跳到主要內容

臺灣博碩士論文加值系統

(35.173.42.124) 您好!臺灣時間:2021/07/26 14:13
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:曾裕良
研究生(外文):Yuh-Liang Tseng
論文名稱:對徒手矯正療法有立即反應的機械性頸部疼痛患者之預後因子探討
論文名稱(外文):Prognostic Factors to Predict Immediate Respondents of Cervical Manipulation for Patients with Mechanical Neck Pain
指導教授:陳文英陳文英引用關係王子娟王子娟引用關係
指導教授(外文):Wen-Yin ChenTzyy-Jiuan Wang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:英文
論文頁數:117
中文關鍵詞:預後因子頸椎徒手矯正療法機械性頸部疼痛臨床預測準則
外文關鍵詞:prognostic factorcervical manipulationmechanical neck painclinical prediction rule
相關次數:
  • 被引用被引用:1
  • 點閱點閱:215
  • 評分評分:
  • 下載下載:34
  • 收藏至我的研究室書目清單書目收藏:0
研究背景:頸部疼痛是種常見且對生活品質,乃至社會整體有著重大影響的健康問題。大多數的頸部疼痛通常無特定或可辨識之病因,而被診斷為機械性頸部疼痛。頸椎徒手矯正療法雖已廣被認為可有效地治療機械性頸部疼痛,然而治療效果並非適用於所有的頸部疼痛病患。這可能是由於缺乏足夠的預後因子資訊所致。回顧過去文獻,少有述及使用包涵頸椎徒手矯正療法等特定治療技術,在治療機械性頸部疼痛之預後因子的探討。因此,本研究之目的為從機械性頸部疼痛病患中,找出對於頸椎徒手矯正療法有良好立即反應之預後因子。材料與方法:本研究為前瞻性、單一族群研究設計;共一百位機械性頸部疼痛病患參與本研究。其人口學資料、病史、症狀加劇與減輕因子、身體負荷因子、疼痛與失能狀況、心理社會因子等藉由訪談調查收集。並由研究者執行一系列之頸部理學檢查包括頸椎關節活動度、頭前傾評估、壓迫測試、牽拉測試、頸椎側滑測試、環椎樞椎旋轉測試、第一肋骨升高測試、上肢張力測試、頸椎短屈肌耐力測試等。患者接受一次頸椎徒手矯正後評估其疼痛改善程度、整體自覺改善、及病患滿意度。只要滿足其中任一療效條件者則判定為對於治療有立即療效者,反之則否。統計上先使用獨立t考驗與卡方測試來評估兩組間人口學資料、症狀、疼痛與失能狀況、心理社會等因子之差異;並以接受者操作特質曲線決定連續變項之二分臨界點。最後以逐步多變項羅吉斯分析辨識有立即療效者之預測模式中的顯著預後因子。並且計算所有潛在預後因子與預測模式各個階層的精確度分析包括敏感性、特異性、正向可能性比率、預測後徒手矯正治療成功率以評估預測力強度。結果:在預測有立即療效者模式中,辨識出六項顯著預後因子—頸部失能量表得分少於11.50分、兩側出現症狀、非久坐式工作型態、移動頸部可使症狀減輕、頸椎後仰時症狀不會加劇、診斷為頸椎關節退化但未壓迫到神經;此預測模式校正後之R平方值為0.50。當六項預後因子中具有四項以上時,對於徒手矯正療法產生立即療效反應的機率可由60%提升至90%。結論:本研究辨識出六項預後因子,可在評估頸部病患時,作為預測頸椎徒手矯正療法立即療效的參考。在選擇治療方式前,使用本研究辨識出的預後因子與預測模式應可增進臨床決策的效率與正確性。
Background. Mechanical neck pain is a common problem with great impact on the quality of life and the society as a whole. Cervical manipulation has been considered an effective treatment for managing mechanical neck pain. However, clinical observation showed that cervical manipulation was not effective for every patient with mechanical neck pain. Development of clinical prediction rules for identifying patients with mechanical neck pain who are likely to respond to cervical manipulation, may improve the treatment success rate. Literature contains insufficient information addressing the prognostic factors related to cervical manipulation treatment for mechanical neck pain. Therefore, the purpose of the study was to identify the prognostic factors to predict immediate respondents of cervical manipulation for patients with mechanical neck pain. Materials and Methods. This study was a prospective cohort trial. One hundred patients with mechanical neck pain participated in the study. Their demographic data, health and illness related data, symptom aggravating or easing factors, physical loading factors, pain and disability level, and psychosocial status were obtained through an interview. A series of physical examinations was also administered. After receiving a cervical manipulation, responsiveness to treatment was determined by the criteria of improvement seen in one of the three outcome variables that include pain intensity, general perceived improvement, and