臺灣博碩士論文加值系統

目的：社區中許多高齡長者有下肢與足部疼痛之問題，但都會歸因於年紀大之關係，因而多被忽略。本研究之目的是希望能瞭解高齡者下肢與足部疼痛及失能之盛行狀況，以及足部疼痛對高齡者影響的因素。期待本研究結果能作為長照機構照護高齡者照顧計畫及長照政策規劃的參考。
研究方法：本研究使用曼徹斯特足部疼痛與功能障礙量表MFPDI，評估個案足部疼痛及功能障礙程度。然因為該量表尚無中文版本，因此計畫先翻譯MFPDI，並進行信度與效度的檢測。將翻譯成中文之MFPDI量表，加入臉譜疼痛分數及生活品質下降比，形成台灣足部健康問卷。以問卷訪談之方式，對台灣中部地區長照相關機構之高齡長者施行訪談，將回收之問卷建檔編碼，以IBM SPSS 20.0版本進行統計資料之分析及處理，使用的統計方法包，括雙變項分析及多變項分析。
研究結果：本研究對象共125名，在下肢與足部30個部位中，主訴1至2個部位疼痛者超過50%。腳痛部位個數的整體平均數為3.77個。腳痛數量以兩隻腳痛居多，佔47.2%，社區型39.1%，住宿型65.8%，顯示幾隻腳痛與機構型態有顯著差異。在疼痛就醫情形方面，因為腳部疼痛而就醫，不論是社區型或是住宿型均以西醫醫院居多。在足部疼痛與功能障礙多變項分析方面，女性、沒有宗教信仰、健康狀況不好者足部功能障礙機率均較高。若以依變項為失能程度分析，有足部障礙者女性平均失能程度比男性少;有信仰者比沒信仰者足部失能程度較少。健康狀況是各相關因素中對失能程度影響力最高者，健康狀不好者比健康狀況好的失能程度較高。
結論：本研究結果顯示，翻譯後的MFPDI量表，具有很高的信度與效度，中文版量表與原始量表的研究結果相似，加入了臉譜疼痛分數及生活品質下降百分數而成的台灣足部健康問卷，可以提供長期照護機構，住民入住時的足部評估之使用，或是帶活動時預防個案跌倒之篩選，希望此台灣足部健康問卷除了能在各長照機構中被使用，未來更能推廣至各社區及醫療相關之機構。

Objective: Many elderly people in the community have foot pain and problems with their lower limbs, but they are attributed to the relationship with old age and are often neglected. The purpose of this study is to understand the prevalence of lower limbs, foot pain and disability in elderly people, as well as the factors that can affect the pain. It is expected that the results of this study will serve as a reference for long-term care institutions for the elderly care programs and long-term policy planning.

Methodology: This study used The Manchester Foot Pain and Dysfunction Index (MFPDI) to assess the level of dysfunction in cases. However, this index is not available in Chinese. Therefore, the first course of action was to translate and perform reliability and validity testing of MFPDI. Once translated, The MFPDI was added to the facial scale and quality of life decline score. Together, they form the Taiwanese Pediatric Health Questionnaire. Interviews were then conducted with senior citizens of the relevant institutions in central Taiwan by means of a survey. The documentation was coded, analyzed and processed by statistical data in IBM SPSS 20.0, and the statistical methods used include double variable analysis and multivariate analysis.

Result: A total of 125 subjects were enrolled in the study. Among the 30 sites of the lower limbs and the foot pain, more than 50% of the patients complained of 1 or 2 pains. The overall average number of foot pain is 3.77. The pain consists mainly in both feet, accounting for 47.2% with 39.1% of individuals residing in community-like institutions versus 65.8% of individuals residing in private quarters. Indicating that there were significant correlation between pain in both feet and institution styles. In the case of pain treatment, individuals from both types of institutions were treated at hospitals that practice Western medicine. In the analysis of multiple variable foot pain and dysfunction, women, those without religious beliefs or those with poor health have higher risk of foot dysfunction. If the degree of disability is analyzed by the variable item, women with foot disorders have less disability on average compared to men. In addition, those with religious beliefs have less foot disability than those who do not have religious beliefs. Health status is the most influential in the degree of all relevant factors. Furthermore, with regardless to the degree of disability, those with worst health conditions have higher degree than those with better health conditions.

