【正文】 目錄 中文摘要?????????????????????????? ?? 1 英文摘要????????????????????? ?? ????? 3 前言?????????????????????? ?? ?????? 5 研究目的???????????????????????????? 7 主要概念???????????????????????????? 8 研究步驟及技術(shù)路線?????????????? ?? ??????? 9 第一部分 基線調(diào)查 研究方法 ????????????????????? ?????? 11 結(jié)果 ?? ????????????????????? ?????? 13 討論 ?????????????????????? ??????? 22 第二部分 干預(yù)研究 研究方法 ????????????????????? ?????? 26 結(jié)果??????????????????????? ?????? 31 討論???????????????????????? ?? ??? 37 結(jié)論????????????????????????? ?? ??? 43 創(chuàng)新點(diǎn)、不足之處及今后研究的建議 ???????????? ?? ?? 44 參考文獻(xiàn)????? ???????????????? ?? ????? 45 附錄???????????????????????? ?? ???? 53 在學(xué)期間發(fā)表文章???????????????????? ?? ?? 63 致謝??????????????????????? ?? ????? 64 綜述???????????????????????? ?????? 65 1 以運(yùn)動(dòng)為主的社區(qū)干預(yù)對(duì)市郊絕經(jīng)后婦女骨健康及跌倒風(fēng)險(xiǎn)的影響 中文摘要 目的： 在 了解 市郊絕經(jīng)后婦女 骨質(zhì)疏松相關(guān)知識(shí)、自我效能和飲食與運(yùn)動(dòng)行為的基礎(chǔ)上，設(shè)計(jì) 以運(yùn)動(dòng)為主的社區(qū)干預(yù)項(xiàng) 目 ，并檢測(cè)其 對(duì)改善市郊絕經(jīng)后婦女骨 密度 、 下肢肌力及平衡功能 的有效性 。 方法： 課題分兩個(gè)階段進(jìn)行 。 第一階段 ： 采用方便 抽 樣的方法， 以 一般情況 問(wèn)卷、 骨質(zhì)疏松癥相關(guān)知識(shí) 量表、骨質(zhì)疏松 自我效能 量表、 飲食與運(yùn)動(dòng) 行為量表 為主要研究工具，對(duì) 符合納入標(biāo)準(zhǔn)的 246 名 上海市郊 絕經(jīng)后 婦女 進(jìn)行基線調(diào)查 。 第二階段 ： 將符合入選條件的 研究對(duì)象按所在地段分為兩組，然后分別從中第一階段調(diào)查對(duì)象中隨機(jī)抽取干預(yù)組 （ 30 例）和對(duì)照組（ 30 例）。 兩組在年齡、性別、文化程度、婚姻狀況、 生育年齡、體重和身高 等方面的差別無(wú)統(tǒng)計(jì)學(xué)意義 （ p＞） 。 對(duì)照組接受常規(guī)護(hù)理。 干預(yù)組予以 為期 6 個(gè)月的以運(yùn)動(dòng)為主的社區(qū)干預(yù)項(xiàng)目， 干預(yù)方式 包括 群體教育 、發(fā)放 《 骨質(zhì)疏松癥患者每天的飲食和生活宣教手冊(cè) 》 與 《預(yù)防 跌倒運(yùn)動(dòng)體操》手冊(cè)、 個(gè)別指導(dǎo)（電話咨詢）、小組鍛煉 與 經(jīng)驗(yàn)交流會(huì)。 在 干預(yù)前、干預(yù) 2個(gè)月、干預(yù) 6個(gè)月分別測(cè)量?jī)山M研究對(duì)象的 骨質(zhì)疏松相關(guān)知識(shí)、自我效能以及行為 ，評(píng)價(jià)其變化情況；并由專業(yè)人員用 相關(guān)儀器 分別在干預(yù)前和干預(yù) 6個(gè)月 測(cè) 定 兩組 研究對(duì)象的 骨密度、下肢肌力和平衡功能 ，評(píng)價(jià)干預(yù)效果 。 結(jié)果： 第一階段： ① 市郊 絕經(jīng)后婦女 骨質(zhì)疏松 知識(shí) 水平 低下 ， 及格率僅為 %。 由低到高依次為：運(yùn)動(dòng)知識(shí)、 飲食知識(shí) 、藥物 知識(shí) 、疾病基本知識(shí)。 ② 年齡較大、文化程度較低或不在婚婦女的知識(shí)水平顯著低于年輕、文化程度較高或在婚的絕經(jīng)后婦女（ p＜ ） 。多元回 歸分析顯示，年齡、文化程度、婚姻進(jìn)入知識(shí)的回歸方程（ F=， p＜ ） 。 ③ 市郊絕經(jīng)后婦女骨質(zhì)疏松相關(guān)自我效能的項(xiàng)目平均分總體水平不高。 ④ 市郊絕經(jīng)后婦女骨質(zhì)疏松相關(guān)行為水平較低，飲食行為的項(xiàng)目平均得分顯著低于運(yùn)動(dòng)行為（ t=,P）。⑤ 市郊絕經(jīng)后婦 2 女骨質(zhì)疏松相關(guān)行為與其相關(guān)知識(shí)與自我效能水平呈顯著正相關(guān)（ r=～,P），多元回歸分析顯示，知識(shí)與自我效能是行 為的預(yù)測(cè)因子。 第二階段： ① 重復(fù)測(cè)量方差分析顯示， 在 干預(yù)前 、干預(yù) 2 個(gè)月和干預(yù) 6 個(gè)月 三個(gè)時(shí)間點(diǎn)， 干預(yù)組和對(duì)照組的知識(shí)水平 、自我效能 和行為狀況均有隨時(shí)間變化的趨勢(shì)（ p），干預(yù)組的得分顯著高于對(duì)照組（ p），且時(shí)間因素與干預(yù)因素存在交互作用（ p） 。 ② 除 120 度峰 力矩 外 ，干預(yù) 組干預(yù) 6個(gè)月后的肌力各項(xiàng)指標(biāo)均 顯著高于 干預(yù)前 （ p） ，而對(duì)照組肌力在干預(yù)前后無(wú)明顯變化 （ p＞ ） 。 ③ 干預(yù)組 6個(gè)月后的 平衡功能 各項(xiàng)指標(biāo) 與干預(yù)前相比無(wú) 明顯下降（ p＞ ） ，但 對(duì)照組 6 個(gè)月時(shí) 的閉眼軌跡長(zhǎng)及閉眼動(dòng)搖能耗 值高于干預(yù)前（ p） 。 ④ 干預(yù)組 干預(yù) 后 6 個(gè)月腰椎 和 股骨 部 位 的 骨密度均無(wú)明顯改變 （ p＞ ） ，而對(duì)照組 L3 椎體 和 股骨頸的骨密度 明顯低于干預(yù)前 （ p） 。 結(jié)論： 市郊 絕經(jīng)后婦女 骨質(zhì)疏松 知 識(shí) 、相關(guān)自我效能及行為均不夠理想，而 以運(yùn)動(dòng)為主的 社區(qū) 綜合干預(yù) 不僅 可 提高 市郊絕經(jīng)后婦女骨質(zhì)疏松知識(shí) 、自我效能 與行為水平， 并可 顯著 增強(qiáng) 下肢肌力，穩(wěn)定平衡功能， 并有助于 防止和延緩骨量丟失 ，維持骨健康，降低跌倒風(fēng)險(xiǎn) 。 