臺灣博碩士論文加值系統

背景︰根據過去的研究，物理治療師職業生涯中發生肌肉骨骼傷病的機率高達91%，而臺灣地區的治療師半年內六成有肩部或下背疼痛，半數有頸部、手腕或膝部疼痛。當物理治療師發生肌肉骨骼傷病時，心理層面會導致情緒不佳，甚至失去熱忱，工作層面會導致減少病患接觸時間或請病假，影響醫療品質，也會影響到日常生活活動與醫療支出等負面影響，是一個值得正視的問題。
目的︰(1) 調查臺灣地區物理治療師發生職業性肌肉骨骼系統傷病的盛行率與影響程度(2)了解物理治療師自我處理職業性肌肉骨骼疼痛之態度與方法(3)探討物理治療師職業性肌肉骨骼傷病之相關因子(4)探討物理治療師職業性肌肉骨骼傷病對工作能力之影響
研究設計︰探索型橫斷面研究
材料與方法︰參考過去的文獻另行設計一份問卷，請兩位專家確認問卷的內容效度，另請10位治療師間隔一星期重複填答，同意百分比為95.5%。資料收集用方便樣本，研究對象為具有執照且每週工作超過30小時的物理治療師，排案條件為有系統性疾病，五年內曾有非工作因素導致的傷害，懷有身孕者。使用SPSS第16版做資料輸入，單變項分析，類別變相使用卡方檢定，等距變項使用獨立樣本t檢定，序位變項使用無母數獨立樣本檢定，找出可能造成的疼痛的相關因子，統計顯著水準訂於0.15。將單因子分析有顯著性者，再進一步利用逐步邏輯斯回歸分析之找出獨立影響因素，利用史比爾曼相關來分析各因子與所有部位疼痛影響程度總分的相關性，利用複回歸分析找出影響工作能力指數最多的身體疼痛部位，統計顯著水準訂於0.05，職業性肌肉骨骼疼痛的因應之道用敘述性統計。
結果︰回收406份，回收率90.4%，有效問卷共403份，男女性別比分別為35%與65%，一年之中97.3%受訪者均有身體某處疼痛，最常發生疼痛的部位為下背或腰(77.2%)，其次是肩頸部，再者是上肢，最少是下肢。與工作相關的頸痛一年的盛行率為54.6％，與工作相關的下背痛一年的盛行率為72.7％。對疼痛的應變措施物理治療師以本身熟知的專業做調整，較少尋求其他中西醫或藥物治療。女性相較於男性易疼痛，造成各部位疼痛的因子，肩頸上肢和下背多與徒手治療、身體姿勢、心智狀態相關，膝部疼痛易發生在小兒治療師，與蹲及身體扭轉等不良的姿勢有關，導致下肢疼痛的因子多與環境設計是否良好相關。疼痛的影響分數與工作能力指數的相關係數達-0.425中度負相關，疼痛程度越嚴重，工作能力狀態越差，本調查有30.5%的受訪者處於工作能力有待提升，或無法勝任，本調查工作能力指數分數38.4±3.9，低於全國勞工41.4±4.5分。
討論︰本研究發現臺灣物理治療師各部位疼痛的比例皆較全國勞工高出2到3倍，女性治療師由於體型較瘦弱，容易產生職業性肌肉骨骼傷病，各關節傷病主要成原因多與該部位施力累積不良姿勢累積和環境設計不適切有關。工作能力指數較全國勞工差，主要原因，身體傷病以及其對工作的影響是主要拉低分數的項目，可知職業性肌肉骨骼疾病對工作能力指數的影響甚鉅。本研究限制由於採主觀填答問卷，可能有回憶誤差，且缺乏客觀的數據，實驗設計為探索型橫斷面研究，在單一時間點收集的資料無法判斷因果，未來的研究可以朝此方面改善，用客觀的記錄方式實際測量，並可以做一年後的追蹤確認因果。
結論︰臺灣物理治療師職業性肌肉骨骼疾病是相當嚴重的，且已影響到工作能力的表現，原因與工作所需的不良姿勢、不適切的環境設計、工作負荷量太大有關。

