整合性人因危害介入課程改善職場肌肉骨骼不適之成效探討：以某醫學中心門診護理人員為例

The Effect of Integrated Ergonomic Hazard Intervention Program on Decreasing Musculoskeletal Disorders among OPD Nurses in Medical Center

曾麗珠(Li-Chu Tseng) ； 官尹珊(Yin-San Kuan) ； 鄭雅儒(Ya-Ju Cheng) ； 陳佩瑩(Pei-Ying Chen) ； 王玫婷(Mei-Ting Wang) ； 酒小蕙(Hsiao-Hui Chiu) ； 明金蓮(Jin-Lain Ming) ； 王柏堯(Po-Yao Wang)

《臺灣職能治療研究與實務雜誌》 17卷1期 (2021/06) Pp. 11-24

https://doi.org/10.6534/jtotrp.202106_17(1).0002

摘要

目的：本研究探討利用整合性人因危害介入課程，是否能改善門診護理人員肌肉骨骼不適及生活品質的問題。方法：研究對象為某醫學中心門診之護理人員，採隨機分組成實驗組與對照組，最終納入分析為實驗組21名及對照組20名，共41名。實驗組接受1周1次，每次2小時，為期4周的課程與訓練，課程內容包含衛教課程、筋膜伸展、肌力強化訓練，針對肩頸、上下背、上下肢等部位，由職能治療師、物理治療師、復健科醫師、肌力教練分別針對各項課程授課。控制組則接受1次衛教課程（50分鐘）。評估方式以北歐肌肉骨骼系統問卷調查表（Nordic Musculoskeletal Questionnaire, NMQ）及台灣簡明版世界衛生組織生活品質問卷（WHOQOL-BREF問卷、壓力疼痛閾值（Pressure Pain Threshold, PPT）等三樣評估工具，以前後測比較研究對象之疼痛情況改變。統計方法以獨立樣本T檢定、成對樣本T檢定、描述性統計為之。結果：NMQ顯示，多數的實驗組受試者在前測時表示感受到下背（29%）、頸部疼痛（19%），經過四周的介入，下背、頸部嚴重疼痛者皆下降為0%。而除了前臂、大腿之外，其他部位之疼痛分數皆下降且達顯著差異（p ＜ .05）。PPT分數，除在左右側股四頭肌、肱橈肌兩處之外，其他如左右側斜方、三角肌、臀中肌皆能發現PPT分數上升，顯示受試者之疼痛閾值提升且達顯著差異（p ＜.05），對於疼痛的耐受度變佳。另在WHOQOL-BREF也發現實驗組受試者，在整體生活品質、生理領域、心理領域之生活品質有進步且達顯著差異（p ＜ .05）。然而，控制組僅接受過一次課程，在NMQ、PPT、WHOQOL-BREF上，分數皆為持平或略為退步，表示控制組四周的疼痛問題與生活品質並未獲得改善。結論：此課程具有改善職場肌肉骨骼不適、提升生活品質的功能，職能治療師可連結相關資源，舉辦人因健康相關課程，減少人因危害所帶來的肌肉骨骼不適，同時提升職能治療於職場人因危害議題之能見度。

關鍵字

人因危害 ； 肌肉骨骼不適 ； 護理師 ； 職場健康促進課程 ； 職能治療

並列摘要

Objective: The aim of this study was to discuss the effect of integrated ergonomic hazard intervention program on decreasing musculoskeletal disorders among nurses who work in the outpatient department of medical center. Method: Forty-one OPD nurses were randomized to either an exercise-training-group (n = 21) or a control-group (n = 20). The exercise-training-group received once a week for 4 weeks of specific training. The program included education lecture ,stretch lesson and muscle strengthening training .Occupational therapist, physical therapist, rehabilitation physician, and strength coach were invited to instruct different lessons for each target muscle groups, such as neck, upper &lower back, upper & lower limbs. The control-group received only one lecture(50min). Primary outcomes were collected by Nordic Musculoskeletal Questionnaire (NMQ), WHOQOL-BREF, and pressure-pain-threshold (PPT) for baseline-test and post test. Independent t-test and Paired T test were performed to examine the effectiveness of the program. (p ＜ .05). Result: NMQ revealed the most of participants felt severe pain occurring in low back (38.1%) and neck (28.6%) in the exercise-training-group. Following the 4 weeks intervention, post intervention test showed rate of significant pain improvement in low back (4.8%) and neck (4.8%), and other body parts also were also significant improved (p ＜ .05), expect forearm and lower limbs (p ＞ .05). PPT also revealed the pain threshold significant increase in Left and Right Trapezius, Deltoid, Gluteus medius muscle, but no difference in quadriceps and Brachioradialis (p ＞ .05). WHOQOL-BREF showed significant improvement in major domain, physical domain and social domain (p ＜ .05). On the other hand, the score of NMQ, PPT, WHOQOL-BREF showed that there was no significant improvement in control group. Conclusion: Integrated ergonomic hazard intervention program is helpful in improving workers' musculoskeletal disorder and the quality of life. This study can not only serve as a reference for workplace health promotion programs but also promote the visibility of occupational therapy to apply ergonomic intervention in the workplace.

並列關鍵字

ergonomic hazard ； musculoskeletal disorders ； nurses ； workplace health promotion program ； occupational therapy