臺灣博碩士論文加值系統

應力性尿失禁是婦女尿失禁中最常見的尿失禁類型，保守療法中的骨盆底肌肉運動可增強骨盆底肌肉的強度，使收縮力量達到最大限度，從而改善應力性尿失禁。本研究中首先探討不同足踝姿勢對婦女骨盆底肌肉活動的影響。募集31位30至56歲的已婚婦女，以生理回饋儀評估不同足踝位置對收縮骨盆底肌肉的影響。結果發現主動足踝位置時之骨盆底肌肉活動顯著高於被動足踝位置，又骨盆底肌肉活動在足踝採蹠屈雙臂舉起姿勢(plantar flexion arms up, PFAU)時達到統計學上意義(p=0.0051)。
本研究續將蹠屈雙臂舉起姿勢融入傳統骨盆底肌肉運動成為蹠屈臂舉式骨盆底肌肉運動，研究目的為探討傳統式及蹠屈臂舉式骨盆底肌肉運動訓練對應力性尿失禁婦女改善尿失禁的成效及不同介入運動模式運動遵從率對治療成效的影響。採隨機實驗研究設計，共召募83位社區婦女為收案對象，39位隨機分派至對照組，44位至實驗組，最終完成訓練者49人(退出率41%)，其中完成傳統式骨盆底肌肉組24人，蹠屈臂舉式骨盆底肌肉組25人，在學習正確收縮骨盆底肌肉後，居家完成為期8週的傳統或蹠屈臂舉式骨盆底肌肉運動訓練及專責研究人員每週電話追蹤後，以經過信效度測試的中文版應力性尿失禁症狀嚴重度及影響度量表、20分鐘尿墊測試進行成效評值。
完成不同介入運動模式訓練後，傳統式及蹠屈臂舉式骨盆底肌肉運動組在應力性尿失禁症狀嚴重度及影響度得分上均較訓練前為低。蹠屈臂舉式骨盆底肌肉運動組在會發生滲尿活動項目及擔心滲尿而避免參加活動項目上明顯少於傳統式骨盆底肌肉運動組 (1.2 vs 0.8分，0.6 vs 0.2分，p< .05)。
在有專業人員提供持續性的督導下骨盆底肌肉運動的遵從率高，對傳統及蹠屈臂舉式骨盆底肌肉運動訓練組有相同的影響，而遵從度越高者應力性尿失禁症狀嚴重度得分改善越多，且蹠屈臂舉式骨盆底肌肉運動除能減少應力性尿失禁症狀嚴重度及影響度外，更能明顯的使婦女可參與的活動增加，有助於社交生活的提升，未來應可將蹠屈臂舉式骨盆底肌肉訓練計劃進行推廣。
本研究欲應用特定疾病的生活品質量表測量傳統及蹠屈臂舉式骨盆底肌肉運動訓練的治療成效，故發展中文版應力性尿失禁症狀嚴重度及影響度量表，並進行信效度的檢定。以跨文化適應過程翻譯中文版應力性尿失禁症狀嚴重度及影響度量表後，以廣告方式招募在過去一年內曾發生應力性尿失禁之婦女共83位參與量表信效度檢定，包括內在一致性及效標關聯效度檢定，且效度分析方面則以簡明版尿失禁症狀困擾量表(UDI-6)及影響量表(IIQ-7)與中文版應力性尿失禁婦女症狀嚴重度及影響度量表進行效標關聯效度檢定。中文版應力性尿失禁婦女症狀嚴重度及影響度量表能反應原量表的內容，量表之內在一致性(Cronbach’s α)總量表為 .843、症狀嚴重度子量表為 .811、影響度子量表為 .862。症狀嚴重度子量表與UDI-6呈有意義之正相關 (r = .653, p < .0001) ，症狀影響度子量表與IIQ-7亦呈有意義之正相關 (r = .702, p < .0001)。本研究顯示經過跨文化適應過程之中文版應力性尿失禁婦女症狀嚴重度及影響度量表可反映原量表內容，具有良好的心理測量特質，未來應可予以推廣。

