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研究生:鍾麗珊
研究生(外文):Li-Sann Choong
論文名稱:彼拉提斯運動介入於脊椎不適患者之療效研究
論文名稱(外文):Effectiveness of Individualized Pilates-evolved Motor Control Exercises on Subjects with Spinal Discomforts
指導教授:王子娟王子娟引用關係
指導教授(外文):Wendy Tzyy-Jiuan Wang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療暨輔助科技學系
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:2009
畢業學年度:97
語文別:英文
論文頁數:187
中文關鍵詞:彼拉提斯運動動作控制下背痛頸痛
外文關鍵詞:Pilatesmotor control exerciselow back painneck pain
相關次數:
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  • 下載下載:177
  • 收藏至我的研究室書目清單書目收藏:1
背景:頸痛與下背痛是最常造成個人與社會損失的肌肉骨骼疾病,也是導致工作失能的主因。大約有10-40%的脊椎疼痛病患會漸漸演變成慢性疼痛,復發的情形也很常見。這些慢性頸痛及下背痛病患的病因多被歸類為「不明原因」,他們的日常生活及活動似乎與一般人無異,可是疼痛高復發率卻是很常見的。脊椎穩定性運動,包括彼拉提斯 (Pilates) 運動在近年逐漸盛行於脊椎疾病的復健治療,其主要的目的是誘發核心肌群的控制,以及促進脊椎深層肌群與淺層肌群之間的平衡與協調,以達到最佳生活功能表現及減少疼痛。透過在器械上以及墊上的彼拉提斯動作控制運動訓練,以提升脊椎病患的功能表現、減少疼痛,並且避免疼痛及傷害的再發生。然而,彼拉提斯運動介入於脊椎病患的療效研究數量不多,所以實證不足。目的:(1)探討彼拉提斯運動於脊椎病患在軀幹耐力、軀幹柔軟度、頭部前凸姿勢、動作品質、功能表現、失能程度、疼痛以及整體自覺改善的療效;(2)追蹤兩個月後的療效;(3)探討彼拉提斯運動過程中以觸覺引導產生的額外治療效果。設計:隨機分組並追蹤兩個月之臨床實驗。方法:招募到的四十五名下背痛或頸痛患者被隨機分配到三組:(1) 觸覺加口頭指導彼拉提斯組 (TVPG) (n=15),(2) 口頭指導彼拉提斯組 (VPG) (n=15),(3) 控制組 (CG) (n=15)。TVPG和VPG各接受12次的個別化彼拉提斯運動治療;TVPG接受觸覺引導及口頭的彼拉提斯指導,而VPG僅接受口頭的指導;CG則沒有給予治療。三組在治療前、治療後以及治療完成兩個月後進行評估測量。 測量:客觀療效測量包括軀幹屈肌及伸肌四分鐘耐力測試 (trunk flexor & extensor 4-minute endurance test)、立姿體前彎柔軟度 (standing forward bend flexibility test)、站立頭部前傾角度 (standing forward head angle)、動作品質測試 (movement dysfunction test);主觀療效測量包括患者特殊功能量表 (patient-specific functional scale, PSFS)、頸痛失能量表 (neck disability index, NDI)、歐氏下背痛失能量表 (Oswestry disability index, ODI)、疼痛程度 (numeric rating scale, NRS) 以及整體自覺改善程度 (global rating scale, GRS)。 統計分析:結果採用二維重複變異數分析 (repeated measures ANOVAs)或二維重複共變數分析 (repeated measures ANCOVAs)來檢定組別與時間的交互作用,再利用事後檢定去比較組間及組內的差異 ,α值設定為小於0.05達統計顯著意義。 結果:三組之間的基本資料無顯著差異。比較三組間運動介入前和運動介入後,結果顯示兩組彼拉提斯運動治療組 (TVGP及VGP)的軀幹屈肌及伸肌耐力、立姿體前彎柔軟度、動作品質、功能表現、失能程度、疼痛以及整體自覺改善有顯著進步。三組間在兩個月追蹤的結果發現,兩組彼拉提斯治療組依然能夠維持軀幹屈肌及伸肌耐力、立姿體前彎柔軟度、動作品質、功能表現、失能程度、疼痛以及整體自覺改善顯著進步的表現。兩組彼拉提斯治療組在組內比較結果發現軀幹屈肌及伸肌耐力、立姿體前彎柔軟度、動作品質、功能表現、失能程度、疼痛以及整體自覺改善都是有顯著進步。然而,三組之間在頭部前凸角度的結果,不管在十二次治療後或兩個月後追蹤的結果都沒有發現顯著差異。控制組所有測試評估在組內或組間都沒有顯著改變。接受額外觸覺引導的TVPG組在動作品質的進步則比只接受口頭指導的VPG組顯著較佳。 結論:這是第一篇使用彼拉提斯器械Reformer和Trapeze Table執行動作控制運動介入於活動相關慢性下背痛及頸痛病患的療效研究。本研究發現十二次個別化彼拉提斯運動介入可以改善下背痛和頸痛患者的功能活動表現、體能表現以及動作品質、亦可減少疼痛;停止治療後進步的療效依然能夠維持兩個月。額外的觸覺引導可以使改善的動作品質有更持久的表現。 臨床意義:透過經彼拉提斯專業機構訓練認證並且具有骨科臨床經驗的物理治療師所施行的個別化彼拉提斯器械運動,對慢性下背痛和頸痛患者而言,是一項有效的運動治療。