patient satisfaction. Independent t tests and Chi-square tests were used to assess the differences between the treatment respondents and nonrespondents. Stepwise multiple logistic regression analyses were used to identify significant prognostic factors for classifying respondents and nonrespondents. Results. Six symptom and diagnosis-related factors including “initial scores on Neck Disability Index < 11.50”, “having bilateral involvement pattern”, “not performing sedentary work > 5 hr/day”, “feeling better while moving the neck”, “without feeling worse while extending the neck”, and “the diagnosis of spondylosis without radiculopathy” were identified to significantly predict the immediate respondents of cervical manipulation. The adjusted R2 for this model was 0.50. The presence of four of these six predictors increased the probability of success with manipulation from 60% to 90%. Conclusion. Dramatic increase of the probabilities of successful cervical manipulation was revealed if we use the prediction model to identify treatment respondents before administering cervical manipulations. This study finding may enhance the efficacy of clinical decision-making in using cervical manipulation intervention.
References:
1. Borghouts JAJ, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain 1998;77:1-13.
2. Hagberg M, Wegman DH. Prevalence rates and odds ratios of shoulder-neck diseases in different occupational groups. Br J Ind Med 1987;44:602-610.
3. Lau EMC, Sham A, Wong KC. The prevalence of and risk factors for neck pain in Hong Kong Chinese. J Public Health Med 1996;18:396-399..
4. Mekela M, Heliovaara M, Sievers K, Impivaara O, Knekt P, Aromaa A. Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol 1991;23:127-133.
5. Cote P, Cassidy JD, Carroll L. The Saskatchewan health and back pain survey: the prevalence of neck pain and related disability in Saskatchewan adults. Spine 1998;23:1689-1698.
6. Ariens GAM, van Mechelen W, Bongers PM, Bouter LM, van der Wal G. Physical risk factors for neck pain. Scand J Work Environ Health 2000;26:7-19.
7. Croft PR, Lewis M, Papageoriou AC, Thomas E, Jayson MIV, Macfarlane GJ, et al. Risk factors for neck pain: a longitudinal study in the general population. Pain 2001;93:317-325.
8. Swezey RL. Chronic neck pain. Rheum Dis Clin North Am 1996;22:411-437.
9. Bogduk N. Neck pain: an update. Aust Fam Physician 1988;17:75-80.
10. Bogduk N, Marsland A. The cervical zygapophyseal joints as a source of neck pain. Spine 1988;13:610-617.
11. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns I: a study in normal volunteers. Spine 1990;15:453-461.
12. Connel MD, Wiesel SW. Natural history and pathogenesis of cervical disk disease. Orthop Clin North Am 1992;23:369-80.
13. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine: a systematic review of the literature. Spine 1996;21:1746-1760.
14. Gross AR, Kay T, Hondras M, Goldsmith C, Haines T, Peloso P, et al. Manual therapy for mechanical neck disorders: a systematic review. Man Ther 2002;7:131-149.
