頸痛患者理學檢查之一致性探討

背景與目的：理學檢查可將病人症狀清楚描述、分類，及針對個別狀況提供適合的治療。故需建立頸部疼痛患者理學檢查的信度。方法：受試者為接受物理治療門診治療之頸痛病人。兩位物理治療師分別進行理學檢查，其中一位治療師進行問卷調查。理學檢查內容包括觀察、觸診、動作檢查、肌肉柔軟度、椎間活動度、肌節檢查及特殊檢查。資料由第三位研究者分析各評估項目的卡帕值(kappa)和測試同意百分比(percent agreement)。Kappa值大於0.40表示信度中等以上。結果：本篇收案共35人，平均年齡44.6±12.3歲。動作測試、椎間活動度及大部份觸診和柔軟度信度在中等以上（kappa值＞0.4），牽拉測試有良好的信度（kappa值＝0.71）。肌節檢查及特殊檢查因結果集中於正常分類，所以同意百分比高（同意百分比＝0.93），但kappa值低（kappa值＝0.00）。結論：清楚定義及標準程序下施行觸診、動作檢查及特殊檢查等引發疼痛程度變化之理學檢查項目，可達較高之施測者間一致性。一致性較低之觀察項目，未來可望以輔助儀器提高一致性。

關鍵字

信度；頸痛；理學檢查；活動度；觸診

並列摘要

Background and Purpose: Patients could be categorized into subgroups according to different pathogenesis of neck pain by physical examination. For applying appropriate treatments to specific subgroups, it is important to establish the reliability of physical examinations for individuals with neck pain. Methods: The participants were recruited from an outpatient physical therapy department. Two physical therapists independently assessed the participants with physical examinations, and one of them helped the subject fulfilling the questionnaires. Physical examinations included observation, palpation, movement test, mobility test, myotomes, and special tests. The third researcher analyzed the data and compared the kappa value and percent agreement in each testing item. Kappa value above 0.4 was considered moderately reliable. Results: Thirty-five participants (mean age=44.6±12.3 years) were enrolled in this study. The observation, flexion and extension items of movement tests, segmental mobility test, most of the palpation, and flexibility tests reached moderate reliability (kappa value＞0.4), The distraction test showed substantial level of consistency (kappa value=0.71). Some myotomes and special tests showed low kappa value (kappa value=0) but high percent agreement (percent agreement 0.93). Conclusion: The tests with symptoms changed, clear definition and standardized procedure could reach highly consistent results, such as palpation, movement tests, and special tests. The agreement of observation examinations with slight to fair level might be improved by using assisted devices in future investigations.

並列關鍵字

Reliability ； Neck pain ； Physical examination ； Range of motion ； Palpation

國際替代計量

頸痛患者理學檢查之一致性探討

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