臺灣博碩士論文加值系統

摘要
妊娠婦女在懷胎期間會受到體重變化、肌肉骨骼系統改變及重心位置改變，而導致下背疼痛、足底壓力提高、跌倒等狀況，尤其在第三孕期更為明顯。足弓被認為是走路時減震、平衡的足部主要結構，隨著足弓高度下降，將會造成身體不穩定度、不正常壓力集中並造成後續許多問題產生，而足弓墊被認為可以支撐足弓，防止足部塌陷，提供良好的穩定度。因此，本研究實驗目的將探討足弓型鞋墊對於第三孕期婦女平衡、足底壓力、疼痛之效益。
本研究招募40位第三孕期低足弓懷孕婦女，並分為足弓型鞋墊組(實驗組)及一般鞋墊組(對照組)進行實驗，觀察兩組的靜態平衡、步行足底壓力峰值以及疼痛指數是否在鞋墊介入前後有顯著差異，本實驗以二因子混和設計變異數分析進行資料處理，顯著水準為α=0.05。
實驗結果顯示，實驗組在閉眼站立平衡測試中，穿鞋墊後內外位移量有顯著減少(p=0.009)，並減少了未穿鞋墊的位移量之30%，顯示實驗組介入後有較佳的穩定度，而在足底壓力峰值測試中則發現實驗組穿鞋墊後大拇指區(p=0.005)及內側中足區(p=0.049)顯著減少，下背疼痛指數在實驗組也可看出鞋墊介入後有顯著的下降(p=0.041)，而對照組在所有項目中前後測皆無顯著差異。
因此，根據本研究的分析發現，穿著足弓支撐型鞋墊可以有效提升站立時閉眼的靜態平衡，增進踝關節內外側之穩定度及本體感，而實驗組鞋墊對於足底內側壓力過大之現象有減緩之效果，達到平均分散壓力目的，另外也發現在穿著鞋墊後兩周，下背疼痛也得到改善，顯示提供良好支撐性可以減緩下背痛的程度。

Pregnant women are suffered from low back pain, higher plantar pressure and fall due to rapid weight gain, change of center of gravity and change of musculoskeletal system, especially in third trimester. Foot arch are regarded a main structure of foot to absorb shock and keep balance. When foot arch height become lower, it may cause posture instability and abnormal distribution of planter pressure. If they ignore this issue, the problems will become more and more heavily. A foot arch-support insole could resist depression of foot arch and provide adequate stability to help ankle motion. Thus the purpose of this study was to investigate the efficacy of arch-support design insoles on balance and gait plantar pressure in pregnant women during third trimester.
Forty women in third trimester of pregnancy with flatfoot were recruited in this study. They were randomly assigned to arch-support group (experimental group) and normal design group (control group). Both groups were accepted collection of demographic data, static balance test, Times Up and Go test, plantar pressure test in walking and pain scale questionnaire. All tests included non-insole and wearing insole situation. The measured data analyzed by two-way mixed Analysis of variance. The SPSS 24.0 was used for statistical analysis and p value of 0.05 was considered to be significant.
Result showed the experiment group had significantly lower COP excursion in M-L direction when eye-closed (p=0.009), plantar pressure in first toe (p=0.005) and medial side of middle foot (p=0.041) between pre-test and post-test. The low back pain scale was significantly decreased in experiment group (p=0.041).Control group had no any difference between pre-test and post-test.
The women in Third Trimester of Pregnancy with arch-support insoles could help static balance in the darkness, decrease abnormal plantar pressure and reduce low back pain.

誌謝 I
摘要 II
Abstract III
目錄 V
圖目錄 VIII
表目錄 IX
第壹章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究假設 3
第四節 研究範圍與限制 4
第五節 研究重要性 4
第六節 操作型定義 5
第貳章 文獻探討 8
第一節 肌肉骨骼系統改變 8
一、身體姿態及構造改變 8
二、足弓變化及影響 10
三、低足弓 11
四、足步型態檢查與評估方式 12
第二節 妊娠與平衡改變 14
一、平衡評量 14
二、妊娠與平衡變化 15
三、鞋墊對於平衡之探討 17
第三節 妊娠與足底壓力探討 19
一、足底壓力介紹 19
二、足底壓力與疼痛 20
三、鞋墊對於足底壓力之探討 22
第四節 本章總結 23
第參章 研究方法 24
第一節 研究對象 24
第二節 實驗儀器與設備 25
一、鞋子 25
二、Footdisc鞋墊 25
三、熱感式型量測器型量測器 27
四、電子足部壓力測試器 27
五、 Novel Pedar 鞋墊式足底壓力量測系統 28
第三節 實驗流程及評估項目 29
一、基本問卷 30
二、足型量測及判別 30
三、步態足壓測量 31
四、靜態平衡測試 32
五、計時起走測試 32
第四節 資料處理 33
第肆章 結果 34
第一節 受試者基本資料 34
第二節 平衡表現 35
第三節 足底壓力峰值測試 38
第四節 數字疼痛量表(Numerical Rating Scale) 42
第伍章 討論 45
第一節 介入足弓支撐型鞋墊對平衡能力之影響 45
第二節 介入足弓支撐型鞋墊對足底壓力峰值之影響 46
第三節 介入足弓支撐型鞋墊對疼痛之影響 48
第陸章 結論及建議 49
參考文獻 50
外文部分 50
中文部分 54
附錄一、受試者須知 56
附錄二、基本問卷調查 57
附錄三、疼痛量表問卷 58
圖目錄
第壹章
圖1- 1 Pedar 鞋墊分區圖 6
第貳章
圖2- 1妊娠身體變化 9
圖2- 2足弓高度 10
圖2- 3足弓介紹 11
圖2- 4扁平足外觀示意圖 12
圖2- 5 AI值計算方法 13
圖2- 6壓力中心移動路徑及橢圓面積 15
圖2- 7平衡策略 16
圖2- 8下肢代償 21
第參章
圖3- 1實驗鞋 25
圖3- 2鞋墊設計圖 26
圖3- 3熱感式型量測器型量測器 27
圖3- 4 電子足部壓力及平衡測試器 28
圖3- 5 PEDAR圖 28
圖3- 6實驗流程圖 29
圖3- 7 foot type index 31
第肆章
圖4- 1閉眼左右位移兩組之比較 37
圖4- 2大拇指壓力峰值兩組比較 40
圖4- 3內側中足壓力峰值兩組比較 40
圖4- 4實驗組鞋墊介入前後之第一拇趾壓力與步態示意圖 41
圖4- 5實驗組鞋墊介入前後之整體壓力峰值與步態示意圖 41
圖4- 6下背疼痛指數兩組比較 43
圖4- 7行走時不適兩組比較 44

表目錄
第壹章
表1- 1孕期體重增加指引 5
第參章
表3- 1科技鞋墊材質 26
第肆章
表4- 1受試者基本資料 34
表4- 2 COP之前後位移量(A-P)比較 35
表4- 3 COP之左右位移量(M-L) 36
表4- 4計時起走測試 37
表4- 5足底壓力各區峰值 39
表4- 6數字疼痛量表 43

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