15. DiFabio RP. Manipulation of the cervical spine: risks and benefits. Phys Ther 1999;79:50-65.
16. Pikula JR. The effect of spinal manipulative therapy (SMT) on pain reduction and range of motion in patients with acute unilateral neck pain: a pilot study. J Can Chiropr Assoc 1999;43:111-119.
17. Cassidy JD, Lopes AA, Hong-Hing K. The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: a randomized controlled trial. J Manip Physiol Ther 1992;15:570-575.
18. Vernon HT, Aker P, Burns S, Viljakaanen S, Short L. Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study. J Manip Physiol Ther 1990;13:13-16.
19. Rogers RG. The effects of spinal manipulation on cervical kinesthesia in patients with chronic neck pain: a pilot study. J Manip Physiol Ther 1997;20:80-85.
20. Jordan A, Bendix T, Niesen H, Hansen FR, Winkel A. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: a prospective, single-blinded, randomized clinical trial. Spine 1998;23:311-319.
21. Bronfort G, Evan R, Nelson B, Aker PD, Goldsmith CH, Vernon H. A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 2001;26:788-799.
22. Evans R, Bronfort G, Nelson B, Goldsmith CH. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine 2002;27:2383-2389.
23. Shekelle PG, Coulter I. Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel. J Spinal Disord 1997;10:223-228.
24. Kjellman G, Skargren E, Oberg B. Prognostic factors for perceived pain and function at one-year follow-up in primary care patients with neck pain. Disabil Rehabil 2002;24:364-370.
25. Skargren EI, Oberg BE. Predictive factors for 1-year outcome of low-back and neck pain in patients treated in primary care: comparison between the treatment strategies chiropractic and physiotherapy. Pain 1998;77:201-207.
26. Ombregt L, Bisschop P, ter veer HJ, van de Velde T. A System of Orthopaedic Medicine. Philadelphia: WB Sauders; 1995.
27. April C, Bugduk N. The prevalence of cervical zygapophyseal joint pain: a first approximation. Spine 1992;17:744-747.
28. Murtagh J, Kenna C. Back Pain and Spinal Manipulation. 2nd ed. Singapore: Butterworth-Heinemann; 1997.
29. Heller JG. The syndromes of degenerative cervical disease. Orthop Clin North Am 1992;23:381-384.
30. Ahlgren BD, Garfin SR. Cervical radiculopathy. Orthop Clin North Am 1996;27:253-263.
31. Giles LGF. Mechanisms of neurovascular compression within the spinal and intervertebral canals. J Manip Physiol Ther 2000;23:107-111.
32. McCormack BM, Weinstein PR. Cervical spondylosis – an update. West J Med 1996;165:43-51.
33. Schneider MJ. Tender points/fibromyalgia vs. trigger points/myofascial pain syndrome: a need for clarity in terminology and differential diagnosis. J Manip Physiol Ther 1995;18:398-406.
34. Friction JR. Myofascial pain of the head and neck: diagnosis and management. J Back Musculoskeletal Rehabil 1996;6:177-194.
35. Gull GA. Cervical headache: a review. In: Boyling JD and Palastanga N, editors. Grieve’s Modern Manual Therapy. 2nd ed. London: Churhill Livingstone; 1994.
36. Alix ME, Bates DK. A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscles. J Manip Physiol Ther 1999;22:534-539.
37. Leone M, D’Amico D, Grazzi L, Attanasio A, Bussone G. Cervicogenic headache: a critical review of the current diagnostic criteria. Pain 1998;78:1-5.
38. Sjaastad O, Fredriksen T, Pfafferanth V. Cervicogenic headache: diagnostic criteria. Headache 1990;30:725-726.
39. Robert C. Fundations for Osteopathic Medicine. 2nd ed. Philadelphia:Lippincott Williams and Wilkins; 2003.
40. Peterson DH, Bergmann TF. Chiropractic Technique: Principles and Procedures. 2nd ed. St. Louis: Mosbi, Inc; 2002.
41. Maitland GD, Banks K, English K, Hengeveld E. Maitland’s Vertebral Manipulation. 6th ed. Oxford: Butterworth-Heinemann; 2001.
