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研究生:李壽興
研究生(外文):So-Shing Lee
論文名稱:退化性膝關節炎患者之症狀、休閒參與與休閒阻礙之研究
論文名稱(外文):A Study of the Symptoms,Recreational Participations and Recreational Constraints for Patients with Knee Osteoarthritis
指導教授:黃娟娟黃娟娟引用關係
指導教授(外文):Chean-Chean Hwang
口試委員:雷文谷王耀聰
口試委員(外文):Wen-Guu LeiYau-Tsung Wang
口試日期:2013-09-26
學位類別:碩士
校院名稱:大葉大學
系所名稱:運動健康管理學系
學門:民生學門
學類:運動休閒及休閒管理學類
論文種類:學術論文
論文出版年:2014
畢業學年度:103
語文別:中文
論文頁數:110
中文關鍵詞:退化性關節炎休閒參與休閒阻礙
外文關鍵詞:osteoarthritisrecreational participationrecreational constraintsOA
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中文摘要
根據2014年世界衛生組織(World Health Organization,WHO)指出:全球60歲以上的人口約有9.6%的男性與18%的女性患有退化性關節炎,在這當中有25%的人沒辦法自行處理每日的生活自理工作,必須仰賴他人協助。退化性關節炎是中老年人常見之疾病,尤其以年長者更易罹患,目前引發退化性關節炎的致病因子尚不明確,但許多實證顯示運動休閒治療能舒緩對疼痛與僵硬的感受程度,並提昇關節肌肉群強度與關節靈活度、穩定度,然而參與運動休閒在此族群中卻屬偏低。因此,希望借研究結果了解退化性關節炎症狀程度、休閒參與、休閒阻礙之相互影響係,作為未來相關人員在提供病患相關知識教育時參考。本研究以臺灣中部地區X光放射線檢查罹患 Kellgren and Lawrence等級2及2以上之退化性膝關節炎患者共202位,男性92位(45.5%),女性110位 (55.5%)進行問卷訪問,問卷資料結果利用AMOS 18.0結構方程式來驗證退化性關節炎症狀程度、休閒參與、休閒阻礙之影響性。研究結果顯示退化性關節炎症狀程度對休閒參與有負向影響關係,而對休閒阻礙有正向直接影響關係,但休閒阻礙對休閒參與有低度正相關,其值未達顯著水準。結論如下: 1.疼痛是造成退化性膝關節炎患者不願參與休閒活動主要原因。2.對不同個體而言,休閒阻礙並非是影響休閒參與的主要原因。3. 較溫和的休閒活動活動較能吸引退化性膝關節炎患者參與。建議舒緩退化性關節炎疼痛、僵硬症狀與提昇身體功能能力,並降低顯見之休閒阻礙,做好退化性關節炎相關疾病症狀管理、鼓勵與激發患者參與休閒活動之內在動機。

Abstract
According to World Health Organization in 2014,more than 9.6 percent male and 18 percent female whose age over 60 years old were affected arthritis all around the world,and 25 percent of them lost their ability to carry out simplist tasks in their dailives.Osteoarthritis(OA)is one of common musculoskeletal diseases in the elder.At present the cause of this irritating disease is still
unrevealed in the hyline deep sea,though there had been proven that participating physical activities had significant improvement in physical function, bodily pain and muscle strength,but the participate rate was low.The purpose of this study was to clarify the relationships among WOMAC, recreational participations,and recreational constraints in patients with KOA.The Method:202 self-reported with doctor diagnosised RKOA patients in central area of Taiwan were invited to fulfill the questionnaires, RKOA was defined as the development of Kellgren -Lawrence grade ≥ 2. WOMAC, modified recreational participation form, and modified recreational constraint form were provided, AMOS 18.0 was to verify the relationships among them.Results showed that the WOMAC symptom indication was significantly negative associated with recreational participations and significantly direct positive associated with recreational constraints. However, the association between recreational constraints and recreational participations
was not statistically significant. In this case. The conclusions were following : 1.Pain was the core cause for participating recreational activities in patients with KOA. 2.Recreational constraints were not the main stumbling block in participating recreational activities in term of different individuals.3.Recreational activities in mild intensity were popular and eye catching for KOA patients. Suggestions: OA related symptom management was a high priority in elderly care ; as such, encouragment and intrinsic motivation strategies were necessary to enhance participation of recreational activities.