Background: Neck pain (NP) and low back pain (LBP) are the most common spinal disorders which could result in huge personal & societal costs, and are major causes of work disability. About 10-40% of patients with spinal pain may become chronic. The majority of people with chronic LBP & NP are classified as “non-specific”, and this population is often considered normal but at a high risk of recurrences. Spinal stabilization exercises (including Pilates-evolved exercises) for the management of LBP and NP are gaining popularity in recent years. These exercises aim to correct the imbalances between the deep stabilizing muscles and their superficial mobilizing counterparts. Through task-specific training and full body movement integration of individualized Pilates-evolved exercises on apparatus and mat, patient-specific goals may be achieved and recurrences of spinal discomforts may be prevented. However, there are still insufficient evidences reported.
Purpose: (1) To determine the effectiveness of Pilates-evolved exercises on improving the trunk endurance, forward head posture, trunk flexibility, quality of movement, patient-specific functional status, disability level, pain and global perceived outcome for adults with spinal discomforts; (2) To determine the 2-month retention of treatment effect; (3) To investigate the additional effect of tactile guidance.
Study design: A randomized controlled trial design and a 2-month longitudinal follow-up study.
Methods: Forty-five subjects with neck or low back discomforts were randomized into 3 groups: (1) the control group (CG) (n=15), (2) the Pilates group with tactile plus verbal guidance, also named as tactile-enhanced group (TVPG) (n=15), and (3) the Pilates group with verbal guidance, also named as verbal-guided group (VPG) (n=15). Subjects of the two Pilates groups (TVPG and VPG) received 4 to 6 weeks (12 sessions) of an individualized Pilates-evolved motor control exercise training, which targeted to train the balance and coordination between the local deep and global superficial stabilizer systems for the spine. Subjects of the CG received no treatment. The initial evaluation and outcome assessment were scheduled at the beginning of the study as well as upon completion of the intervention and 2 months following intervention.
Outcome measures: Objective outcome included trunk flexor and extensor endurance, forward head angle, and standing forward bend flexibility, Movement Dysfunction Test. Subjective outcome included patient-specific functional scale, disability index, pain scale, and global perceived improvement scale.
Statistics analysis: Two-way repeated measures ANOVAs or ANCOVAs (using the baseline score as the covariate) were used to examine the group by time interaction. Post host tests were used for the between-group & within-group comparisons if a significant interaction was found (α<0.05).
