臺灣博碩士論文加值系統

本研究的目的為探討頸部非器質性症狀與人格特質、心理健康之相關性。非器質性行為模式代表一些出現的症狀，其來源並非器官產生器質性變化而引發的症狀。有些頸部疼痛病患為何會出現不同程度之頸部非器質性症狀，是否與心理層面例如心理健康、焦慮、人格特質、生活品質有相關值得進一步探討。
研究方法方面，研究對象來自高雄醫學大學附設醫院復健科門診治療病人，病患頸部疼痛超過6個月，共52人（男性15人，女性37人）平均年齡44.25±14.64歲，範圍18-80歲。研究工具包括頸部非器質性症狀測試、艾氏人格問卷-成人精簡版(Eysenck Personality Quiestionnaire, EPQ)、華人健康問卷(Chinese Health Questionnair, CHQ-12) 世界衛生組織健康相關生活品質問卷簡明版-台灣版本（WHOQoL-BREF台灣版）、自我健康狀態量表(Short-form 36)及貝克焦慮量表(Beck Anxiety Inventory-BAI)。頸部非器質性症狀測試的方法分五大項七個測驗，五項內容為1. 觸痛反應包含輕觸疼痛 (superficial tenderness)和非解剖相關性疼痛(nonanatomy tenderness)、2.模擬測試(simulation)反應、3.關節活動度（range of motion）反應、4.區域性混亂(regional disturbance)反應，包括感覺下降(sensory loss)和肌力下降(motor loss)和5.過度反應(over reaction)。非器質性症狀測試七個測驗，若病患有出現反應，即出現症狀給一分，總分最高七分最低零分。研究內容包括測試頸部非器質性症狀測試施測者間信度研究和頸部非器質性症狀測試與各種心理健康量表之關係。
結果方面，頸部非器質性症狀測試之施測者間信度研究，七個測驗試施測者間一致性Kappa 數值介於0.37至0.85之間，總分之階級內相關係數ICC為0.90。非器質性症狀測試總分與焦慮分數最為相關(r=0.54，p<0.001)與華人健康問卷總分有關、 Short-form 36中之生理功能和一般健康狀況面向和生命力面向此三個面向、Short-form 36心理健康總分以及與WHOQoL-BREF中之心理健康範疇得分以及自我評定目前生活滿意程度有關(r 值介於-0.28至0.42, p值介於0.05至0.001)。若將非器質性症狀測試總分分為高分組(3-7分)與低分組(0-2分)，分析兩組心理健康情形差異性，貝克焦慮量表、Short-form 36中之一般健康面向和活力面向、世界衛生組織生活品質中之心理範疇範疇與生活品質的滿意程度兩組都有顯著統計上的差異(p<0.05)。
結論由信度分析結果，本研究之頸部非器質性症狀測試是可信的。頸部非器質性症狀測試主要與焦慮與自我評定目前健康生活滿意程度高度相關，越焦慮的病患其頸部非器質性症狀越多，自我認知健康生活品質越高則頸部非器質性症狀越少。臨床應用方面，頸部非器質性症狀的測試是一個可信的測試，可能提供了治療師瞭解病患心理狀況的簡易方法，可轉介病患做進一步的心理測試或需要不同專業的治療介入。

The “non-organic signs” is an illness behavior not related to an organic structure problem. Many chronic neck pain patients are afflicted with difference non-organic signs. What problems do these non-organic signs lead to? The relationship between the cervical non-organic signs and the psychological well-being need to be studied. The purpose of this study was to investigate the relationship between cervical non-organic signs and personality, psychological well-being in patients with chronic neck pain.
Method: Fifty-two chronic neck pain patients (male: 15, female: 37, mean age: 44.25±14.64，range :18-80 ) with symptoms persisted over 6 months duration were recruited to participate from Departments of Rehabilitation, Kaohsiung Medical University Hospital. The study’s instruments included Eysenck Personality Questionnaire, Chinese Health Questionnaire (CHQ), WHO Quality of Life- BREF Taiwan version (WHOQOL-BREF), Short-form 36 Taiwan version (SF-36), and Beck Anxiety Inventory (BAI) and the presence of non-organic signs in these patients. The examination of cervical non-organic signs included five dimensions and seven items. First dimension is tenderness response, which combine the testing of superficial tenderness and nonanatomy tenderness. Second dimension is simulation response. Third dimension is range of motion response. The fourth dimension is regional disturbance response, which combine the testing of the condition of sensory loss and motor loss. The fifth dimension is over-reaction response. If the symptom is presented, the positive response is recorded and the sum of symptom be scored. The pilot study was performed to attain the inter-rater reliability. After finishing the inter-rater reliability study, the relation of cervical non-organic signs, personality and psychological well-being was studied.
Inter-rater reliability of the assessment of the cervical non-organic signs was good. The Kappa value ranged from 0.37 to 0.85. The ICC value of the total score of the cervical non-organic sign was 0.90. The total score of cervical non-organic signs were significantly correlated with anxiety, CHQ, the physical function, vitality and general health dimensions of SF-36, the psychological summary score of SF-36, the psychological health dimension, and the question asked about the satisfying level of life at present from WHOQOL-BREF. The patients was divided into two groups with a cut-off score 2, one was higher score group (3-7) and the other was lower score group (0-2). The score of anxiety, the physical function and vitality dimension of SF-36, the psychological health dimension and the question asked about the satisfying level of life at present from WHOQOL-BREF were statistically significant difference between two groups (p<0.05).
In conclusion, the test of cervical non-organic sign is a reliable tool for physical therapists to evaluate the patients with chronic neck pain.. The cervical non-organic sign was highly correlated with anxiety and satisfaction level of life at present. The clinical implication is that the test of cervical non-organic signs gives more patient’s psychological information for therapist. Those patients with many cervical non-organic signs will be suggested for detail psychological tests and intervention by relevant discipline.

中文摘要………………….…………………………………………… I
英文摘要………………………………………………………………III
目次…………………………………………………………………….V
表目錄…………………………………………………………………VII
第一章 緒論
第一節 研究動機….………….……………………………......1
第二節 研究目的………………………………………………2
第二章 文獻回顧………………………………………………3
第三章 研究材料與方法
第一節 研究對象……..………………………………………13
第二節 研究工具……………………………………………..13
第三節 施測過程……………………………………………..22
第四節 統計分析……………………………………………..23
第四章 研究結果
第一節 施測者間信度先驅研究..…………………………..25
第二節 頸部非器質性症狀與人格特質及各種心理健康
量表之關係…………………………………………..26
第三節 頸部非器質性症狀高分組與低分組在人格特質、
各種心理健康量表與尋求相關醫療之差異情形….29
第五章 討論
第一節 頸部非器質性症狀之施測者間信度研究…………30
第二節 非器質性症狀測試與焦慮、與人格特質相關結果
之探討各種心理健康量表相關性 ..………………32
第三節 頸部非器質性症狀測試與SF36、WHOQoL內容
相關性之探討………………………………………34
第四節 非器質性症狀測試之高分或低分表現在各種心
理健康與尋求相關醫療之差異情形……….………35
第五節 研究限制與未來研究方向…………………………37
第六章 結論與建議..………………………..……………39
參考文獻…………………………………………………………41
表…………………………………………………………………45
附錄………………………………………………………………53

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姚開屏。台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊。2000,台灣版世界衛生組織生活品質問卷發展小組。