Conclusion: The results of this study showed that the translated MFPDI scale comes with high confidence and validity. The Chinese version of the scale is similar to the original one. The Taiwanese Pediatric health questionnaire, in addition with the facial pain score and the percentage of quality of life decline score. The Taiwanese foot health questionnaire can be used in long-term care institutions for foot assessment during a resident’s stay or the screening of fall prevention when activities are held. I hope that the Taiwanese Pediatric health questionnaires can be used in the various long-term institutions. In addition, I hope it can be more widely extended to the community, and medical related institutions in the future.

目錄
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 高齡者常見下肢疾患及其盛行率 4
壹、類風濕性關節（Rheumatoid Arthritis RA） 4
貳、退化性膝關節炎（Osteoarthritis OA） 5
參、骨質疏鬆（Osteoporosis） 6
肆、下肢靜脈曲張（Varicose veins） 7
第二節 高齡者常見足部疾患及其盛行率 8
壹、痛風（Gout） 8
貳、糖尿病足（DM foot） 9
參、雞眼（Corns） 9
肆、拇趾外翻（Hallux Valgus HV） 10
伍、灰指甲（Onychomycosis） 10
陸、香港腳(Tinea pedis/Athlete’s foot) 11
柒、趾甲內生（Ingrown toenail） 12
第三節 高齡者下肢及足部問題評估的工具 13
壹、曼徹斯特足部疼痛與功能障礙量表 13
貳、足部健康問卷 14
參、美國骨科醫師學會足部和踝關節模組評估 14
肆、布里斯托爾足部評估 15
伍、足功能指數 16
第三章 研究方法 17
第一節 MFPDI中文化過程 18
壹、前譯（Forward translation） 20
貳、形成專家小組（Expert panel） 20
叁、反向翻譯（Back translation） 20
肆、認知訪談及預試（cognitive interviewing and pre-testing） 21
第二節 研究設計 22
壹、研究架構 22
貳、資料來源 23
第三節 研究對象及資料收集 24
壹、收案條件及排除條件 24
貳、收案程序 24
參、研究工具 25
第四節 研究變項定義 26
壹、自變項說明 26
貳、依變項 27
第五節 信度與效度檢測方法 33
第六節 統計分析方法 36
壹、雙變項分析 36
貳 、多變項分析 36
第四章 研究結果 37
第一節 個案屬性與機構型態 38
第二節 下肢與足部疼痛情形 40
第三節 足部疼痛與失能程度盛行狀況 43
壹、足部疼痛與失能程度 43
貳、不同機構型態足部疼痛失能程度 45
第四節 不同機構型態足部疼痛失能分析 47
第五節 疼痛就醫情形 48
第六節 足部疼痛與功能障礙多變項分析 49
壹、足部疼痛與功能障礙之相關因素 49
貳、在足部功能向度方面失能之分析 51
參、在個人感受及疼痛向度失能之分析 53
肆、足部疼痛與失能在影響工作/休閒生活向度之分析 55
伍、下肢疼痛程度之相關因素 57
第五章 討論 59
第一節 MFPDI量表中文化之討論 59
壹、翻譯過程 59
貳、轉化過程 59
第二節 下肢與足部疼痛與功能障礙盛行狀況之討論 61
壹、下肢與足部疼痛之盛行率 61
貳、失能障礙之盛行率 62
第三節 下肢與足部疼痛與功能障礙相關因素之討論 63
壹、年齡 63
貳、性別 63
參、宗教信仰 63
肆、健康狀況 64
第四節 研究限制 65
壹、研究對象限制 65
貳、量表中文化限制 65
叁、患者自我報告限制 66
第六章 結論與建議 67
第一節 結論 67
第二節 建議 67
壹、MFPDI建議 67
貳、對未來研究之建議 67
參考文獻 69
附錄
表3-1個案屬性變項操作型定義 27
表3-2足部疼痛部位變項操作型定義 29
表3-3 足部疼痛與障礙變項操作型定義 30
表3-4就醫經驗操作型定義 32
表3-5-1曼徹斯特足部疼痛及障礙量表內部一致性 34
表3-5-2曼徹斯特足部疼痛及障礙量表複本信度 35
表3-5-3曼徹斯特足部疼痛與障礙與生活品質相關 35
表4-1-1個案屬性與機構型態 39
表4-2-1個案下肢與足部疼痛狀況 41
表4-2-2個案下肢與足部疼痛部位數及一隻或兩隻腳痛 42
表4-3-1足部疼痛與失能程度 44
表4-3-2足部疼痛失能程度與機構型態之相關性 46
表4-4-1足部疼痛分析 47
表4-5-1下肢與足部疼痛就醫狀況 48
表4-6-1足部功能障礙與否及其失能程度相關因素 50
表4-6-2足部疼痛與障礙在足部功能向度方面之分析 52
表4-6-3足部疼痛與失能在個人感受及疼痛向度方面之分析 54
表4-6-4足部疼痛與失能在影響工作/休閒生活向度方面之分析 56
表4-6-5下肢與足部疼痛部位數之相關因素分析 58
 
