체계적 문헌고찰: 척수장애인의 일상생활 기능 향상을 위한 재활운동 및 체육 프로그램
A systematic review: Rehabilitative exercise programs for improving daily functions of individuals with a spinal cord injury
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초록
척수장애인의 건강증진과 일상생활 기능 향상을 위해서 규칙적인 신체활동 참여는 필수적이다. 척수손상 발생 직후 병원 급성 재활 기간이 끝나면 지역사회 복귀와 독립적인 사회참여를 위해 재활운동 및 체육 프로그램의 역할이 매우 중요하지만, 근거에 기반한 프로그램이 부족한 실정이다. 따라서 본 연구의 목적은 국내·외 척수장애인 대상 재활운동 및 체육 프로그램 관련 연구의 주제와 흐름을 객관적이고 체계적으로 분석하여 근거에 기반한 중재 프로그램 개발에 구체적인 방향을 제시하는 것이다. PICO-TSS의 기준에 따라 선택한 연구 문제를 KISS, RISS, KMbase, Academic Search Complete, PubMed 및 ERIC을 사용하여 2010년 1월부터 2021년 7월까지 발행된 국문 또는 영문 학술논문 을 대상으로 하였다. 주요 검색어는 척수 또는 척수장애를 기본으로 신체활동, 운동, 재활 및 일상생활을 서로 조합하 여 검색하였다. 제목, 초록, 전체 문헌은 6명의 연구자에 의해 평가되었다. 1, 2차 선별은 연구자 독립적으로 수행하였 으며, 3차 선별부터 3명의 연구자가 교차 검토하는 방식으로 진행되었고, 연구자 간의 불일치한 결과는 토의를 통해 전 원 동의를 거쳐 최종 자료를 추출하였다. 문헌선정흐름도(PRISMA)에 따라 1차 검색된 3,957편의 논문(국내:317편, 국 외:3,640편)은 최종 57편(국내:14편, 국외:43편)으로 추출되었다. 이 중 37편의 무작위대조실험 논문은 Cochrane's Risk of Bias Tool을 이용하여 비뚤림 위험 평가를 시행하였다. 선정된 논문은 연구정보(저자와 출판연도), 연구대상, 연구설계 유형, 집단별 참여자 수, 중재방법, 중재결과로 나누어 결과를 제시하였다. 구체적으로 신체활동에 관한 연구 49편, 일상생활 기능 5편, 치료 3편이었으며, 연구설계 방법에 따라 무작위대조실험 37편, 단일연구 18편, 종단연구 2편으로 확인되었다. 중재 프로그램에 따라 핸드바이크, 탄성밴드 운동, 일반적 근력운동, 보행으로 분류되었다. 결론 적으로, 본 연구는 척수장애인의 일상생활 기능 향상을 위해 관련 문헌을 체계적으로 분석하여 근거에 기반한 프로그 램 개발을 위한 단초를 제공하였다. 척수장애인의 재활운동 및 체육 참여 촉진을 위해 본 연구의 결과를 바탕으로 프 로그램 개발과 효과성 검증을 위한 폭넓은 후속 연구가 이어지기를 기대한다.
Abstract
Regular physical activity participation has positive effects on daily functioning of people with a spinal cord injury. A rehabilitative exercise is probably a prerequisite to independently take part in leisure-time physical activity, but little is known about how to develop the rehabilitative exercise programs for this population. Thus, this study systematically reviewed existing literature to obtain scientific evidence regarding rehabilitative exercise interventions for people with a spinal cord injury. The researchers used six databases, including KISS, RISS, KMbase, Academic Search Complete, PubMed and ERIC, to search for articles published from January 2010 to July 2021 based on inclusion and exclusion criteria guided by PICO-TSS. Keywords of physical activity, exercise, rehabilitation, and daily living with a spinal cord or a spinal cord injury were used. All authors were involved in the searching and screening processes using the title, abstract, and full text independently and did cross checks. Of the 3,957 relevant papers, a total of 57 studies were selected according to PRISMA. There were 49 studies regarding physical activity, five studies regarding daily functions, three studies regarding physical therapy. These studies implemented interventions utilizing muscle training, locomotor training, hand bike, or resistance band. In addition, the selected programs set muscle strength, respiratory management, balance, walking competency, and wheelchair skills as the targeted dependent variables. The study findings indicate that fitness related program is the most relevant and needed for people with a spinal cord injury. Future researchers may design evidence-based rehabilitative exercise programs that incorporate the fitness components to help people with a spinal cord injury to freely participate in health-enhancing physical activity in community settings.
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