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研究生:陳人毓
研究生(外文):Chen, Jen-Yu
論文名稱:逐步整合徒手治療對於頸部疼痛的處理成效
論文名稱(外文):Effectiveness Of Stepwise Integrated Manual Therapy In The Treatment Of Neck Pain
指導教授:蔡秀純蔡秀純引用關係郭家驊郭家驊引用關係
指導教授(外文):Tsai, Shiow-ChwenKuo, Chia-Hua
口試委員:李裕滄
口試委員(外文):Lee, Yu-Tsang
口試日期:2012-07-20
學位類別:碩士
校院名稱:臺北巿立體育學院
系所名稱:運動科學研究所
學門:民生學門
學類:運動科技學類
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:99
中文關鍵詞:徒手治療頸部疼痛關節活動心率變異度
外文關鍵詞:heart rate variabilitymanual therapyneck painrange of motion
相關次數:
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  • 收藏至我的研究室書目清單書目收藏:0
頸部疼痛在身體方面是常見的問題,並且在現今社會中造成嚴重的經濟負擔。最近的研究顯示,採用非侵入性徒手介入,以及多模式的方式處理頸部疼痛具有良好的成效。本研究目的為整合常用的肩頸疼痛徒手治療技術,逐步施行於研究個案,以探討頸部疼痛的處理成效。其中採用的徒手治療方式為軟組織按壓技術、等長收縮阻力技術與衝擊式矯正技術。本論文的研究對象來源為大台北地區社區團體與公司行號,符合收案條件為個案自覺頸部疼痛,並且數字疼痛比例量表 (Numeric Pain Rating Scale, NPRS) 分數≧2分。35位符合收案的民眾參與本研究,隨機分配,其中實驗組有20位,控制組有15位。實驗組方面,針對左右各3個肩頸部位軟組織的好發痛點施以按壓,其次針對頸部肌肉群施以左右各一次的等長收縮誘發技術,最後針對胸椎部位施以二次低振幅、高衝擊的外力矯正;控制組方面則施以模擬的操作介入,以輕微觸碰取代按壓,誘發左右轉時不給予阻力,胸椎矯正時不施以外力。實驗前後皆給予測量疼痛分數、頸部關節活動度、5分鐘心率變異儀器檢測,以及操作後的自覺綜合改善分數 (Global Rating of Change, GROC)。本研究結果顯示,在疼痛分數方面,經過徒手治療後兩組的改變程度,實驗組的疼痛分數明顯降低,實驗組降低的分數相對於控制組降低的分數有顯著差異 (p<0.0005)。在頸部關節活動度方面,經過徒手治療後,實驗組的關節活動角度明顯增加,與控制組相較有顯著差異 (p<0.0005);治療後兩組的組間比較,實驗組相對於控制組在左側灣、右側彎的角度有顯著差異 (p=0.02, p=0.04)。在心率變異儀器經由電腦分析所得的數據方面,經過徒手治療後,實驗組相對於控制組在心跳間距的平均數值、心跳總數與心率有顯著差異 (p<0.0005, p=0.004, p<0.0005)。在綜合改善方面,實驗組個案自覺改善很多,控制組個案自覺改善非常少或幾乎沒改變。逐步整合徒手治療能有效舒緩頸部疼痛,恢復頸部的關節活動度,對於頸部疼痛的處理,是一種快速、安全又有效的方式。建議未來運用在運動員隨隊的防護工作,操作者只要透過正確的學習與訓練,都能在適當時機給予運動員立即性的處理,減輕運動員肩頸疼痛問題,增進運動員在運動場上的表現。
Neck pain is one of the most common problems in health care, and significantly contributes economic burden in modern society. Evidence suggests the use of non-operative manual intervention and multimodal approach for the treatment of neck pain. The purpose of this study was to examine the effects of stepwise integrated manual therapy in patients with a primary complaint of neck pain. The integration of manual therapy in this study and operated through steps are soft tissue inhibitory technique, resisted isometric technique and thrust manipulation technique. Subjects of this study were from society or company in Taipei. They were eligible for the study if they had neck pain and the numeric pain rating scale (NPRS)≧2. Thirty-five subjects were recruited consecutively in this study and randomly assigned to treatment group or control group. There were twenty subjects arranged to treatment group, and fifteen to control group. After the baseline assessment and test, subjects were received our manual therapy. The experimental group received integrated manual therapy included soft tissue inhibitory technique for tender-points, resisted isometric technique to facilitate muscle contraction and twice thoracic spine thrust manipulation technique step by step. The control group received sham intervention, using light touch instead of inhibition and non-resistance of facilitation than sham manipulation of thoracic spine. Data were obtained before and after each treatment, including numeric pain rating scale, neck active range of motion (flexion, extension, left lateral flexion, right lateral flexion, left and right rotation) and five minutes electro-cardiac monitor. The results showed that after manual therapy, the difference of neck pain score was significantly reduced in the experimental group compared to the control group (p<0.0005). According to the change of cervical range of motion, the experimental group was significantly increased after manual therapy. The difference of general dimensions of cervical spine was significantly increased in the experimental group compared to the control group (p<0.0005). In addition, after the treatment there were significant difference between experimental group and control group in left lateral flexion and right lateral flexion (p=0.02, p=0.04). In the data transferring from electro-cardiac monitor, there was significant difference in the mean of heart rate interval, total heart beats and heart rate (p<0.0005, p=0.004, p<0.0005). In the self-measuring score of global rating of change also showed that subjects of experimental group feel moderate improvement after treatment, while control group feel no or little change. Stepwise integrated manual therapy can relief pain and regain neck mobility effectively. It is a kind of fast, safe and effective way to treat neck pain. We suggest using this method to protect athlete. Through the well-trained operator, can provide the athlete to cure pain and enhance competition performance.
