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基于网络的增强韧性计划改善老年人群的韧性、身体活动和幸福感:随机对照试验。

A Web-Based Resilience-Enhancing Program to Improve Resilience, Physical Activity, and Well-being in Geriatric Population: Randomized Controlled Trial.

机构信息

College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan.

Department of Nursing, Mackay Medical College, Taipei, Taiwan.

出版信息

J Med Internet Res. 2024 Jul 25;26:e53450. doi: 10.2196/53450.

Abstract

BACKGROUND

Resilience is a protective factor in healthy aging, helping to maintain and recover physical and mental functions. The Resilience in Illness Model has proven effective in fostering resilience and well-being. Physical activity is crucial for older adults' independence and well-being, even as aging causes a progressive decline. Additionally, older adults face challenges such as spousal loss and physical disability, making preventive intervention strategies necessary.

OBJECTIVE

This study aims to develop and evaluate a web-based program to enhance resilience, physical activity, and well-being among community-dwelling older adults. Additionally, we aim to gather feedback on the program's strengths and limitations.

METHODS

A 4-week resilience-enhancing program was created, incorporating role-play and talk-in-interaction and focusing on 3 key skills: coping, control belief, and manageability. The program included scenarios such as becoming widowed and suffering a stroke, designed to engage older adults. A pilot test preceded the intervention. As a result of the COVID-19 pandemic, the program shifted from in-person to web-based sessions. A single-blind, parallel-group, randomized controlled trial was conducted. Participants aged over 65 years were recruited offline and randomly assigned to either an intervention or control group. A certified resilience practitioner delivered the program. Outcomes in resilience, physical activity, and well-being were self-assessed at baseline (T0), 4 weeks (T1), and 12 weeks (T2) after the program. A mixed methods approach was used to evaluate feedback.

RESULTS

A web-based participatory program enhancing 3 skills-coping, control belief, and manageability for resilience-was well developed. Among 96 participants, 63 were randomized into the intervention group (n=31) and the control group (n=32). The mean age in the intervention group was 69.27 (SD 3.08) years and 74.84 (SD 6.23) years in the control group. Significant between-group differences at baseline were found in age (t45.6=-4.53, P<.001) and physical activity at baseline (t61=2.92, P=.005). No statistically significant between-group differences over time were observed in resilience (SE 7.49, 95% CI -10.74 to 18.61, P=.60), physical activity (SE 15.18, 95% CI -24.74 to 34.74, P=.74), and well-being (SE 3.74, 95% CI -2.68 to 11.98, P=.21) after controlling for baseline differences. The dropout rate was lower in the intervention group (2/31, 6%) compared with the control group (5/32, 16%). Moreover, 77% (24/31) of participants in the intervention group completed the entire program. Program feedback from the participants indicated high satisfaction with the web-based format and mentorship support.

CONCLUSIONS

This study demonstrated that a web-based resilience-enhancing program is appropriate, acceptable, feasible, and engaging for community-dwelling older adults. The program garnered enthusiasm for its potential to optimize resilience, physical activity, and well-being, with mentorship playing a crucial role in its success. Future studies should aim to refine program content, engagement, and delivery methods to effectively promote healthy aging in this population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05808491; https://clinicaltrials.gov/ct2/show/NCT05808491.

摘要

背景

韧性是健康老龄化的保护因素,有助于维持和恢复身体和心理健康功能。疾病中的韧性模型已被证明在培养韧性和幸福感方面非常有效。体育活动对老年人的独立性和幸福感至关重要,即使随着年龄的增长会导致功能逐渐下降。此外,老年人面临着配偶丧失和身体残疾等挑战,因此需要预防干预策略。

目的

本研究旨在开发和评估一个基于网络的项目,以增强社区居住的老年人的韧性、体育活动和幸福感。此外,我们旨在收集对该项目的优势和局限性的反馈。

方法

创建了一个为期 4 周的增强韧性的方案,纳入角色扮演和互动对话,并重点关注 3 项关键技能:应对、控制信念和可管理性。该方案包括丧偶和中风等情景,旨在吸引老年人参与。在干预之前进行了试点测试。由于 COVID-19 大流行,该方案从面对面改为基于网络的会议。进行了一项单盲、平行组、随机对照试验。招募线下年龄超过 65 岁的参与者,并随机分配到干预组或对照组。由经过认证的韧性从业者提供方案。在方案开始时(T0)、4 周后(T1)和 12 周后(T2),自我评估韧性、体育活动和幸福感的结果。采用混合方法评估反馈。

结果

为增强韧性的 3 项技能(应对、控制信念和可管理性)而开发的基于网络的参与性方案得到了很好的发展。在 96 名参与者中,63 名被随机分配到干预组(n=31)和对照组(n=32)。干预组的平均年龄为 69.27(SD 3.08)岁,对照组为 74.84(SD 6.23)岁。在基线时发现组间存在显著差异,包括年龄(t45.6=-4.53,P<.001)和基线时的体育活动(t61=2.92,P=.005)。在控制了基线差异后,在韧性(SE 7.49,95%CI -10.74 至 18.61,P=.60)、体育活动(SE 15.18,95%CI -24.74 至 34.74,P=.74)和幸福感(SE 3.74,95%CI -2.68 至 11.98,P=.21)方面,未观察到组间随时间的差异。与对照组(5/32,16%)相比,干预组的辍学率较低(2/31,6%)。此外,干预组 77%(24/31)的参与者完成了整个方案。参与者对基于网络的格式和导师支持表示高度满意。

结论

本研究表明,基于网络的增强韧性方案适合、可接受、可行且能吸引社区居住的老年人参与。该方案激发了参与者对其优化韧性、体育活动和幸福感的潜力的热情,导师的支持在方案的成功中发挥了关键作用。未来的研究应旨在进一步完善方案内容、参与度和交付方法,以有效促进该人群的健康老龄化。

试验注册

ClinicalTrials.gov NCT05808491;https://clinicaltrials.gov/ct2/show/NCT05808491。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4a2/11310648/62193d6d1ba0/jmir_v26i1e53450_fig1.jpg

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