Stress urinary incontinence is common in women. Conservative management includes pelvic floor muscle exercises to increase strength and muscular contraction forces to improve incontinence. In the preliminary study we examined the effects of passive and active ankle dorsiflexion and plantar flexion on pelvic floor muscle activity during exercises. A total of 31 married women were recruited to performed random pelvic floor muscle contractions while standing, and in 8 passive and active ankle positions while pelvic floor muscle activity was simultaneously measured by electromyography. Active ankle positions resulted in greater pelvic floor muscle activity than the horizontal foot position, passive ankle dorsiflexion and passive plantar flexion position. Significantly greatest muscle activity was seen with ankles in the plantar flexion position with arms up (PFAU) (p=0.0051). We suggest PFAU could be incorporated with traditional Kegel exercise as part of exercise.
Then we incorporate the PFAU with traditional Kegel exercise, hence as the plantar flexion and arms up pelvic floor muscle training. This study specifically explored the effectiveness of plantar flexion and arms up pelvic floor muscle training for SUI women as well as the compliance rate and the relations to trial results. This was a randomized controlled trail. 83 SUI women enrolled, 39 women were assigned to control group, 44 women to experimental group (41% attrition rate), and 49 women completed the trail. 24 women in control group, 25 women in experimental group. Participants completed an eight weeks session of traditional or plantar flexion and arms up pelvic floor muscle training program with a trained nurse, and telephone surveys were also conducted intensively on the weekly basis. We evaluated the effectiveness of pelvic floor muscle training based on the result of SUI severity and impact index (Chinese version), 20-minute pad test.
After the eight weeks pelvic floor muscle training sessions, the SUI severity index and impact index were lower than before in both control and experimental group. Plantar flexion and arms up pelvic floor muscle training group participants demonstrates less urinal leakage (1.2. vs 0.8 score, p< .05). And due to less urinal leakage, the participants’ tendency to avoid activities significantly decreased (0.6 vs 0.2 score, p< .05 ).
Supervised pelvic floor muscle training maintained a consistent exercise compliance rate to keep up the effectiveness of both pelvic floor muscle training programs. Higher exercise compliance rate conducted higher improvement in SUI symptom severity index. The plantar flexion and arms up pelvic floor muscle training program can help women to make improvement on their SUI conditions, enable them to engage in more daily activities, and improve their social life. The plantar flexion and arms up pelvic floor muscle training program is recommended to future participants of SUI treatment.
Disease specific quality of life questionnaire was used to evaluate the outcome of pelvic floor muscle training in this study. The symptom severity index and symptom impact index for female stress incontinence was translated according to the cross cultural adaptation process recommendation. A sample of women (n=83) who experienced stress incontinence in the past year were enrolled with advertisement. After translating the questionnaire, we conducted psychometric testing by internal consistency and criterion-related validity. The UDI-6 and IIQ-7 were used for the testing of criterion-related validity of the Chinese version of symptom severity index and symptom impact index. The scales’ Cronbach’s αwere: overall =.843, the symptom severity index subscale = .811, the symptom impact index subscale = .862. The scales’ criterion-related validity: the symptom severity index subscale was positively significantly correlated with UDI-6 (r = .653, p < .0001), the symptom impact index subscale also was positively significantly correlated with IIQ-7 (r = .702, p < .0001). The Chinese version symptom severity index and symptom impact index for female stress incontinence captured the content and meaning of the original questionnaire through the cross cultural adaptation process, and possessed good psychometric properties. We suggest the Chinese version of symptom severity index and symptom impact index for female stress incontinence would be promoted in the future.

第一章 緒論……………………………………………………… 1
第一節 前言………….………………………………………… 2
第二節 文獻查證………………………………………………… 5
一 應力性尿失禁流行病學及對婦女生活品質的影響. 5
二 應力性尿失禁的處置………………………………………… 8
三 骨盆底肌肉活動……..….………………………………… 11
四 骨盆底肌肉運動………………..………………………. 13
五 影響骨盆底肌肉運動成效的相關因素……………………. 18
六 骨盆底肌肉運動成效的測量….…………………………… 21
第三節 研究目的…………………….……………………… 32
第二章 足踝位置對婦女骨盆底肌肉收縮活動的影響………… 33
中文摘要…………………………………………………………… 34
英文摘要…………………………………………………………… 35
第一節 緒論…………………………………………………………………… 36
第二節 研究方法與材料………………………………………… 40
第三節 結果……………………………………………………… 46
第四節 討論……………………………………………………… 52
第五節 結論……………………………………………………… 56
第三章 中文版應力性尿失禁婦女症狀嚴重度及影響度量表之信效度測試……………………………………………………………………57
中文摘要…………………………………………………………… 58
英文摘要…………………………………………………………… 59
第一節 緒論…………………………………………………………………… 61
第二節 研究方法與材料………………………………………… 66
第三節 結果……………………………………………………… 74
第四節 討論…………………………………………………………………… 82
第五節 結論…………………………………………………………………… 87
第四章 蹠屈臂舉式骨盆底肌肉運動對婦女應力性尿失禁治療成效探討……………………………………………………………………88
中文摘要…………………………………………………………… 89
英文摘要…………………………………………………………. 91
第一節 緒論…………………………………………………………………… 93
第二節 研究方法與材料………………………………………… 97
第三節 結果…………………………………………………………………… 108
第四節 討論…………………………………………………………………… 121
第五節 結論………………………………………………………………… 130
第五章 結論…………………………………………………………………… 131
第一節 結論……………………………………………………… 132
第二節 研究限制………………………………………………… 134
第三節 建議……………………………………………………… 136
參考資料…………………………………………………………… 138
附錄
附錄一 Symptom Severity Index & Symptom Impact Index for stress incontinence in women……………………………… 162
附錄二 原量表作者同意翻譯書……………………………… 164
附錄三 中文版應力性尿失禁婦女症狀嚴重度及影響度量表. 165
附錄四 尿失禁症狀困擾及影響量表簡明版(UDI-6 & IIQ-7).. 168
附錄五 骨盆底肌肉運動記錄表……………………………… 169
附錄六 尿失禁次數登錄表…………………………………… 170
附錄七 電話訪談記錄單……………………………………… 171
附錄八 骨盆底肌肉運動指引手冊專家效度名單……………. 172
附錄九 專家效度審查意見表………………………………… 173
附錄十 傳統式骨盆底肌肉運動指引手冊…………………… 175
附錄十一 蹠屈臂舉式骨盆底肌肉運動指引手冊…………… 180

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