圖目錄

圖3-1 MFPDI量表中文化流程圖 19
圖3-2 研究架構 22
圖3-3 足部疼痛區域圖 28

參考文獻
中文參考文獻
中華民國國家發展委員會（2018）。 台灣地區人口推估報告。取自 https://www.ndc.gov.tw/Content_List.aspx?n=695E69E28C6AC7F3
內政部戶政司（2018）。 台灣正式邁入高齡社會。取自 https://www.moi.gov.tw/chi/chi_news/news_detail.aspx?type_code=02&sn=13723
王德錦、陳敏夫、周逢復 （1977）。 下肢靜脈曲張及其治療方法。當代醫學（40），頁 134-140。
甘宗本 （2012）。 下肢靜脈曲張治療的新趨勢－參加「美國靜脈論壇」實作研討會心得。臺灣醫界， 55（10），頁 35-38。
呂耀卿 （1976）。 足癬 （Tinea Pedis）。當代醫學（32），頁 534-537。
宋增楷 （20 07）。 香港腳與濕[Athlete's foot and Humidity]。傳統醫學雜誌， 18（1），頁 20-23。
林世昌 （2013）。 類風濕性關節炎免疫生物製劑治療之新進展[Update on the Treatment of Rheumatoid Arthritis with Immune Biological Agents]。台灣醫學， 17（1），頁 30-33。
徐慧娟、吳淑瓊、江東亮 。(1996) 。跌倒對社區老人健康生活品質的影響.
中華公共衛生雜誌， 15(6) ， 525-532。
陳昱瑞 （1976）。 母趾嵌甲症（Ingrown Toenail）。當代醫學（37），頁 1053-1054。
陳富鈞、許惠恒 （2014）。 糖尿病足慢性潰瘍之成功治療經驗－病例報告[Successful Experience in Treating Unhealed Chronic Diabetic Foot Ulcer: A Case Report]。北市醫學雜誌， 11（4），頁 95-102。
國際骨質疏鬆基金會（2016）。 愛惜骨骼：受護未來。取自http://share.iofbonehealth.org/WOD/2016/press-release/WOD%20Press%20Release_Chinese%20Traditional.pdf
湯夢彬、陳守堅、李之微、溫增光、孫曉光、賴義傑 （2011）。 灰指甲。家庭醫學與基層醫療， 26（9），頁 377-381。
黃資雅、杜明勳、陳宏益、陳弘哲 （2015）。 老人跌倒之評估與預防。家庭醫學與基層醫療， 30（1），頁 2-8。
蔡嘉哲、余光輝、林孝義、梁統華、陳峙仰、陳俊宏等人 （2013）。 台灣痛風與高尿酸血症 2013 診治指引。Formosan Journal of Rheumatology， 27（2），頁 1-26。
衛生福利部國民健康署（2013）。 55歲糖友截肢心情苦!防失「足」有妙方 一檢 二顧 三控制。取自 https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1133&pid=2607
衛生福利部國民健康署（2015）。 銀髮抗「鬆」要「動」要「營養」。取自 https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1135&pid=2991
魏繼東 （2005）。 膝關節顧性關節炎的綜合治療。中國廠礦醫學， 18（4），頁 329-331。
潘文涵、吳幸娟、葉乃華、張新儀、洪淑怡等人 (1999) 。
台灣營養健康狀況變遷調查 Nutritional Science Journal, 1999, Vol.24,
No.1, pp.1~10