原創聲明書………………………………………………………… ii
學位考試審定書…………………………………………………… iii
中文摘要…………………………………………………………… iv
英文摘要…………………………………………………………… vi
謝誌………………………………………………………………… viii
目錄………………………………………………………………… ix
表目錄……………………………………………………………… xiii
圖目錄……………………………………………………………… xiv
第壹章 緒論……………………………………………………… 1
第一節 研究背景…………………………………………… 1
第二節 研究動機…………………………………………… 4
第三節 研究目的…………………………………………… 5
第四節 研究假設…………………………………………… 6
第五節 研究架構…………………………………………… 6
第六節 名詞與操作定義…………………………………… 7
第貳章 文獻探討………………………………………………… 12
第一節 認識疼痛…………………………………………… 12
第二節 頸部疼痛…………………………………………… 14
第三節 徒手治療…………………………………………… 22
第四節 頸部疼痛的徒手治療……………………………… 33
第參章 材料與方法……………………………………………… 36
第一節 研究設計…………………………………………… 36
第二節 研究對象…………………………………………… 36
第三節 研究場所與時間…………………………………… 38
第四節 研究工具說明……………………………………… 38
第五節 徒手治療操作說明………………………………… 41
第六節 倫理考量…………………………………………… 44
第七節 資料處理與分析…………………………………… 44
第肆章 研究結果………………………………………………… 46
第一節 研究對象基本屬性分布…………………………… 46
第二節 逐步整合徒手治療對頸部疼痛在疼痛程度的成效 48
第三節 逐步整合徒手治療對頸部疼痛在頸部活動度的成
效……………………………………………… 49
第四節 逐步整合徒手治療對頸部疼痛在心率變異數據的
成效…………………………………………… 52
第五節 逐步整合徒手治療對頸部疼痛個案在自覺綜合改
善的成效……………………………………… 55
第伍章 討論……………………………………………………… 57
第一節 逐步整合徒手治療對於減輕個案之疼痛程度的成
效…………………………………………………… 57
第二節 逐步整合徒手治療對於增進個案之頸部活動度的
成效………………………………………………… 58
第三節 逐步整合徒手治療對於改變個案之心率變異數據
的成效……………………………………………… 59
第陸章 結論與建議……………………………………………… 62
第一節 結論………………………………………………… 62
第二節 逐步整合徒手治療在運動科學的應用…………… 63
第三節 研究限制與建議…………………………………… 64
參考文獻…………………………………………………………… 67
圖及表……………………………………………………………… 78
附錄ㄧ 人體試驗暨倫理計畫審查證明書……………………… 90
附錄二 研究計畫說明暨參與同意書…………………………… 91
附錄三 個案基本資料表………………………………………… 92
附錄四 數字比例疼痛量表……………………………………… 93
附錄五 綜合改善量表…………………………………………… 94
附錄六 實驗操作過程說明……………………………………… 95
附錄七 心率變異儀器檢測電腦分析圖說明…………………… 97
附錄八 研究服務方案廣告單…………………………………… 99
表目錄
表1 研究設計表…………………………………………… 88
表2 徒手操作前後心率變異數據………………………… 89
圖目錄
圖1 研究架構……………………………………………… 78
圖2 研究流程……………………………………………… 79
圖3 徒手治療介入前後兩組疼痛程度變化……………… 80
圖4 徒手治療介入前後兩組疼痛減輕程度分布………… 81
圖5 徒手治療介入前後兩組前彎角度變化…………………… 82
圖6 徒手治療介入前後兩組前彎角度增加量………………… 82
圖7 徒手治療介入前後兩組後仰角度變化…………………… 83
圖8 徒手治療介入前後兩組後仰角度增加量………………… 83
圖9 徒手治療介入前後兩組左側彎角度變化………………… 84
圖10 徒手治療介入前後兩組左側彎角度增加量……………… 84
圖11 徒手治療介入前後兩組右側彎角度變化………………… 85
圖12 徒手治療介入前後兩組右側彎角度增加量……………… 85
圖13 徒手治療介入前後兩組左轉角度變化…………………… 86
圖14 徒手治療介入前後兩組左轉角度增加量………………… 86
圖15 徒手治療介入前後兩組右轉角度變化…………………… 87
圖16 徒手治療介入前後兩組右轉角度增加量………………… 87


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