testissä tasapainopisteet paranivat kuuden kuukauden aikana IR:llä 15,4% ja KR:llä 22,7%, mutta ryhmien välisen muutoksen ero ei ollut tilastollisesti merkitsevä (ryhmä-aika-yhdysvaikutus p=0,606). Testipisteet lisääntyivät trendinomaisesti tuolista ylösnousunopeudessa IR:llä 3,5 ja KR:llä 2,5-kertaiseksi (p=0,436), kävelynopeudessa IR:llä 1,5 ja KR:llä 1,4-kertaiseksi (p=0,200) ja yhteispisteissä IR:llä 1,5 ja KR:llä 1,4-kertaiseksi (p=0,674).
Kuuden kuukauden mittainen tehostettu kotikuntoutusinterventio ei vaikuttanut ikääntyneiden fyysiseen aktiivisuuteen ja toimintakykyyn sairaalajakson jälkeen.
Physical activity among older people is important, because it is associated with better ability of function even without help. Many of aged individuals does not attain the function they had before hospitalization. Intensive rehabilitation would enable their living at home as long as possible and thus limit increasing costs to the society. Previous research about the effect of home rehabilitation among older people after hospitalization is yet insufficient. The purpose of this randomised controlled trial (RCT) was to investigate if an intensive 6-month home rehabilitation program has effect on physical activity and physical function among older people after hospitalization.
Participants in this RCT were aged 60 years or over living in Jyväskylä or nearby who had been in hospital care because of surgery or accident that had caused back or lower limb injury (n=106). After the hospital stay, intervention group participated in an intensive 6-month rehabilitation program, which included seven home visits and three phone counselling calls given by a physiotherapist. Control group received usual care after hospitalization, which typically includes counselling about the home exercises given by a physiotherapist at the hospital during the stay. The data was collected during two weeks after hospitalization and three and six months after the baseline measurements. The amount and intensity of physical activity was collected with Hookie AM 20 accelerometer, which was attached to subjects’ thigh. Physical function was measured with Short Physical Performance Battery (SPPB). Data was analysed with SPSS 18 program using repeated measures ANOVA in addition to descriptives.
At baseline, groups did not differ statistically significantly from each other. During the 6-month intervention, none of the changes of PA and physical function variables differed between the groups. In detail, passive time increased 15% in intervention group (IG), but also 11,7% in control group (CG; p for interaction 0,934). Light physical activity decreased 0,1% in IG and increased 1,2% in CG (p=0,273). Moderate physical activity increased 1,9% in IG and 4,5% in CG (0,680). In SPPB-test, balance points increased 15,4% in IG but also 22,7% in CG (p=0,606). In chair stand test, points increased 3,5-fold in IG but also 2,5-fold in CG (p for interaction 0,436). The corresponding coefficients were 1,5-fold and 1,4-fold in gait speed (p=0,200) and 1,5-fold and 1,4-fold in total points (p=0,674).
The 6-month intensive home rehabilitation program was not effective on physical activity and physical function compared to usual care among older people after hospitalization.
