- 學位論文
雷射針灸配合穴位電針對退化性膝關節炎的療效評估—一雙盲隨機對照試驗
Combined effect of laser acupuncture and electroacupuncture in knee osteoarthritis patients – a double-blind randomized controlled trial
摘要
研究背景：膝退化性關節炎好發於高齡者，主要症狀為膝關節僵硬、疼痛、關節活動受限等，導致生活功能減退，影響獨立自主能力。臨床上，穴位電針是傳統針刺配合電針儀的治療方式，過去研究顯示具有良好的止痛效果。此外，雷射針灸為一種低能量雷射結合傳統針灸原理之治療方式，具有無痛、無侵入性、和零感染的優點，可緩解肌肉疼痛，改善血液循環，適合用在針刺刺痛感較明顯的穴位。然而，對於單用雷射針灸或合併電針治療膝關節退化性疾病的治療效果尚不是很清楚 研究目的： 探討雷射針灸配合穴位電針對退化性膝關節炎的療效。 實驗方法：招募對象為50位年齡大於50歲之退化性膝關節炎之患者，且活動時膝關節疼痛VAS大於3分（滿分10分），疼痛已超過三個月，經X光檢查依據Kellgren-Lawrence Grading Scale of knee為1至3級。排除任一側膝關節曾施行關節置換手術，或曾外傷骨折變形者。亦排除重度肥胖（BMI數值大於35）及近一個月內曾因退化性膝關節炎進行患側關節腔注射或針灸治療者。受試者被隨機均分為兩組：雷射針灸及穴位電針組（LA plus EA組）或偽雷射針灸及穴位電針組（sham LA plus EA組），進行每週3次，為期四週的雷射針灸及穴位電針療程。每次治療時紀錄休息及活動時疼痛VAS分數及止痛藥物使用頻率；第一次治療前及第12次治療後取得WOMAC、KOOS，並測量膝關節彎曲活動角度、股四頭肌僵硬度、身體組成評估，測試張眼單腳站立平衡及30秒椅子坐立等。 實驗結果： 在12次治療後，兩組在組內之活動及休息時疼痛VAS分數（LA plus EA: Effect size(ES) =1.48/ 1.03；sham LA plus EA: ES=2.38/ 1.41）、張眼單腳站立平衡測試（LA plus EA: ES=0.68；sham LA plus EA: ES=0.37）與30秒椅子坐立測試（LA plus EA: ES=0.35；sham LA plus EA: ES=0.34）均有顯著進步；然而，僅有LA plus EA組在WOMAC與KOOS量表上有顯著改善（WOMAC: ES=0.52；KOOS: ES=0.70）。在分量表中，WOMAC日常活動分量表（function: ES=0.56）與五項KOOS分量表（Symptoms: ES=0.67；Pain: ES=0.69；ADL: ES=0.51；Sport: ES=0.43；QOL: ES=0.60）在LA plus EA組均有顯著進步。至於兩組間的各項數值前後變化量比較，則無顯著差異。 結論： 雷射針灸搭配穴位電針可有效減緩退化性膝關節炎患者之疼痛及增強下肢活動功能，並且無嚴重不良反應，但與對照組相比，在膝蓋疼痛減輕量上無明顯組間差異。在治療年長者的前中期退化性膝關節炎，此研究結果推薦雷射針灸合併穴位電針治療，以減輕疼痛、提升下肢活動功能及改善生活品質。
並列摘要
Background: Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with outstanding analgesic effect and minimal side effect. Laser acupuncture (LA) and electroacupuncture (EA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies. Objectives: This study aims to investigate the combined effect of LA and EA in KOA patients. Methods: Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (LA plus EA) or control group (sham LA without laser output plus EA). All subjects in the treatment group will undergo a combined LA and EA treatment thrice a week for 4 weeks. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, single-leg stance test, and the 30-s chair stand test before and after 4 weeks of intervention. Results: After the twelve interventions, there were significant intra-group improvements for the visual analog scale during activity(LA plus EA: Effect size(ES) =1.48；sham LA plus EA: ES=2.38), visual analog scale during rest (LA plus EA: ES=1.03；sham LA plus EA: ES=1.41), single-leg stance test(LA plus EA: ES=0.68；sham LA plus EA: ES=0.37), and the 30-s chair stand test (LA plus EA: ES=0.35；sham LA plus EA: ES=0.34) in both groups. WOMAC(ES=0.52), KOOS score (ES=0.70), WOMAC function subscales (function: ES=0.56), and all five KOOS subscales (Symptoms: ES=0.67；Pain: ES=0.69；ADL: ES=0.51；Sport: ES=0.43；QOL: ES=0.60) had significant improvements only in LA plus EA group. However, there was no significant difference of outcome changes between the treatment and control groups. Conclusion: LA combined with EA decreased knee pain and improved physical function in elderly people with mild-to-moderate KOA, although no notable between group difference on VAS changes were found when being compared to sham LA plus EA treatment. No serious adverse effect was reported. Based on the findings in this study, we recommend the combined treatment of LA and EA for KOA population to reduce pain, improve function and quality of life.