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系統識別號 U0026-1805201211522900
論文名稱(中文) 從工作相關姿勢與多面向參數的評估探討低強度背部運動治療計劃對下背痛電腦族的治療效益
論文名稱(英文) Effect of low-intensity back school on working postures, multi-dimensional parameters and low back pain among computer users
校院名稱 成功大學
系所名稱(中) 物理治療研究所
系所名稱(英) Department of Physical Therapy
學年度 100
學期 2
出版年 101
研究生(中文) 林家穗
研究生(英文) Chia-Sui Lin
學號 T66991046
學位類別 碩士
語文別 英文
論文頁數 69頁
口試委員 指導教授-卓瓊鈺
召集委員-蔡一如
口試委員-楊政峰
中文關鍵字 坐姿工作者  電腦族  背痛  背部運動訓練 
英文關鍵字 seated worker  computer users  low back pain  back school 
學科別分類
中文摘要 研究背景與目的:電腦族是典型的坐姿工作者,而在電腦族常見的骨骼肌肉系統症狀中,下背痛的發生率已被證實是明顯較高的。雖然近來已有越來越多的研究著重於電腦族骨骼肌肉系統症狀的治療,但仍欠缺研究探討低強度背部運動訓練對患有下背痛的坐姿電腦工作者的治療效益,同時,在亞洲地區也尚未有人結合工作姿勢風險的評估、脊椎角度以及其他多面向的相關參數的評估進一步探討低強度背部運動訓練的治療效益。因此,本篇研究的目的乃在探討在台灣地區施行低強度背部運動訓練對於患有慢性下背痛的坐姿電腦工作者之治療效益,同時也想藉由工作姿勢風險、脊椎角度以及其他多面向的相關參數評估來探討背部運動訓練的治療效益。研究方法:本研究共納入30位患有3個月以上慢性下背痛的坐姿電腦工作者,所有的參與者必須每週使用電腦超過20小時且年紀介於20-45歲。所有的參與者都會接受連續四週、每週一次、每次持續一個小時的低強度背痛運動訓練課程。前測與後測的評估項目包括每個參與者的工作姿勢、脊椎角度、下背疼痛程度、身體失能指數、日常功能評估以及害怕活動的程度。統計方法採用兩組相依樣本t檢定(Paired t test)以及魏可遜等級和檢定(Wilcoxon Rank Sum Test)比較治療前後在角度、問卷和量表的差異。進一步根據所有受測者在初評時的背痛程度分成兩個次小組進行探討,研究者採用獨立t檢定(Independent t test)和曼-惠特尼U考驗法(Mann-Whitney U test)比較兩個次小組在初評時的差異,而重複量數變異性分析(Analysis of variance with repeated measure)則用來檢定時間和組別兩個因子的交互作用。皮爾遜積差相關係數(Pearson correlation coefficient)與斯皮爾曼等級相關(Spearman rank order correlation)用來檢定疼痛程度與其他參數之相關性。結果:所有參與者每日使用電腦的平均時數為9.68個小時。經過低強度背痛運動訓練課程後,過去7天的下背疼痛分數(p=0.05)、雙側的快速全身姿勢評估量表(REBA) (右側,p=0.03;左側,p=0.02)以及歐式下背痛失能量表(modified OSW) (p<0.01)都有明顯的下降。在姿勢的改變上,則發現在直立坐姿(reference sitting) (p=0.02)以及工作姿勢(p=0.03)下,腰椎角度以及骨盆角度都有明顯的下降。在舒適的站姿(p<0.01)和身體前彎(p=0.04)的情況下,骨盆角度則有明顯的增加。當根據所有受測者在初評時的背痛程度分成兩個次小組進行進一步探討時,發現中度症狀組經過低強度背部運動訓練後日常功能的失能指數明顯下降的比輕度症狀組來的多(p=0.04)。此外在角度上也發現,兩組在治療前沒有顯著差異,在經過運動訓練後,中度症狀組的腰椎角度在站姿的情況下明顯大於輕度症狀組(p=0.05),而在執行身體前彎的測試時,中度症狀組的骨盆傾斜角度則明顯小於輕度症狀組(p=0.04)。進一步探討疼痛程度與各參數的關聯性發現:疼痛的嚴重程度和工作時數(γ=0.43, p=0.03)、坐姿的自由度(γ=-0.42, p=0.04)、過去七天疼痛改變的分數 (γ=0.57, p=0.003)以及日常功能失能量表的改變分數(γ=0.45, p=0.03)均有顯著相關。結論:根據本研究的結果,我們確定低強度背部運動訓練對於有下背痛的坐姿電腦工作者在背痛程度、工作現場的調整、日常功能以及相關姿勢的改變均有正向的效益。另外,由於我們發現工作時數、背痛分數的改變量和日常功能失能量表的改變分數與背痛的嚴重程度均呈現正相關;而不同背痛程度的組別,在經過運動訓練過後,兩組姿勢的差異有放大的現象。因此,我們建議若之後的研究欲進行低強度背部運動訓練之效益探討時,應將參與者在治療前的背痛嚴重程度納入考量,以防止治療效益因組別進步的差異而被抵銷。
英文摘要 Background and purposes: Computer users are typical seated office workers. The high prevalence of musculoskeletal symptom for computer users was found on lower back region. Although there is a growing interest to improve musculoskeletal disorders among computer users, none of the previous study discussed the treatment effects of low-intensity back school among seated computer users with chronic LBP in Taiwan. Simultaneously no study explored the treatment effects by assessing workstation ergonomics, posture correction, and multi-dimensional parameters. Two main purposes of the current study were: first, to explore the treatment effects of low-intensity back school among seated computer users with non-specific chronic low back pain in Taiwan; second, to evaluate the treatment effects of the low-intensity back school on seated computer users by using posture analysis and multi-dimensional parameters. Methods: Thirty seated computer users with non-specific chronic low back pain for at least 3 months, computer use for at least 20 hours a week, and aged between 20-45 years were included. All participants received a low-intensity back school program, which consisted of 4 sessions, once a week course, and each lasted an hour. The initial examination and re-evaluation includes working posture, spinal curvature assessment, pain intensity, physical impairment, daily function, and fear of movement. Paired t and Wilcoxon