 
外文參考文獻
Barnett, S., Campbell, R., & Harvey, I. (2005). The Bristol Foot Score: developing a patient-based foot-health measure. J Am Podiatr Med Assoc, 95(3), 264-272.
Becker, B. A., & Childress, M. A. (2018). Common Foot Problems: Over-the-Counter Treatments and Home Care. American family physician, 98(5).
Bell‐Syer, S. E., Khan, S. M., & Torgerson, D. J. (2012). Oral treatments for fungal infections of the skin of the foot. Cochrane Database of Systematic Reviews(10).
Bennett, P. J., Patterson, C., Wearing, S., & Baglioni, T. (1998). Development and validation of a questionnaire designed to measure foot-health status. J Am Podiatr Med Assoc, 88(9), 419-428.
Boulton, A. J. M. (2000). The Diabetic Foot. In K. R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, K. Dungan, A. Grossman, J. M. Hershman, G. Kaltsas, C. Koch, P. Kopp, M. Korbonits, R. McLachlan, J. E. Morley, M. New, L. Perreault, J. Purnell, R. Rebar, F. Singer, D. L. Trence, A. Vinik, & D. P. Wilson (Eds.), Endotext. South Dartmouth (MA): MDText.com, Inc.
Bryant, A., & Knox, A. (2015). Ingrown toenails: the role of the GP. Aust Fam Physician, 44(3), 102-105.
Budiman-Mak, E., Conrad, K. J., & Roach, K. E. (1991). The Foot Function Index: a measure of foot pain and disability. Journal of clinical epidemiology, 44(6), 561-570.
Cho, S. Y., Kim, Y. C., & Choi, J. W. (2018). Epidemiology and bone-related comorbidities of ingrown nail: A nationwide population-based study. J Dermatol, 45(12), 1418-1424.
Clinic, M. (2018). Athlete's foot. Retrieved from https://www.mayoclinic.org/diseases-conditions/athletes-foot/symptoms-causes/syc-20353841
Dearden, P., & Wines, A. (2017). Foot problems in older people.
Erh, B. X. Y., He, H. G., Carter, K. F., Cheung, P. P., Tan, D. S., Wang, W., & Rome, K. (2019). Validation of the Chinese Manchester foot pain and disability index (C-MFPDI) among patients with inflammatory arthritis.
J Foot Ankle Res, 12, 6.
Farndon, L., Concannon, M., & Stephenson, J. (2015). A survey to investigate the association of pain, foot disability and quality of life with corns. J Foot Ankle Res, 8(1), 70.
Farndon, L. J., Vernon, W., Walters, S. J., Dixon, S., Bradburn, M., Concannon, M., & Potter, J. (2013). The effectiveness of salicylic acid plasters compared with 'usual' scalpel debridement of corns: a randomised controlled trial. J Foot Ankle Res, 6(1), 40.
Ferrari, S. C., Santos, F. C. d., Guarnieri, A. P., Salvador, N., Correa, A. Z., Hala, A. Z. A., . . . Trevisani, V. F. M. (2008). Manchester foot pain associated disability index in the feet of elderly people: cultural adaptation, validation, and translation into the portuguese language. Revista Brasileira de Reumatologia, 48(6), 335-341.
Gijon-Nogueron, G., Ndosi, M., Luque-Suarez, A., Alcacer-Pitarch, B., Munuera, P. V., Garrow, A., & Redmond, A. C. (2014). Cross-cultural adaptation and validation of the Manchester Foot Pain and Disability Index into Spanish. Quality of Life Research, 23(2), 571-579.
Garrow, A. P., Papageorgiou, A. C., Silman, A. J., Thomas, E., Jayson, M. I., & Macfarlane, G. J. (2000). Development and validation of a questionnaire to assess disabling foot pain. Pain, 85(1-2), 107-113.
Grassi, W., & De Angelis, R. (2012). Clinical features of gout. Reumatismo, 63(4), 238-245.
Hindmarsh, J. J., & Estes, E. H. (1989). Falls in older persons: causes and interventions. Archives of Internal Medicine, 149(10), 2217-2222.
Ho, B., & Baumhauer, J. (2017). Hallux rigidus. EFORT open reviews, 2(1), 13-20.
Johanson, N. A., Liang, M. H., Daltroy, L., Rudicel, S., & Richmond, J. (2004). American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments: reliability, validity, and sensitivity to change. JBJS, 86(5), 902-909.