42. Lewit K. Manipulative Therapy in Rehabilitation of the Locomotor System. 3rd ed. Oxford: Butterworth-Heinemann; 1999.
43. Kaltenborn FM. The Spine: Basic Evaluation and Mobilization Techniques. 2nd ed. Minnesota: Olaf Norlis Bokhandel, 1993.
44. Greenman PE. Principles of Manual Medicine. 2nd ed. Baltimore: Williams and Wilkins; 1996.
45. Evans DW. Mechanism and effects of spinal high-velocity, low-amplitude thrust manipulation: previous theories. J Manip Physiol Ther 2002:25:251-262.
46. Pickar JG. Neurophysiological effects of spinal manipulation. Spine J 2002;2:357-371.
47. Bolton PS. Reflex effects of vertebral subluxations: the peripheral nervous system. An update. J Manip Physiol Ther 2000;23:101-103.
48. Budgell BS. Reflex effect of subluxation: the automonic nervous system. J Manip Physiol Ther 2000;23:104-106.
49. Haldeman S. Neurologic effects of the adjustment. J Manip Physiol Ther 2000;23:112-114.
50. Brodeur R. The audible release associated with joint manipulation. J Manip Physiol Ther 1995;18:155-164.
51. Mann T, Refshauge KM. Causes of complications from cervical spine manipulation. Aust J Physiother 2001;47:255-266.
52. Coulter ID. Effacacy and risks of chiropractic manipulation: what does the evidence suggest? Int Med 1998;1:61-66.
53. Michaeli A. Dizziness testing of the cervical spine: can complications of manipulation be prevented? Physiother Theory Pract 1991;7:243-250.
54. Rivett DA, Milburn P. A prospective study of complications of cervical spine manipulation. J Man Manip Ther 1996;4:166-170.
55. Sloop PR, Smith DS, Goldenberg E, Dore C. Manipulation for chronic neck pain: a double-blind controlled study. Spine 1982;7:532-535.
56. Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J 2004;4:335-356.
57. Atchison JW. Manipulation efficacy: upper body. J Back Musculoskeletal Rehabil 2000;15:3-15.
58. Whittingham W, Nilsson N. Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil). J Manip Physiol Ther 2001;24:552-555.
59. Nordemar R, Thorner C. Treatment of acute cervical pain – a comparative group study. Pain 1981;10:93-101.
60. Hermanek P. Prognostic factor research in oncology. J Clin Epidemiol 1999;52:371-374.
61. Flynn T, Fritz J, Whitman J, Wainner R, Magel J, Rendeiro D, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine 2002;27:2835-2843.
62. Lanier DC, Stockton P. Clinical predictors of outcome of acute episodes of low back pain. J Fam Pract 1988;27:483-489.
63. Leclerc A, Niedhammer I, Landre MF, Ozguler A, Etore P, Pietri-Taleb F. One–year predictive factors for various aspects of neck disorders. Spine 1999;24:1455-1462.
64. Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atchison LE, et al. The prediction of chronicity in paitients with an acute attack of low back pain in a general practice setting. Spine 1995;20:478-484.
65. Eriksen W, Natvig B, Knardahl B, Bruusgaard D. Job characteristics as predictors of neck pain: a 4-year prospective study. J Occup Environ Med 1999;41:893-901.
66. Viikari-Juntura E, Martukainen R, Luukkonen R, Mutanen P, Takala EP, Riihimaki H. Longitudinal study on work related and individual risk factors affecting radiating neck pain. Occup Environ Med 2001;58:345-352.
67. Fredriksson K, Alfredsson L, Koster M, Thorbjornsson CB, Toomingas A, Torgrn M, et al. Risk factors for neck and upper limb disorders: results from 24 years of follow up. Occup Environ Med 1999;56:59-66.