tests were used to test the difference of questionnaire and kinematic parameters between pre- and post-treatment. Further comparison of the results between two subgroups depends on the discomfort levels at baseline. Independent t test and Mann-Whitney U test were used to compare the difference of baseline data between two subgroups. Analysis of variance with repeated measure on time factor was used for dependent measurement analysis. Pearson correlation and Spearman rank order correlation were used to explore the correlation between pain intensity and other parameters. Results: The mean hours of daily computer usage was 9.68 hours. After the low-intensity back school, significant decreases on numerical rating scale over past 7 days (p=0.05), Rapid Entire Body Assessment scores on bilateral sides (right side, p=0.03; left side, p=0.02), and modified Oswestry low back pain disability questionnaire (p<0.01) were found. For postural correction, significant decreases on lumbar angles during reference sitting (p=0.02) and working posture (p=0.03) were observed. In standing (p<0.01) and toe touching test (p=0.04), pelvic angle increased significantly. When all participants were further divided into 2 groups according to their discomfort scores, a greater decrease on modified OSW was found in the moderate pain subgroup than in the mild pain subgroup after the low-intensity back school (p=0.04). The differences on lumbar angle of standing (p=0.05) and pelvic angle of toe touching test (p=0.04) between two subgroups were apparent after the intervention. Regarding to the relationship between pain and computer usage habit, it was found that there were significant correlations between low back pain intensity and working hours (γ=0.43, p=0.03), change score of NRS over past 7 days (γ=0.57, p=0.003), change score of modified OSW (γ=0.45, p=0.03), and freedom of sitting (γ=-0.42, p=0.04). Conclusion: According to the results of current study, we confirmed the effect of low-intensity back school on pain intensity, workstation ergonomics, daily function and postural alteration in LBP computer users. Besides, low back pain intensity was positively correlated to working hours, change score of NRS over past 7 days, and change score of modified OSW. Moreover, the differences of postural alternation between different severity subgroups were amplified after the low-intensity back school. Therefore, we suggested if future study likes to explore the effect of low-intensity back school, researchers should take the participants’ baseline pain severity into consideration for avoiding the alleviation of treatment effect.
論文目次 Abstract I
中文摘要 IV
Acknowledge VI
Table of Contents VII
List of Tables IX
List of Figures X
Chapter 1. Introduction - 1 -
1.1、Computer users and musculoskeletal symptoms - 1 -
1.2、Computer users’ occupational characters - 1 -
1.3、Back school intervention - 2 -
1.4、Measurements of treatment effect - 4 -
1.5、Motivations and purposes - 14 -
Chapter 2. Method - 15 -
2.1、Study population - 15 -
2.2、Procedure - 16 -
2.3、Program of intervention - 16 -
2.4、Outcome measures - 17 -
2.5、Data analysis - 22 -
Chapter 3. Results - 24 -
3.1、Treatment effect on questionnaires. - 24 -
3.2、Treatment effect on postural angles. - 24 -
3.3、Mann-Whitney U test and repeated measure: two-subgroup difference. - 25 -
Chapter 4. Discussion - 27 -
4.1、Baseline characteristics of participants. - 27 -
4.2、Treatment effect of low-intensity back school - 28 -
4.3、Two-subgroup difference. - 36 -
4.4、Limitations. - 38 -
Conclusion - 40 -
References - 41 -
Appendix - 63 -
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