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研究生:林錚苑
研究生(外文):Lin,Cheng-Yuan
論文名稱:使用芳香療法緩解社區老人膝關節疼痛之成效探討─隨機對照實驗研究
論文名稱(外文):Effects of using aromatherapy to relieve knee pain for the elders in community: A randomized controlled trial
指導教授:張李淑女張李淑女引用關係
指導教授(外文):Chang Lee,Shu-Nu
口試委員:歐明秋張李淑女謝嫣娉
口試委員(外文):Ou,Ming-ChinChang Lee,Shu-NuHsieh, Yen-Ping
口試日期:2012-06-25
學位類別:碩士
校院名稱:亞洲大學
系所名稱:健康產業管理學系長期照護組
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:117
中文關鍵詞:芳香療法骨關節炎膝關節疼痛隨機對照分派實驗
外文關鍵詞:Osteoarthritisknee painaromatherapyrandomized controlled trial (RCT)
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研究背景: 骨關節炎為造成老人失能之重要原因,膝關節疼痛為老人最常主訴之疼痛部位,且多數患者仰賴社區中的照顧。近年芳香療法逐漸被應用於健康照護領域,但是,在廣泛的接受並應用芳香療法為社區老人疼痛問題的輔助療法之前,我們仍需要更多的實證研究來確認其效用。
研究目的:本研究目的在於探討社區中具膝蓋關節疼痛的老人塗抹複方芳香保健精油與嬰兒油後疼痛的緩解程度。
研究方法:本研究針對中部三個社區中具膝關節疼痛困擾之老人,採隨機對照分派實驗研究(Randomized controlled trial,RCT)將受試者老人分實驗組(N=41人)以複方芳香保健精油及對照組(N=40人)嬰兒油塗抹,並以The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)與Pain of Visual analog scale (VAS)量表,評估介入後老人關節疼痛感之差異程度。
研究結果:分析結果顯示30分鐘介入前後,在VAS分數下降程度,兩組皆達顯著水準(p<0.005),但在活動時的疼痛分數評估實驗組下降程度則明顯優於對照組(p<0.001;p<0.005)。顯示塗抹複方芳香精油對關節活動時的疼痛減輕程度較塗抹嬰兒油顯著。在WOMAC量表測量分數,於連續兩個月的介入,兩組下降皆達顯著水準(p<0.001),但是在介入一個月時,不論在疼痛度、僵硬度以及生活功能,實驗組的成效皆明顯優於對照組(p<0.001;p<0.05),顯示兩組皆有改善疼痛效果,但是塗抹複方芳香保健精油的成效更為顯著。
結論與建議:此研究結果顯示複方芳香保健精油塗抹確實可緩解社區老人關節疼痛與不適感。長期使用複方芳香保健精油或嬰兒油塗抹關節疼痛處皆能降低關節疼痛感,但是塗抹具關節止痛、抗發炎配方的複方芳香保健精油則止痛效果較顯著且持續使用的效果也較顯著。此結果對長期受關節疼痛困擾患者有極大貢獻。