關(guān)鍵詞： 絕經(jīng)后婦女、骨密度、下肢肌力、平衡功能 、跌倒風(fēng)險(xiǎn) 3 Effect of munitybased program based on exercise on improving bone health and fall risk of menopausal women in suburb Abstract Objective: To develop a munitybased program mainly including exercises and to examine its effectiveness on improving the bone density, muscle power of lower limbs and the equilibrium function of suburban menopausal women on the basis of knowing their relative knowledge of osteoporosis, selfefficacy, diet and exercises. Method: This research project is carried on by two stages. The First Stage: On the principle of convenience sampling, the baseline survey was conducted on 246 menopausal women from the suburbs of Shanghai who met the inclusion criteria with the main instruments of General Status Questionnaire, Osteoporosisrelated knowledge Questionnaire, Osteoporosisrelated Selfefficacy Scale and Diet and Exercises Scale. The Second Stage: 60 menopausal women from the first stage who met the inclusion criteria were divided randomly into experimental group and control group according to the regions. Differences of the two groups on age, sex, educational level, marital status, childbearing age, weight and height had no statistically significance (p)..The experimental group participated in the munitybased program mainly based on the exercises while the control group received the routine nursing care. The main interventions included lectures, distribution of “Brochure of Daily Diet and Life for Osteoporosis Patients” and “Brochure of TumblingPreventing Exercises and Gymnastics ”, individual guide (telephone consultation), group exercises and experience exchange symposiums. The relative knowledge of osteoporosis, selfefficacy and behaviors of both groups were measured respectively before and 2 and 6 months after the intervention and changes were evaluated. Meanwhile, the bone density, muscle power of lower limb and equilibrium function of both groups were measured by the professionals with the relative instruments before and 6 months after the intervention to evaluate the effect of intervention. Results: The First Stage: ① The suburban menopausal women’s knowledge of osteoporosis was humble, barely with the pass rate of %, which from low to high were for exercises, diet, medicines and simple diseases. ② Those menopausal women who were older, lack of education or not in marriage had obviously less knowledge than those younger, bettereducated or in marriage(p). By multiple regression analysis, the age, educational level and marriage were included in knowledge regression equation (F=, p). ③ The suburban menopausal 4 women’s average score on the project regarding to the selfefficacy of osteoporosis was not high generally. ④ The suburban menopausal women’s behaviors regarding to osteoporosis was relatively low. The average score on diet was obviously lower than that on exercises (t=, P). ⑤ The suburban menopausal women’s behaviors regarding to osteoporosis correlated positively with their relative knowledge and level of selfefficacy(r=~, P). By multiple regression analysis, knowledge and selfefficacy were predictors of the behavior. The Second Stage: ① By repetitive measure analysis of variance and observing 3 time points (before and 2 and 6 months after the intervention), there existed the tendency that the level of knowledge, selfefficacy and behavioral status of experimental group and control group changed with time. The score of experimental