Background: Ninety-one percent of physical therapists (PTs) reported experiencing work-related musculoskeletal pain or discomforts at some time in their working life. Over 60% of Taiwanese PTs reported experiencing work-related shoulder or low back pain and over 50% experiencing neck, wrist or knee pain within half a year. As work-related musculoskeletal disorders (WMSDs) occured, they would have negative emotional effect such as bad mood and loss of enthusiasm to work, negative work effect such as decreasing time of patient contact and taking sick leave. All of the above might influence quality of medical treatment given by the injured PTs and the quality of daily activities and medical expense of the injured PTs. Since the musculoskeletal pain occurred in Taiwanese PTs has not been vigorously investigated we conducted this survey study.
Purposes: (1) To determine 1-year prevalence of WMSDs of PTs in Taiwan. (2) To investigate the responses to injuries of Taiwanese PTs with WMSDs (3) To determine work-related factors of WMSDs in Taiwanese PTs. (4) To investigate the influence of WMSDs of work ability index.
Study Design: An exploratory cross-sectional study.
Materials and Methods: A structural questionnaire was designed for this study. Two experts were consulted to assess the content validity of the questionnaire. Then 10 PTs were recruited for answering the questionnaire twice with 1 week apart to determine the test-retest reliability of the questionnaire. The percent agreement was 95.5%. A convenient sample of 403 Taiwanese licensed PTs who currently worked more than 30 hours per week were recruited. The exclusion criteria included subjects who were not willing to fill in the questionnaire completely, had systematic diseases or had injuries which were not work-related within 5 years, or were pregnant. Chi-square tests (for nominal variables) and/or independent t-tests (for interval/ratio variables) and/or appropriate nonparametric analyses (for ordinal variables) were used to investigate the effect of each factor. Significant differences of all factors between pain and painfree groups was set at P <0.15. A multiple stepwise logistic regression was then used to determine the association among work-related factors and WMSDs. Spearman’s rho was used to determine the association among work-related factors and the influence of WMSDs. A multiple regression was used to determine the body region that causes negative effect of work ability index. Significant difference was set at P <0.05.
Results: Four hundred and six questionnaires were returned. The overall response rate was 90.4%. There were 403 valid questionnaires. The 1-year prevalence of pain occurred in any body region was 97.3%. The 1-year prevalence of work-related neck pain was 54.6% and work-related low back pain was 72.7%.The most common area of the WMSDs was low back (77.2%), the second common area was shoulder and neck and then the upper extremities. The less common area occurring WMSDs was the lower extremities. The response of PTs who suffered WMSDs tended to use their own professional knowledge to adjust their work habits. Very few therapists went to seek for other traditional or western medicine. Female physical therapists were more likely to develop WMSDs than males. The factors that were related to upper extremities, neck and low back pain included performing manual therapy, poor posture while working and mental status. Pediatric physical therapists who often need to squat and adopt awkward working postures had higher prevalence of self-reported musculoskeletal symptoms in the knee area. Lower extremity pain was significantly related to the design of working environment. The correlation coefficient between the impact of the WMSDs and the work ability index was -0.425. The more serious the pain was, the lower score of the work ability index. The work ability index of the participants averaged 38.4±3.9, which was lower than the norm of the nation-wide workers in Taiwan (41.4±4.5).
Discussion: The prevalence of each body area pain in physical therapists was 2 to 3 times higher than nation-wide workers in Taiwan. Female therapists tended to develop WMSDs easier than male therapists. Significant factors associated with each body region pain were related to overuse of that body region, prolonged time of sustaining a poor posture and inappropriately designed work environment. The study was an exploratory cross-sectional study. Therefore, the cause and effect relationship could not be established.
Conclusion: The issue of WMSD of Taiwanese physical therapists is very serious and it may influence their performance of job duties. Significant determinants of WMSDs in physical therapists included poor posture, inappropriate work environment and too much workload.

誌謝…………………………………………………………………………………….i
目錄……………………………………………………………………………………ii
表目錄……………………………………………………………………………........v
圖目錄…………………………………………………………………………….......ix
中文摘要……………………………………………………………………...……....x
英文摘要………………………………………………………………...…...…… ..xiii
第一章 緒論
第一節 研究背景與動機……………………………………………………..…1
第二節 研究的重要性…………………………………………………………..3
第三節 研究目的………………………………………………………………..4
第二章 文獻回顧
第一節 物理治療師職業傷病的盛行率………………………………………..5
第二節 物理治療師職業性肌肉骨骼傷病常見的部位………………………..6
第三節 職業性肌肉骨骼傷病的因應之道……………………………………..7
第四節 導致物理治療師職業性肌肉骨骼傷病的危險因子…………………...8
第五節 醫療人員不同部位職業性肌肉骨骼傷病之危險因子……………….10
第六節 總結與研究方向……………………………………………………….16
第三章 研究方法
第一節 研究對象…………………………………………………………...….17
第二節 研究設計與架構………………………………………………………17
第三節 研究測量與工具………………………………………………………18
第四節 統計分析………………………………………………………………21
第四章 結果
第一節 研究對象來源及基本特性……………………………………………23
第二節 工作內容與概況………………………………………………………24
第三節 身體層面之調查………………………………………………………27
第四節 運動習慣、工作能力指數與睡眠品質………………………………30
第五節 各部位疼痛因子分析…………………………………………………32
第五章 討論
第一節 治療師基本資料的探討………………………………………………43
第二節 疼痛情形之探討………………………………………………………44
第三節 頸背痛的深入探討……………………………………………………46
第四節 疼痛的因應之道………………………………………………………48
第五節 職業性肌肉骨骼傷病各部位疼痛因子的探討………………………49
第六節 整體身體部位的工作相關因子………………………………………58
第七節 工作能力指數的相關探討………………………………………….…61
第八節 研究限制與未來研究方向…………………………………………….63
第六章、結論與建議………………………………………………………………..66

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