                目錄索引
中文摘要..................................................iii
英文摘要...................................................iv


內容目錄
第一章 緒論...............................................1
第一節 研究背景與動機........................................1
第二節 研究目的.............................................4
第三節 研究問題.............................................4
第四節 研究限制.............................................4
第五節 名詞釋義.............................................5
第二章 文獻探討................................................6
第一節 退化性膝關節炎........................................6
第二節 休閒參與的定義、理論與相關研究..........................31
第三節 休閒阻礙的定義與相關研究...............................48
第三章 研究方法與步驟..........................................52
第一節 研究流程............................................52
第二節 研究架構............................................53
第三節 研究假設............................................54
第四節 研究對象與抽樣方法....................................54
第五節 研究工具............................................54
第六節 資料分析............................................64
第四章 結果與討論.............................................67
第五章 結論與建議.............................................85
第一節 結論...............................................85
第二節 建議...............................................85
參考文獻.......................................................87
附錄A........................................................107

表目錄

表2-1-1 美國風濕醫學會診斷退化性膝關節炎標準.........................24
表2-1-2 美國風濕醫學會診斷退化性膝關節炎標準.........................24
表2-1-3 美國風濕醫學會診斷退化性膝關節炎標準.........................25
表2-1-4 X光照射比對Kellgren and Lawrence的分級...................25
表2-1-5 修定之科林斯關節軟骨程度分級...............................26
表2-2-1 美國疾病控制與預防中心建議孩童參與之身體活動..................35
表2-2-2 美國疾病控制與預防中心建議成人參與之身體活動..................35
表2-2-3 美國疾病控制與預防中心建議老人參與之身體活動..................36
表2-2-4 美國疾病控制與預防中心建議產婦參與之身體活動..................36
表3-5-1 關節炎自評量表項目分析表..................................56
表3-5-2 關節炎自評量表KMO與Bartlett檢定表.........................57
表3-5-3 關節炎自評量表信度分析表..................................57
表3-5-4 休閒參與量表項目分析表....................................58
表3-5-5 休閒參與量表KMO與Bartlett檢定表...........................60
表3-5-6 休閒參與量表信度分析表....................................60
表3-5-7 休閒阻礙量表項目分析表....................................61
表3-5-8 休閒阻礙量表KMO與Bartlett檢定表...........................62
表3-5-9 休閒阻礙量表信度分析表.....................................62
表4-1-1 樣本性別分佈摘要表........................................67
表4-1-2 樣本年齡分佈摘要表........................................68
表4-1-3 樣本收入分佈摘要表........................................68
表4-1-4 身體質量指數分佈摘要表.....................................69
表4-2-1 膝關節炎症狀現況分析表.....................................69
表4-2-2 休閒活動之現況分析表.......................................70
表4-2-3 休閒阻礙之現況分析表.......................................71
表4-3-1 膝關節症狀程度測量糢型之驗證性分析摘要表.......................72
表4-3-2 膝關節症狀程度配適度修正前後比較摘要表.........................73
表4-3-3 休閒參與測量糢型之驗證性分析摘要表............................75
表4-3-4 休閒參與配適度修正前後比較摘要表..............................76
表4-3-5 休閒阻礙測量糢型之驗證性分析摘要表............................78
表4-3-6 休閒阻礙配適度修正前後比較摘要表..............................79
表4-3-7 整體糢型參數摘要表..........................................81
表4-3-8 整體糢型配適度修正前後比較摘要表...............................82
表4-3-9 整體糢型影響摘要表..........................................84

圖目錄

圖2-2-1 膝關節之解剖圖.............................................9
圖2-3-1 休閒阻礙階層模式圖.........................................43
圖3-1-1 研究流程圖................................................52
圖3-2-1 研究架構圖................................................53
圖4-3-1 膝關節症狀程度一階驗證性分析圖................................73
圖4-3-2 休閒參與一階驗證性分析圖.....................................76
圖4-3-3 休閒阻礙一階驗證性分析圖.....................................79
圖4-3-4 整體模型路徑圖.............................................82



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