五音八段锦治疗老年精神分裂症患者平衡与 认知能力的随机对照试验

A Randomized Controlled Trial of Five-Tone Baduanjin on Balance and Cognitive Ability in Elderly Patients with Schizophrenia

摘要: 目的：探讨五音八段锦对精神专科医院长期住院的老年精神分裂症患者的平衡与认知能力的疗效和影响因素。方法：选取2024年6月至7月在重庆市长寿区精神卫生中心住院的老年精神分裂症患者40例，开展为期12周的单中心、单盲、随机对照试验，利用随机数对等分至对照组和试验组各20例。对照组进行工娱治疗，试验组在此基础上进行五音八段锦治疗。在12周末分析主要结局平衡与步态量表(Tinetti Performance Oriented Mobility Assessment, POMA)和次要结局简易智能状态检查(Mini-Mental State Examination, MMSE)在组内和组间的差异。在多重线性回归分析中，设置性别、年龄、BMI、病程、奥氮平等价剂量、基线POMA或MMSE评分为自变量，分析与结局POMA和MMSE评分分别相关的预测因素。结果：主要结局的组内比较显示，对照组的结局POMA评分(18.40 ± 5.45)与其基线(17.85 ± 5.15)对比差异无统计学意义(t = −1.222, P = 0.237)，而试验组的结局POMA评分(22.00 ± 2.85)显著高于其基线(19.15 ± 3.44)，差异有统计学意义(t = −5.838, P < 0.001)。组间比较显示，试验组的结局POMA评分显著高于对照组，差异有统计学意义(t = −2.582, P = 0.014)。次要结局的组内比较显示，对照组的结局MMSE评分(17.80 ± 5.69)较其基线(17.70 ± 5.88)无显著改善，差异无统计学意义(t = −0.418, P = 0.681)，而试验组的结局MMSE评分(18.30 ± 6.06)较其基线(17.00 ± 5.41)有显著提高，差异有统计学意义(t = −2.204, P = 0.040)。组间比较显示，试验组与对照组结局MMSE评分的差异无统计学意义(t = −0.269, P = 0.789)。多重线性回归分析发现，性别(B = 3.367, t = 2.712, P = 0.010)、年龄(B = −0.424, t = 0.133, P = 0.003)、基线MMSE评分(B = 0.314, t = 0.110, P = 0.007)对结局POMA评分的影响有统计学意义；BMI (B = 0.784, t = 3.703, P = 0.001)和基线POMA评分(B = 0.470, t = 0.176, P = 0.011)对结局POMA评分的影响有统计学意义。结论：五音八段锦可以改善长期住院的老年精神分裂症患者的平衡功能，对认知功能的疗效尚不明确。年龄偏小、男性及较好的基础平衡能力是预测治疗后认知改善的因素，适当的体质指数和较好的基础认知水平是预测治疗后平衡能力改善的保护因素。

Abstract: Objective: To investigate the efficacy and influencing factors of Five-Tone Baduanjin on balance and cognitive ability in elderly patients with schizophrenia undergoing long-term hospitalization in a psychiatric specialty hospital. Methods: In a 12-week, single-center, single-blind, randomized controlled trial conducted at the Chongqing Changshou Mental Health Center between June and July 2024, 40 elderly inpatients with schizophrenia were equally assigned to control and experimental groups using random numbers. The control group received occupational and recreational therapy, while the experimental group received Five-Tone Baduanjin therapy in addition to the standard occupational and recreational therapy. At the end of the 12 weeks, differences within and between groups were analyzed for the primary outcome, the Tinetti Performance Oriented Mobility Assessment (POMA) scale, and the secondary outcome, the Mini-Mental State Examination (MMSE). Multiple linear regression analyses were performed to identify predictors associated with the outcome POMA and MMSE scores, using gender, age, BMI, duration of illness, olanzapine equivalent dose, baseline POMA score, or baseline MMSE score as independent variables. Results: Intra-group comparison of the primary outcome showed no statistically significant difference between the final POMA score (18.40 ± 5.45) and the baseline (17.85 ± 5.15) in the control group (t = −1.222, P = 0.237). In contrast, the experimental group’s final POMA score (22.00 ± 2.85) was significantly higher than its baseline (19.15 ± 3.44), with a statistically significant difference (t = −5.838, P < 0.001). Inter-group comparison revealed that the final POMA score in the experimental group was significantly higher than that in the control group, with a statistically significant difference (t = −2.582, P = 0.014). For the secondary outcome, intra-group comparison showed no significant improvement in the MMSE score (17.80 ± 5.69) compared to baseline (17.70 ± 5.88) in the control group (t = −0.418, P = 0.681), whereas the experimental group’s final MMSE score (18.30 ± 6.06) was significantly improved compared to its baseline (17.00 ± 5.41, t = −2.204, P = 0.040). Inter-group comparison indicated no statistically significant difference in the final MMSE scores between the experimental and control groups (t = −0.269, P = 0.789). Multiple linear regression analysis found that gender (B = 3.367, t = 2.712, P = 0.010), age (B = −0.424, t = 0.133, P = 0.003), and baseline MMSE score (B = 0.314, t = 0.110, P = 0.007) had statistically significant effects on the final POMA score. BMI (B = 0.784, t = 3.703, P = 0.001) and baseline POMA score (B = 0.470, t = 0.176, P = 0.011) had statistically significant effects on the final MMSE score. Conclusion: Five-Tone Baduanjin can improve balance in elderly patients with schizophrenia undergoing long-term hospitalization, but its effect on cognitive function remains unclear. Younger age, male gender, and better baseline balance ability were predictors of cognitive improvement after treatment. Appropriate BMI and better baseline cognitive level were protective factors predicting improved balance ability after treatment.