Results: Both Pilates groups showed significant improvements in trunk flexor and extensor endurance, flexibility, quality of movement, Patient-Specific Functional Scale (PSFS), disability, pain and global perceived outcome from the baseline to 6 weeks after treatment, but no significant improvement was found in the change of the forward head angle. Upon completion of treatment, no statistical differences were found in all outcome measures between the tactile-enhanced group and the verbal-guided group. In follow-up analysis, both Pilates groups were able to maintain the significant improvement in trunk flexor and extensor endurance, flexibility, quality of movement, PSFS, disability, pain and global perceived outcome throughout the 2-month follow-up period. The CG showed no significant improvement in all outcome measures throughout the 3-month study period. The TVPG showed significantly better improvement in quality of movement as compared to the VPG and CG. No significant difference was found in forward head angle among three groups throughout the study period.
Conclusions: This is a pioneer study using a Movement Dysfunction Test to assess the effect of an individualized Pilates-evolved exercise program on the Pilates Reformer & Trapeze equipment to enhance motor control for people with activity-related back and neck pain. Patient-specific functional goals can be successfully achieved under an effective task-specific individualized Pilates program. Twelve sessions of individualized Pilates exercises demonstrated significant benefit in reducing pain and disability, improving function, physical fitness and quality of movement, and the effect could be maintained for at least 2 months after intervention. Additional tactile guidance can lead to longer effect on better quality of movement.
Clinical relevance: An individualized Pilates apparatus training program delivered by an experienced physical therapist with Pilates training background can be an effective exercise therapy approach for people with low back pain and neck pain.
TABLE OF CONTENTS i
ACKNOWLEDGEMENTS iv
LIST OF TABLES vi
LIST OF FIGURES ix
ABSTRACT xiii
Chapter 1 - INTRODUCTION 1
1.1 Background 1
1.2 Significance of the Study 2
1.3 Purposes 3
1.4 Hypotheses 3
Chapter 2 - LITERATURE REVIEW 5
2.1 Theory of Spinal Stability 5
2.2 Theory of Motor Learning 6
2.3 Motor Control Dysfunctions in the Presence of Low Back Pain or Neck Pain 9
2.4 Effects of Exercise Therapy for Low Back Pain or Neck Pain 10
2.5 Specific Spinal Stabilization Exercise / Motor Control Exercise 13
2.6 Pilates-evolved Motor Control Exercise 17
2.7 Current Clinical Studies of Pilates Exercises 20
2.8 Outcome Measures of Management for Spinal Pain 23
2.9 Clinical Assessment of Motor Control Dysfunction 25
2.10 Summary 29
Chapter 3 - METHODS 30
3.1 Study Design 30
3.2 Participants 30
3.2.1 Recruitment 30
3.2.2 Inclusion criteria 30
3.2.3 Exclusion criteria 31
3.3 Outcome Measurements and Testing Procedures 31
3.3.1 Objective outcome 31
3.3.2 Subjective outcome 37
3.4 Intervention 40
3.4.1 Instruments 42
3.4.2 Principles of intervention 42
3.4.3 Stages of intervention 43
3.5 Study Flow 45
3.6 Statistical Analysis 46
3.7 Preliminary Study 46
Chapter 4 - RESULTS 48
4.1 Demographic Data 48
4.2 Trunk Endurance Test 50
4.3 Standing Forward Head Angle 52
4.4 Standing Forward Bend Flexibility Test 53
4.5 Movement Dysfunction Test 54
4.6 Patient-Specific Functional Scale (PSFS) 58
4.7 Oswestry Disability Index (ODI) and Neck Disability Index (NDI) 59
4.8 Numeric Rating Pain Scales (NRS) 60
4.9 Global Rating Scale (GRS) 61
Chapter 5 - DISCUSSION 63
5.1 Improvement in Physical Fitness-related Outcome 64
5.2 Changes in Standing Forward Head Posture 65
5.3 Improvement in Quality of Movement 67
5.4 Improvement in Function and Disability 72
5.5 Reduction in Pain Intensity 75
5.6 Improvement in Global Perceived Improvement 76
5.7 Limitations 77
5.8 Future Studies 77
Chapter 6 - CONCLUSION 79
Chapter 7 - CLINICAL RELEVENCE 80
REFERENCES 81
APPENDICES 137
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