頸部理學檢查之信度研究

背景與目的：頸部疼痛是物理治療師臨床上常遭遇到的問題，通常治療前必須先執行一些理學檢查以評估病患之狀況，方能夠給予更精確與更有效的治療。然而，許多臨床常用的頸部評估方法之信度仍尚未被建立。因此，本研究的目的在於探討物理治療常用的頸部評估測試之信度。方法：本研究之受試者為20名沒有任何頸部不適症狀的成年人，施測者為同一人。所有受試者於當日與隔日重複受測，以計算每項測試的測試者內信度(intra-rater reliability)。本研究所包括的測試包含頭前傾評估、頸部短屈肌耐力測試、頸椎側滑活動度測試、環椎樞椎旋轉活動度測試、第一肋骨升高測試、與上肢張力測試等。結果：共有20位(9男11女，年齡34.5±16.8歲)健康成年人完成測試。頭前傾評估測試之當日與隔日信度分別為ICC=0.98及0.83。頸部彎曲耐力測試之當日與隔日信度為ICC=0.99及0.98。頸椎側滑測試的結果，除了枕骨左側滑動(κ=0.44)和頸椎第五節右側(κ=0.26)之隔日信度較低之外，枕骨右側滑動與其他頸椎節數無論左右兩側的當日與隔日信度均有中等以上的信度(κ=0.60-1.00)。三項神經張力測試(正中神經、橈神經、尺神經)，除了橈神經測試的隔日信度卻僅有輕微的信賴程度(κ=0.25)外，所有當日及隔日信度都在良好範圍內(κ=0.64-1.00)。環椎樞椎旋轉測試(κ=0.89-1.00)與第一肋骨升高測試(κ=0.77-0.85)的當日與隔日信度亦都顯示有實質上之信度。結論：本研究檢驗了臨床常用之頸椎理學檢查之測試者內當日與隔日信度，除了驗證過去相關文獻曾探討的常用理學檢查之各項測試的測試者內信度均不錯外，更發現過去尚未被探討過的寰椎樞椎旋轉測試、第一肋骨升高測試、中下段頸椎側滑測試與上肢張力測試中的橈神經與尺神經測試亦具有良好的信度，以上所有的發現提供了臨床上執行頸部理學檢查的信度參考。(物理治療2003;28(6):333-340)

關鍵字

頸椎；理學檢查；再測試信度

並列摘要

Background: Neck pain is a common clinical problem. Physical examinations are often administered to assess patient's physical condition before rendering treatments. However, reliability of the commonly used physical examinations of the cervical spine has not been well established. Therefore, the purpose of this study was to explore the reliabilities of six physical examinations in the management of neck pain. Methods: Healthy adults without neck disorders were recruited in our study. One rater completed all examinations for all subjects. The tests included the forward head assessment, short neck flexors endurance test, cervical lateral glide tests, atlantoaxial rotation test, first rib elevation test, and upper limb tension tests (ULTTs). Results: Twenty subjects (9 males and 11 females, mean age = 34.5±16.8 years old) completed all physical examinations. Excellent within- and between-day reliabilities were found in the forward head assessment (ICC = 0.83-0.98), the cervical short flexors endurance test (ICC = 0.98-0.99), the atlantoaxial rotation test (κ = 0.89- 1.00), and the first rib elevation test (κ=0.77-0.85). The reliability of the lateral gliding tests in almost all segments were beyond moderately agreement (κ= 0.60- 1.00) except the between-day reliabilities of lateral gliding tests of the left occiput (κ=0.44) and the right C5 (κ=0.26) were low. In the three ULTTs (median, radial, and ulnar bias), within- and between-day reliabilities were also beyond moderate agreement (κ=0.64-1.00) except for the between-day reliability in radial bias test (κ= 0.25). Conclusion: Excellent intra-rater within- and between-day reliabilities were established in most tests. In addition, we found excellent reliability in the un-reported lateral glide tests of middle and lower segments and radial and ulnar bias in ULTTs. These findings warranted scientific evidence for these commonly used physical examinations. (FJPT 2003;28(6):333-340)

並列關鍵字

Cervical spine,Physical examination,Test-retest reliability

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頸部理學檢查之信度研究

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