職能治療師在協助站立桌訓練之人因危害探討

站立桌訓練是復健科生理職能治療的熱門作業項目之一，由於站立桌的硬體與環境限制，使的職能治療師操作該訓練時必須使用不對稱的姿勢並以單手施力來對訓練者進行抬舉，協助身障個案在輪椅上進行從坐到站的轉位，而個案站立起身不足的力氣則就必須由治療師來承擔，沉重的體重和需要快速協助個案就定位來進行訓練，常導致成治療師的肌肉骨骼的損傷，本研究針對該項訓練時治療師的姿勢、個案的身材、坐高來進行研究分析並給予此項目的改善建議。在某中部醫學中心職能治療科室中的治療師，使用人因性危害風險評估、站立桌情境問卷、人因性危害問卷調查及拍攝治療師在進行站立桌訓練的影片，影片拍攝不同治療師協助自己主責個案進行站立桌訓練，包括從坐到站及從站到坐的協助過程，再藉由軟體來分析影片進行脊椎角度的變化及受力情形的模擬。從人因性危害風險評估工具結果，KIM-LHC的評估風險等級男性為中高、女性為高，OWAS風險等級為AC3、AC4，RULA風險等級為AL4，都指向了該訓練對治療師造成肌肉骨骼損傷很大的風險。問卷調查全部治療師都將該訓練作業放入身體負荷排名中的前三名且都有面對該訓練時有不同情境下產生困擾的經驗，有一半的治療師在上肢、背部都有產生不適的情形。利用所拍攝的影片數據套用到軟體模擬站立桌訓練，在最少彎腰20度及25公斤的負荷模擬下治療師的腰椎L4/L5受力都超過荷重負荷的3400N安全線。歸納以上研究評估與數據，顯示出主要風險因子為姿勢、施力、環境與設備、人員這四項因素。從研究結果驗證了該作業訓練的存在高的人因危害風險，並在討論風險因子後針對這四項因子可進行的改善給予臨床治療師改善建議，如在訓練時給予外在動力輔助、使用懸吊系統、起身器、電動升降桌等、也可以在人力允許下，配置兩名以上的協助者或進行個案能力需求的協助量篩選，這些方法都可以降低站立桌訓練的人因危害風險。

關鍵字

職能治療師；站立桌；不對稱性姿勢；單手抬舉作業

並列摘要

The standing table training is one of the popular tasks in the field of physiotherapy rehabilitation. Due to hardware and environmental limitations of the standing table, therapists must use asymmetrical postures and exert force with one hand to lift the trainee, assisting them in transferring from sitting to standing on the wheelchair. In cases where the trainee lacks sufficient strength to stand up, the therapist has to bear the weight and provide quick assistance to position the trainee. This often leads to musculoskeletal injuries for the therapist, given the heavy weight and the need for rapid assistance in positioning the trainee. This study focuses on analyzing the therapist's posture, the trainee's physique, and the seating height during this training to provide improvement recommendations. Therapists at a certain central medical center's occupational therapy department were evaluated using human factors risk assessment, standing table scenario questionnaires, human factors hazard questionnaires, and video recordings of therapists conducting standing table training with their assigned trainees. The recorded videos captured different therapists assisting their trainees in both sitting-to-standing and standing-to-sitting processes. Software was used to analyze changes in spinal angles and simulate force distribution based on the video data. Based on the results of the human factors risk assessment tools, the KIM-LHC assessment indicated moderate to high risk for male therapists and high risk for female therapists. The OWAS assessment showed AC3 and AC4, while the RULA assessment showed AL4, all pointing to significant musculoskeletal injury risks for therapists during this training. The questionnaire survey revealed that all therapists ranked this training among the top three in terms of physical demand and experienced various difficulties during the training. Half of the therapists reported discomfort in the upper limbs and back.Using the recorded video data, simulations of standing table training were conducted with a minimum bending of 20 degrees and a load of 25 kg. The lumbar L4/L5 force on the therapists exceeded the 3400N safe line for load-bearing. Summarizing the research evaluation and data, the main risk factors identified are posture, exertion, environment, equipment, and personnel-related factors. The research results confirmed the high human factors risk of this training operation. After discussing the risk factors, improvement recommendations were provided for clinicians. These included providing external power assistance during training, using suspension systems, lifters, electric height-adjustable tables, and, where feasible, assigning multiple assistants or conducting screening for the trainee's capacity requirements. These measures can help reduce human factors risks associated with standing table training.