| Summary: | 博士 === 國立臺灣大學 === 物理治療學研究所 === 99 === Elderly population is rapidly increasing in number and proportion, osteoporosis has become a major global public health issue, including Asia and Taiwan. Osteoporosis is a systemic disorder and is characterized by low bone mass, leading to bone fragility and an increased susceptibility to fractures. The complications and sequelae that coming with osteoporotic fractures always cause great burden to the society and medical care system. Many studies have proven that exercise can improve the bone mineral density, decrease bone loss, prevent fall and so on. However, most studies focused on the effects of different types of exercises, few studies compared the therapeutic effects among different delivery modes. To the medical providers, what is the most cost-effective program is important. The purposes of this thesis are as follows: Study 1: To compare the effectiveness of home-based exercise, group exercise and education group. Study 2: To conduct a cost-effectiveness analysis (CEA) for the 3 programs and the incremental cost effectiveness analysis (ICEA) comparing with the education group. Study I was a prospective randomized controlled trial. Eighty seven postmenopausal women with osteoporosis and age older than 50 years old were recruited. They were randomized into home-based exercise, group exercise or education group. The intervention was for 3 months, evaluation was done before and after the intervention and one year after starting the program. The outcome measures included: bone mineral density (BMD: the second evaluation was done at the 6th month), muscle strength, balance, functional mobility, quality of life, and numbers of fall. Data was analysed using the 11.0 version of SPSS and a was set at 0.05 for all analyses. Descriptive statistics was used to show the baseline characteristics of the three groups. Kruskal–Wallis test was used to compare difference among groups. Friedman test was used to analyze the differences among all three time points within the groups. Study II, a CEA and ICEA for the 3 programs was executed. The cost was based on the budget for performing the programs, and the effectiveness was measured including the changes in BMD, muscle strength, balance, functional mobility, quality of life, and numbers of fall. The result of study I showed that three groups had a trend of improvement in most outcomes. There was almost no significant difference among three groups at each time point (p> 0.05). The data of all modes was pooled together, the results showed that grip strength had significant improvement at 12- month follow- up comparing to baseline and 3- month assessments; functional mobility, balance (using one leg standing with eyes opened), and total score of Qualeffo- 31 all showed significant improvements between baseline and 3- month and between baseline and 12- month assessment (p< 0.05). All fall numbers of 3 modes declined till half year after intervention. The results of study II showed that home- based exercise was the most cost effective one among 3 delivery modes of exercise for improving QOL. For fall prevention, education program might be the most cost effectiveness program. The sensitivity analysis was conducted, the results did not change. However, if the productivity cost was neglected, home- based exercise was the most cost- effective option in most variables. We concluded that all 3 modes of exercise could get similar effects on mobility and lowering the fall risk. A comprehensive education program with home exercise program may be an effective way to prevent osteoporosis and fall. When cost effectiveness is considered, education program or home- based exercise may be the better options.
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