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研究生:陳力平
研究生(外文):Li-Ping Chen
論文名稱:臺灣老人下背痛時使用針灸治療及其相關臨床因素探討
論文名稱(外文):Utilization of acupuncture and associated clinical factors for low back pain among the elderly: a retrospective population-based cross-sectional study.
指導教授:許昇峰許昇峰引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:針灸研究所碩士班
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:62
中文關鍵詞:老人針灸下背痛
外文關鍵詞:elderlylower back painacupuncture
相關次數:
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  • 收藏至我的研究室書目清單書目收藏:2
全球人口老化的時代已來臨,台灣也已於21 世紀的前十年步入高齡
化社會。高齡化社會的重大影響之一包含醫療照護資源的需求增加,而進一步影響整體社會經濟負擔。下背痛是老人常見的症狀,不但會有身體上的不適,也會影響其日常生活。雖然目前一些下背痛指引均建議考慮針灸治療,但是對於老年族群的下背痛著墨的針灸文獻卻很少。
本研究為探討有下背痛診斷的老人針灸使用情形及相關因素,利用
健保資料庫資料分析探討老人使用針灸治療與其基本特質疾病及醫療利用情形的相關性及其影響。
本研究結果發現,罹患下背痛的老人, 其過去門診次數及醫療費用
較高,而有較高的比例使用針灸治療。經控制其他因素後發現,有下背痛診斷的老人相對於沒有下背痛診斷的老人有41%較高的比例使用針灸治療,曾有使用止痛藥者、神經安定劑者、有腦血管疾病、無併發症之糖尿病者或骨關節炎者傾向於使用針灸。進一步分層分析發現,下背痛診斷與否的老人被診斷有腦血管疾病或骨關節炎、高門診經驗等因素下都有較高的比例會使用針灸治療,有下背痛者確有稍高比例使用針灸,但無下背痛診斷且年齡大於75 老人比較不會使用針灸。
這次研究發現,患有下背痛的老人,當有腦血管、糖尿病前期或骨
關節炎病史或曾有使用西藥止痛者傾向於使用針灸。這樣的結果可以提供給臨床執業者在照護老人及提昇照護品質上參考,未來需要進一步的研究探究老人下背痛針灸治療的成效。

Global aging era is coming, while Taiwan was recognized as the aging society in the first decade of the 21st century. One of the major impacts due to becoming the aging society is the incremental demands of health care resources, which will increase overall socio-economic burden. Low back pain
is one of the common diseases in the elderly. This symptom will not only result in the physical discomforts, but also affect the daily actives among the elderly. While some lower back pain guidelines recommend using acupuncture, there are limited literatures elaborating the utilization of
acupuncture among the elderly with or without low back pain.
The study utilized the National Health Insurance Research databases to explore the factors associated with the use of acupuncture for elderly among those with or without low back pain. The potential factors included the basic information, comorbidities, co-medications, and other medical care utilizations.
Those elderly with low back pain tended to ever utilize more medical resources and use acupuncture. After controlling for other factors, elderly with low back pain seemed 41% more likely to utilize acupuncture than those
without low back pain. Elderly with the following characteristics tended to use acupunctures: ever use pain medications, neuroleptic medications, being diagnosed with stroke, DM without complications, or osteoarthritis. Stratify analyses showed that elderly with strokes, osteoarthritis or those ever made more outpatient visits tended to use acupuncture for both groups. Elderly aged
more than 75 tended to use acupuncture for those with low back pain but not for those without low back pain.
This study demonstrated that elderly with strokes, earlier DM, osteoarthritis and ever use pain killers tended to use acupuncture. These findings can help to facilitate high quality of medical care for the elderly with low back pain. Further research is needed to explore the outcomes of using
acupuncture for the elderly with low back pain.

中文摘要 I
英文摘要 II
目錄 IV
表目錄 VII
圖目錄 VIII
第一章 前言 9
第一節 研究背景 9
一.人口老化 9
二. 下背痛 10
三.另類療法使用情形 10
四.台灣的健保資料庫 13
第二節 研究目的 14
一.研究主題 14
二.研究目的 14
第二章 文獻探討 15
第一節 老人醫療資源的利用情形 15
第二節 老人與慢性病 16
第三節 下背痛的診斷與治療 17
第四節 針灸治療的現況 18
第五節 針灸治療下背痛的使用情形及其臨床治療效果 19
第六節 健保資料庫針灸相關研究 20
第七節 小結 20
第三章 材料與方法 22
第一節 研究架構 22
一.研究假設 22
二.資料來源 22
三.研究流程 23
第二節 研究設計 25
一.老人下背痛針灸使用探索 25
第四章 結果 30
第一節 罹患下背痛及無下背痛老人的臨床特徵 30
第二節 影響使用針灸治療的因素 39
第五章 討論 47
第一節 病患基本特徵校正 47
第二節 就醫行為 48
第三節 系統性疾病對針灸治療下背痛的影響 50
第四節 影響使用針灸治療的因素 51
第五節 研究限制 53
第六節 未來研究方向 53
第六章 結論 55
第七章 參考文獻 57





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