68. Ariens GAM, Bongers PM, Douwes M, Miedema MC, Hoogendoorn WE, van der Wal G, et al. Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study. Occup Environ Med 2001;58:200-207.
69. Singer J, Gilbert JR, Hutton T, Taylor DW. Predicting outcome in acute low back pain. Can Fam Physician 1987;33;655-659.
70. Cherkin DC, Deyo RA, Street JH, Barlow W. Predicting poor outcomes for back pain seen in primary care using patient’s own criteria. Spine 1996;21:2900-2907.
71. Coste J, delecoeuillerie G, DeLara AC, LeParc JM, Paolaggi JB. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice. Br Med J 1994;308:577-580.
72. Chou YC. The additional effect of a neck class on subjects with neck pain [thesis]. Taipei: National Yang-Ming Univ.; 2003.
73. Stratford PW, Binkley JM, Riddle DL. Healthe status measures: strategies and analytic methods for assessing change scores. Phys Ther 1996;76:1109-1123.
74. Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manip Physiol Ther 1991;14:409-415.
75. Chan DW, Chan TSC. Reliability, validity and the structure of the General Health Questionnaire in a Chinese context. Psychol Med 1983;13:363-371.
76. Chan DW. The Chinese version of the General Health Questionnaire: does language make a difference? Psychol Med 1985;15:147-155.
77. Chong MY, Wilkinson G. Validation of 30- and 12-item versions of the Chinese Health Questionnaire (CHQ) in patients admitted for general health screening. Psychol Med 1989;19:495-505.
78. Chen CS, Tsang HY, Chong MY, Tang TC. Validation of the Chinese Health Questionnaire (CHQ-12) in community elders. Kaohsiung J Med Sci 2000;16:559-565.
79. Gemmell HA, Hayes BM. Patient satisfaction with chiropractic physicians in an independent physician’s association. J Manip Physiol Ther 2001;24:556-559.
80. Youdas JW, Carey JR, Garrett TR. Reliability of measurement of the cervical spine range of motion — comparison of three methods. Phys Ther 1991;71:98-106.
81. Garrett TR, Youdas JW, Madson TJ. Reliability of measuring forward head posture in a clinical setting. J Orthop Sport Phys Ther 1993;17:155-160.
82. Magee DJ. Orthopedic physical assessment. 3rd ed. Philadelphia: WB Sauders; 1997.
83. Butler DS. Mobilization of the Nervous System. Melbourne: Churchill Livingstone; 1991.
84. Grimmer K. Measuring the endurance capacity of the cervical short flexor muscle group. Cephalalgia 1994;40:251-254.
85. Tseng YL, Wang TJ, Chen WY, Yen LL. Reliability of physical examinations in cervical spine. FJPT 2003;28:333-340.
86. Viikari-Juntura E. Interexaminer reliability of observations in physical examinations of the neck. Phys Ther 1987;67:1526-1532.
87. Wainner LRS, Fritz JM, Irrgang JJ, Boninger ML, Dellito A, Allison CS. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003;28:52-62.
88. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. New Jersey: Prentice-Hall; 2000.
89. Fagan TJ. Nomogram for Bayes theorem. N Engl J Med 1975;293:257.
90. Sackett DL. A primer on the precision and accuracy of the clinical examination. JAMA 1992;267:2638-2644.
91. Buckle P. Upper limb disorders and work: the importance of physical and psychosocial factors. J Psychosom Res 1997;43:17-25.
92. Hagberg M. ABC of work related disorders: neck and arm disorders. Br Med J 1996;313:419-422.
93. Janda V. Muscle imbalance. In: Rehabilitation of the Spine: A Practitioner’s Manual. Libenson C, editor. Baltimore: Williams and Wilkins; 1996.
94. McKenzie RA. The Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy. Waikanae: Spinal Publications (N.Z.) LTD; 1990.
95. Dujardin B, van den Ende J, Gompel AV et al. Likelihood ratios: a real improvement for clinical decision making? Eur J epidemiol 1994;10:29-36.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top