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[{"key": "dc.contributor.advisor", "value": "Nikander, Riku", "language": "", "element": "contributor", "qualifier": "advisor", "schema": "dc"}, {"key": "dc.contributor.author", "value": "Ojala, Saara", "language": "", "element": "contributor", "qualifier": "author", "schema": "dc"}, {"key": "dc.date.accessioned", "value": "2018-10-11T05:34:58Z", "language": null, "element": "date", "qualifier": "accessioned", "schema": "dc"}, {"key": "dc.date.available", "value": "2018-10-11T05:34:58Z", "language": null, "element": "date", "qualifier": "available", "schema": "dc"}, {"key": "dc.date.issued", "value": "2018", "language": "", "element": "date", "qualifier": "issued", "schema": "dc"}, {"key": "dc.identifier.uri", "value": "https://jyx.jyu.fi/handle/123456789/59797", "language": null, "element": "identifier", "qualifier": "uri", "schema": "dc"}, {"key": "dc.description.abstract", "value": "Ik\u00e4\u00e4ntyneiden on t\u00e4rke\u00e4\u00e4 olla fyysisesti aktiivisia, sill\u00e4 se on yhteydess\u00e4 parempaan toimintakykyyn ja itsen\u00e4isyyteen. Sairaalahoidon j\u00e4lkeen moni ik\u00e4\u00e4ntynyt ei saavuta sit\u00e4 edelt\u00e4nytt\u00e4 tasoa toimintakyvyss\u00e4. Kustannusten hillitsemiseksi ik\u00e4\u00e4ntyneiden kotona p\u00e4rj\u00e4\u00e4miseen ja kuntoutukseen tulee panostaa. Aikaisempi tutkimustieto on puutteellista kotikuntoutuksen vaikuttavuudesta sairaalasta kotiutuvilla ik\u00e4\u00e4ntyneill\u00e4. T\u00e4ss\u00e4 Pro Gradu-tutkielmassa selvitettiin, onko tehostetulla kuuden kuukauden mittaisella kotikuntoutuksella vaikutusta ik\u00e4\u00e4ntyneiden fyysiseen aktiivisuuteen ja toimintakykyyn sairaalajakson j\u00e4lkeen.\n\nTutkimus oli satunnaistettu kontrolloitu tutkimus, jonka kohdejoukkona olivat Jyv\u00e4skyl\u00e4n seudulla asuvat yli 60-vuotiaat henkil\u00f6t, jotka olivat olleet sairaalahoidossa alaraajan tai sel\u00e4n leikkauksen tai tapaturman vuoksi (n=106). Koeryhm\u00e4l\u00e4iset osallistuivat sairaalasta kotiuduttuaan kuusi kuukautta kest\u00e4v\u00e4\u00e4n kuntoutusinterventioon, joka sis\u00e4lsi seitsem\u00e4n fysioterapeutin kotik\u00e4ynti\u00e4 ja kolme puhelinohjausta. Kontrolliryhm\u00e4 sai vallitsevan hoitok\u00e4yt\u00e4nn\u00f6n mukaista hoitoa, johon sis\u00e4ltyy yleens\u00e4 fysioterapeutin osastolla antama ohjeistus kotiharjoitteista. Mittaukset tehtiin pian sairaalasta kotiutumisen j\u00e4lkeen sek\u00e4 kolmen ja kuuden kuukauden kuluttua alkumittauksista. Fyysist\u00e4 aktiivisuutta mitattiin kuutena per\u00e4kk\u00e4isen\u00e4 p\u00e4iv\u00e4n\u00e4 reiteen kiinnitett\u00e4v\u00e4ll\u00e4 Hookie AM 20 -kiihtyvyysmittarilla. Fyysist\u00e4 toimintakyky\u00e4 mitattiin lyhyell\u00e4 fyysisen suorituskyvyn testist\u00f6ll\u00e4 (Short physical performance-battery, SPPB-testi). Aineisto analysoitiin SPSS 18 -ohjelmalla toistomittausten varianssianalyysi-menetelm\u00e4ll\u00e4.\n\nTutkimusryhm\u00e4t eiv\u00e4t eronneet alkutilanteessa merkitsev\u00e4sti toisistaan. Interventioryhm\u00e4n (IR) ja kontrolliryhm\u00e4n (KR) fyysisen aktiivisuuden ja fyysisen toimintakyvyn muutos eiv\u00e4t eronneet tilastollisesti merkitsev\u00e4sti kuuden kuukauden tutkimuksen aikana. Passiivisesti vietetty aika lis\u00e4\u00e4ntyi interventioryhm\u00e4ll\u00e4 (IR) 15%, mutta my\u00f6s kontrolliryhm\u00e4ll\u00e4 (KR) 11,7% (ryhm\u00e4-aika-yhdysvaikutus p=0,934). Kevyt fyysinen aktiivisuus v\u00e4heni IR:ll\u00e4 0,1% ja lis\u00e4\u00e4ntyi KR:ll\u00e4 1,2% (p=0,273). Keskiraskas fyysinen aktiivisuus lis\u00e4\u00e4ntyi IR:ll\u00e4 1,9% ja KR:ll\u00e4 4,5% (p=0,680). Fyysist\u00e4 toimintakyky\u00e4 mittaavassa SPPB-testiss\u00e4 tasapainopisteet paranivat kuuden kuukauden aikana IR:ll\u00e4 15,4% ja KR:ll\u00e4 22,7%, mutta ryhmien v\u00e4lisen muutoksen ero ei ollut tilastollisesti merkitsev\u00e4 (ryhm\u00e4-aika-yhdysvaikutus p=0,606). Testipisteet lis\u00e4\u00e4ntyiv\u00e4t trendinomaisesti tuolista yl\u00f6snousunopeudessa IR:ll\u00e4 3,5 ja KR:ll\u00e4 2,5-kertaiseksi (p=0,436), k\u00e4velynopeudessa IR:ll\u00e4 1,5 ja KR:ll\u00e4 1,4-kertaiseksi (p=0,200) ja yhteispisteiss\u00e4 IR:ll\u00e4 1,5 ja KR:ll\u00e4 1,4-kertaiseksi (p=0,674).