臺灣博碩士論文加值系統

目前治療嚴重髖關節問題的病人主要是以人工髖關節置換為主要方法，針對這類患者，設計一套手術後的復健運動來提升患者的肌力，避免併發症產生是很重要的。本研究之目的是希望瞭解在現行的健保體制下，人工髖關節置換患者手術後已無法得到充分的物理治療，對這些置換關節的患者施以居家運動治療促進其功能及肌力是否可行？以及評估台灣人工髖關節置換患者執行居家運動之依從性高低，並瞭解居家運動之依從性對運動效果的影響？有56位單側人工髖關節置換至少半年的病人參與本研究，隨機分配為兩組：29位為實驗組，27位為控制組，在第一次檢測和三個月後兩組受試者皆接受評估，包括髖關節肌力、功能及行走速度三種測試。實驗組於第一次評估後，教予居家復健運動處方。執行居家運動的依從性，從兩方面評估:一為“執行量”二為“執行品質”。經居家運動訓練後有明顯差異的變數，與居家運動執行量、執行品質以及個人特質做相關性分析。結果顯示:實驗組與控制組兩組在哈雷氏髖關節功能評分以及患側髖關節外展、屈曲、伸直等動作的力距頂值(peak torque)上有明顯差異，但兩組在開刀側髖關節內收、非開刀側髖關節外展、內收、屈曲、伸直以及步行速度上均沒有差異。哈雷氏髖關節功能分數及髖關節屈曲的力距頂值與居家運動執行品質(運動扭曲程度)及運動後會疲乏有關，髖關節外展、伸直的力距頂值與個人特質中的是否有運動習慣有關。執行頻率與自我評分、執行運動是否感到疲乏以及運動扭曲程度，這三個變數有明顯相關。所以，對髖關節置換術後半年以上的病人，三個月的居家運動，至少六次的電話追蹤，這樣的設計對台北市髖關節置換的病人應是有幫助的，而且執行居家運動動作較正確者或平時就有規律運動習慣的病人，可以有較好的肌力、功能及行走速度表現。運動扭曲和執行量的依從性之間有高相關性，提醒運動指導者對於運動扭曲項目過多的病患，應特別加強聯絡或是仍透過門診物理治療，不應以居家運動完全取代門診物理治療。

The patients with serious hip problems are mostly treated by total hip replacement. It is then important to design a set of exercise for these patients, to help them enhance their muscle strength, promote functional recovery and prevent postoperative complications. In the current insurance system in Taiwan, total hip replacement patient can not get completely physical therapy. Thus, the purpose of this study is to find out if it is feasible to apply home exercise program on them and to help them enhance their muscle strength and operative outcome. Also, we would like to evaluate the compliance of total hip replacement patients in executing the home exercise program, and to investigate the effect of such compliance to the exercise program. The results of this study show that the experimental group and control group have significant differences on Harris hip score and the peak torque of affected hip abductor, flexor, extensor. However, there is no significant difference on operated hip adductor, all hip muscles of non-operated side, and pace speed. The improvement of Harris hip score and peak torque of hip flexor is related to the extent of exercise distortion. The increases of peak torque of hip abductor and flexor are related to the exercise hobby. The practice ratio depends on loyalty, post-exercise fatigue and the extent of exercise distortion. Therefore, for those patients who had done the total hip replacement operation for more than half year, if give them three month home exercise, and at least six telephone follow ups. This study found out that those patients who execute their home exercise seriously-- those who had more accurate movements or those who do exercise regularly will have better performance. Exercise distortion and compliance of home program are highly related. It is recommended that the patient who execute the home exercise incorrectly will also tend to have lower exercise compliance, the instructor should emphasize on connection or through outpatients department of physical therapy, not just by home exercise only.

目錄 ------------------------------------------- i
表目錄 ----------------------------------------- iii
附件目錄 --------------------------------------- iv
中文摘要 --------------------------------------- v
英文摘要 --------------------------------------- vi
第一章 前言
研究背景-------------------------------- 1
研究目的-------------------------------- 4
實驗假設-------------------------------- 5
名詞定義-------------------------------- 7
第二章 文獻回顧
居家運動(home exercise)與門診物理治療
(regular physical therapy)------------- 9
影響居家運動成效的因素----------------- 10
控制居家運動的執行品質----------------- 13
等速肌力測試儀之信度及效度------------- 14
第三章 研究方法及步驟
受試者--------------------------------- 15
設備----------------------------------- 15
實驗步驟------------------------------- 16
資料分析與統計------------------------- 21
第四章 結果----------------------------------- 22
第五章 討論----------------------------------- 24
第六章 結論----------------------------------- 30
參考文獻 ------------------------------------- 31
表格 ----------------------------------------- 36
附件 ----------------------------------------- 41

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