Kannus, P., Niemi, S., Sievanen, H., Korhonen, N., & Parkkari, J. (2016). Fall-induced fractures of the calcaneus and foot in older people: nationwide statistics in Finland between 1970 and 2013 and prediction for the future. Int Orthop, 40(3), 509-512. doi:10.1007/s00264-015-2875-7
Kaoulla, P., Frescos, N., & Menz, H. B. (2008). Development and validation of a Greek language version of the Manchester Foot Pain and Disability Index. Health and quality of life outcomes, 6(1), 39.
López, D. L., González, L. C., Iglesias, M. E. L., Canosa, J. L. S., Sanz, D. R., Lobo, C. C., & de Bengoa Vallejo, R. B. (2016). Quality of life impact related to foot health in a sample of older people with hallux valgus. Aging Dis, 7(1), 45.
Lopez, D. L., Callejo Gonzalez, L., Losa Iglesias, M. E., Canosa, J. L., Sanz, D. R., Lobo, C. C., & Becerro de Bengoa Vallejo, R. (2016). Quality of Life Impact Related to Foot Health in a Sample of Older People with Hallux Valgus. Aging Dis, 7(1), 45-52.
Marinozzi, A., Martinelli, N., Panascì, M., Cancilleri, F., Franceschetti, E., Vincenzi, B., . . . Denaro, V. (2009). Italian translation of the Manchester-Oxford Foot Questionnaire, with re-assessment of reliability and validity. Quality of Life Research, 18(7), 923-927.
Menz, H. B., Morris, M. E., & Lord, S. R. (2005). Foot and ankle characteristics associated with impaired balance and functional ability in older people. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(12), 1546-1552.
Menz, H. B., Morris, M. E., & Lord, S. R. (2006). Foot and ankle risk factors for falls in older people: a prospective study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(8), 866-870.
Mooyeon Oh-Park, Jonathan Kirschner, Dena Abdelshahed, Dennis DJ Kim(2019)
Painful Foot Disorders in the Geriatric Population: A Narrative Review
American Journal of Physical Medicine & Rehabilitation Articles
Oddis, C. V. (1996). New perspectives on osteoarthritis. The American journal of medicine, 100(2), 10S-15S.
Piraccini, B. M., & Alessandrini, A. (2015). Onychomycosis: A Review. J Fungi (Basel), 1(1), 30-43.
Riskowski, J. L., Hagedorn, T. J., & Hannan, M. T. (2011). Measures of foot function, foot health, and foot pain: American Academy of Orthopedic Surgeons Lower Limb Outcomes Assessment: Foot and Ankle Module (AAOS-FAM), Bristol Foot Score (BFS), Revised Foot Function Index (FFI-R), Foot Health Status Questionnaire (FHSQ), Manchester Foot Pain and Disability Index (MFPDI), Podiatric Health Questionnaire (PHQ), and Rowan Foot Pain Assessment (ROFPAQ). Arthritis Care Res (Hoboken), 63 Suppl 11, S229-239.
Sattin, R. W. (1992). Falls among older persons: a public health perspective. Annual review of public health, 13(1), 489-508.
Singh, D., Bentley, G., & Trevino, S. G. (1996). Fortnightly review: callosities, corns, and calluses. Bmj, 312(7043), 1403-1406.
Sothornwit, J., Srisawasdi, G., Suwannakin, A., & Sriwijitkamol, A. (2018). Decreased health-related quality of life in patients with diabetic foot problems. Diabetes, metabolic syndrome and obesity: targets and therapy, 11, 35.
Stamuli, E., Torgerson, D., Northgraves, M., Ronaldson, S., & Cherry, L. (2017). Identifying the primary outcome for a randomised controlled trial in rheumatoid arthritis: the role of a discrete choice experiment. J Foot Ankle Res, 10, 57.
Tak, S. H., & Laffrey, S. C. (2003). Life satisfaction and its correlates in older women with osteoarthritis. Orthopaedic Nursing, 22(3), 182-189.
Thomas, M. J., Roddy, E., Zhang, W., Menz, H. B., Hannan, M. T., & Peat, G. M. (2011). The population prevalence of foot and ankle pain in middle and old age: a systematic review.Pain, 152(12), 2870-2880.
Williams, A., & Bowden, A. (2004). Meeting the challenge for foot health in rheumatic diseases. The Foot, 14(3), 154-158.