\n\nKuuden kuukauden mittainen tehostettu kotikuntoutusinterventio ei vaikuttanut ik\u00e4\u00e4ntyneiden fyysiseen aktiivisuuteen ja toimintakykyyn sairaalajakson j\u00e4lkeen.", "language": "fi", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.abstract", "value": "Physical activity among older people is important, because it is associated with better ability of function even without help. Many of aged individuals does not attain the function they had before hospitalization. Intensive rehabilitation would enable their living at home as long as possible and thus limit increasing costs to the society. Previous research about the effect of home rehabilitation among older people after hospitalization is yet insufficient. The purpose of this randomised controlled trial (RCT) was to investigate if an intensive 6-month home rehabilitation program has effect on physical activity and physical function among older people after hospitalization.\n\nParticipants in this RCT were aged 60 years or over living in Jyv\u00e4skyl\u00e4 or nearby who had been in hospital care because of surgery or accident that had caused back or lower limb injury (n=106). After the hospital stay, intervention group participated in an intensive 6-month rehabilitation program, which included seven home visits and three phone counselling calls given by a physiotherapist. Control group received usual care after hospitalization, which typically includes counselling about the home exercises given by a physiotherapist at the hospital during the stay. The data was collected during two weeks after hospitalization and three and six months after the baseline measurements. The amount and intensity of physical activity was collected with Hookie AM 20 accelerometer, which was attached to subjects\u2019 thigh. Physical function was measured with Short Physical Performance Battery (SPPB). Data was analysed with SPSS 18 program using repeated measures ANOVA in addition to descriptives.\n\nAt baseline, groups did not differ statistically significantly from each other. During the 6-month intervention, none of the changes of PA and physical function variables differed between the groups. In detail, passive time increased 15% in intervention group (IG), but also 11,7% in control group (CG; p for interaction 0,934). Light physical activity decreased 0,1% in IG and increased 1,2% in CG (p=0,273). Moderate physical activity increased 1,9% in IG and 4,5% in CG (0,680). In SPPB-test, balance points increased 15,4% in IG but also 22,7% in CG (p=0,606). In chair stand test, points increased 3,5-fold in IG but also 2,5-fold in CG (p for interaction 0,436). The corresponding coefficients were 1,5-fold and 1,4-fold in gait speed (p=0,200) and 1,5-fold and 1,4-fold in total points (p=0,674).\n\nThe 6-month intensive home rehabilitation program was not effective on physical activity and physical function compared to usual care among older people after hospitalization.", "language": "en", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Submitted by Paivi Vuorio (paelvuor@jyu.fi) on 2018-10-11T05:34:58Z\nNo. of bitstreams: 0", "language": "en", "element": "description", "qualifier": "provenance", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Made available in DSpace on 2018-10-11T05:34:58Z (GMT). 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