Background: Osteoarthritis is a common cause of disability in older adults, and the knee was the most commonly reported site of pain complaints. Most patients with the condition will be managed in the community. Recently aromatherapy has been gradually prevailed in healthcare system; however, more research is needed before aromatherapy becomes a widely accepted alternative remedy.
Aim: This study was aim to investigate the effects of aromatherapy to relieve the knee pain for the elders in community.
Methods: This study was carried out in three communities. A single-blind, placebo-controlled randomized study was conducted to evaluate the effects of aromatherapy to relieve the knee pain for the elders in community. A total of 81 elders with knee pain were randomly allocated to 2 groups, 41 in experimental group and 40 in the control (placebo) group. No significant differences in demographics and health conditions between two groups were noted. For the elders in experiment group we anointed essential oil on their knee twice a week for 8 weeks. For the elders in control group, we anointed baby oil with no essential oil on their knee also twice a week for 8 weeks. Outcome measures included a Visual Analogue Scale (VAS) of pain intensity and the Western Ontario and McMaster universities (WOMAC) osteoarthritis index of pain, disability and joint stiffness in knee.
Results: The mean scores of VAS decreased significantly by 30 minutes after the first intervention in both groups (p <0.005) and sustained throughout every intervention. However, the amelioration of pain during activity was significantly more prominent in the experimental group comparing with that in the controls (p < 0.001). The scores in WOMAC were also reduced significantly at 1 and 2 months (p < 0.001) in both groups. Nevertheless, in first month of intervention, the scores of pain, stiffness and motor disturbance in experimental group were reduced much more remarkably as compared with placebo group (P < 0.01, P < 0.05).
Conclusion: Positive effects with both groups were observed. Moreover, the beneficial long-term effects on knee pain with aromatherapy appeared to be sustained. In conclusion, aromatherapy can significantly relieve the knee pain for the elders in community.
中文摘要
Abstract
目 錄 i
表 目 錄 iv
圖 目 錄 v
第壹章 緒 論 1
第一節 研究背景 2
第二節 研究動機 4
第三節 研究目的 6
第貳章 文獻查證 7
第一節 骨關節炎 7
壹、 臨床表徵 8
貳、 診斷檢查 8
叁、 治療與處置 9
第二節 慢性疼痛與輔助替代性補充療法 12
壹、 慢性疼痛 12
貳、 輔助與替代性補充療法(Complementary and Alternative Medicine,CAM) 13
第三節 芳香療法(Aromatherapy)的整體療癒性 15
壹、 芳香療法的定義 15
貳、 芳香療法在台灣與貴族療法的迷思: 16
叁、 人工合成香精油的缺點 18
第四節 芳香精油(Essential oil)的本質定義 19
壹、 芳香物質與精油組成成份分析 20
貳、 精油的作用途徑 21
叁、 相關精油查證 23
肆、 精油的毒性及使用濃度與禁忌 26
第五節 芳香療法運用在老人與疼痛照護的實證研究 28
壹、 芳香療法與老人照護 28
貳、 芳香療法運用於慢性疼痛之研究 30
第叁章 研究方法 33
第一節 研究假說 33
第二節 研究架構 34
第三節 研究對象與樣本 35
壹、 研究對象(參與者) 35
貳、 研究樣本數 35
第四節 研究設計 37
壹、 研究場所 37
貳、 研究步驟與流程 37
叁、 工具測量的時間與次數分配 39
肆、 研究流程 40
第五節 研究測量工具及信效度 44
壹、 個人基本資料 44
貳、 Pain of Visual Analogue Scale ,VAS (疼痛視覺模擬十分量表) 44
參、 The Western Ontario and McMaster Universities Osteoarthritis Index ,WOMAC 45
肆、 操作型定義 47
第六節 人體實驗之研究倫理 51
壹、 自主性與知情同意 51
貳、 穩私與保密性 52
叁、 可能傷害及處理 52
第七節 資料處理與統計分析方法 53
壹、 描述性統計 53
貳、 推論性統計 53
第肆章 研究結果 55
第一節 研究對象基本屬性分布情形 55
第二節 實驗介入前兩組疼痛指數(Baseline)的之差異比較與分布情形 59
第三節 VAS量表分數的兩組差異比較 62
第四節 WOMAC疼痛指數的兩組平均分數差異獨立t檢定 64
第五節 兩組組內之VAS疼痛指數前後測量差異比較 66
第六節 兩組老人WOMAC疼痛指數前後測量之成對樣本t檢定 69
第伍章 討論 73
第一節 社區健康老人膝關節疼痛程度與治療情形之討論 74
第二節 塗抹複方芳香保健精油緩解膝關節疼痛感成效之討論 75
壹、 安慰劑效應(placebo effect): 79
貳、 親密性的接觸帶來的腦內啡之生成: 80
叁、 共同空間內吸聞精油所帶來的成效: 81
第四節 芳香療法落實於長期照護之可近性討論 82
第陸章 結論與建議 84
第一節 結論 84
第二節 研究限制與建議 86
壹、 研究對象的限制 86
貳、 收案期間的限制與樣本數 86
叁、 人力上的限制: 87
肆、 研究場所的限制 87
伍、 芳香療法的專業性使本研究無法進行雙盲研究 87
陸、 受試者年齡較高者,教育程度低 88
第六節 芳香照護在長期照護領域的應用建議 89
壹、 長期照護實務的建議 89
貳、 未來研究者的建議 90
叁、 長期照護政策的建議 90
第柒章 參考文獻 92
中文文獻 92
英文文獻 96
附錄一、 IRB人體實驗倫理審查委員會申請書 105
附錄二、 研究說明暨參與同意書 106
附錄三、 個人基本資料表、VAS量表 107
附錄四、 研究工具─WOMAC 3.0 中文版 109
附錄五、 精油塗抹步驟 111
附錄六、 複方成份分析報告 112

表 目 錄
表3-4-1 介入工具(芳香精油、嬰兒油濃度比例對照表) 41
表3-4-2 研究設計表 43
表3-4-1.1 基本資料自變項操作型定義 47
表3-4-1.2 自變項操作型定義(續) 48
表3-4-2.1 依變項操作型定義 49
表3-4-2.2 依變項操作型定義(續) 50
表4-1.1 兩組骨關節炎老人基本屬性資料分析( 1/2) 57
表4-1.2 兩組老人治療情形與分布情況(2/2) 58
表4-2 兩組老人塗抹實驗前測疼痛分數(BASELINE)差異比較之獨立T檢定 61
表4-3 VAS疼痛指數測量的之兩組平均分數差異獨立T檢定 63
表 4-4 WOMAC疼痛指數測量的兩組平均分數差異獨立T檢定 65
表4-5 兩組老人VAS疼痛指數前後測量之成對樣本T檢定 67
表4-6 兩組老人WOMAC量表前後測量成對樣本T檢定 71

圖 目 錄
圖2-4-1 檸檬香茅氣相層析圖 21
圖3-1 研究架構 34
圖3-4-1 研究流程圖 40
圖3-4-1 精油口徑大小圖 42
圖3-5-1 VAS 視覺類比模擬量表: 45
圖4-5 兩組老人VAS量表前後測比較圖 68
圖4-6 兩組老人WOMAC量表總分前後差異比較圖 72
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