姿勢矯正回饋訓練在機械性頸痛患者之應用

The Application of Postural Correction Biofeedback Training for Clients with Mechanical Neck Pain

李彥成(Yen-Cheng Lee)

指導教授 ： 郭藍遠

高雄醫學大學/醫學院/運動醫學系研究所/碩士(2013年)

https://doi.org/10.6832/KMU.2013.00007

摘要

背景：近年來，機械性頸痛已是相當普遍的肌肉骨骼疾病，其造成醫療資源需求及經濟負擔增加的問題不容小覷。許多研究認為，長時間維持不良的靜態頸部姿勢可能是導致頸痛的主因。部分文獻曾使用姿勢運動來介入受試者，發現具有正向的效果。然而就本研究所知，過去的研究很少合併姿勢矯正和視、聽覺回饋來訓練頸痛受試者，並同時評估訓練後頸部六個主要動作方向(屈曲、伸展、左右旋轉、左右側彎)的感覺動作功能與自我感知臨床症狀改善的程度。目的：探討姿勢矯正合併回饋訓練對於機械性頸痛患者臨床症狀的影響。方法：20位機械性頸痛受試者隨機分配為控制組與訓練組，控制組給予六個主動頸椎關節活動作為安慰劑，訓練組則進行每次一小時，共四小時的姿勢矯正回饋運動，於一週內完成。主觀參數使用相關問卷評估介入前後指數的變化。而客觀參數使用六自由度電磁場軌跡追蹤系統來評估介入前後頸部六個動作方向的頭部位置並由Matlab計算關節回位之誤差值，包括:絕對誤差值及其變異誤差值，頸部活動時動作單元的個數、最大角速度、達到最大角速度之時間百分比、及最大關節活動度的改變。此外觀測主觀參數的改善與客觀參數的改善之間的關聯性，並且決定影響主觀參數變化的重要因子。結果：介入姿勢矯正回饋訓練的受試者，主觀參數方面，只在恐懼逃避信念的指數有顯著改善(p<0.05)。客觀參數方面，頸部關節回位絕對誤差值在屈曲、伸展、向右旋轉、向左側彎動作時有顯著改善(p<0.05)；頸部關節回位變異誤差值在屈曲、伸展、向左旋轉動作時有顯著改善(p<0.05)。而控制組在動作單元個數在伸展、向右旋轉、向左旋轉動作時有顯著減少(p<0.05)，以及頸部最大關節活動度在向右旋轉時有明顯減少(p<0.05)。另外並發現，訓練組之頸部關節回位絕對誤差值的改善與疼痛指數的改善呈現正相關，且可解釋68%疼痛強度改善的變異量；而最大關節活動度的改善與恐懼逃避信念指數的改善呈現負相關，且可解釋46%恐懼逃避信念指數身體活動部分改善的變異量。結論：姿勢矯正回饋訓練可藉由改善感覺動作功能，進而影響機械性頸痛患者的臨床症狀。

關鍵字

機械性頸痛 ； 姿勢矯正回饋訓練 ； 回位誤差 ； 變異誤差 ； 動作單元

並列摘要

Background: In recent years, mechanical neck pain (MNP) has become a widespread musculoskeletal disorder. The issue that it results in increasing the requirements of medical resource and economic burden should not be underestimated. Many studies suggested that people maintain static and poor neck posture for a long time may cause neck pain. Some researches have used postural exercise to train client with neck pain and found its positive effect. However, to our knowledge, few studies combined postural correction and visual/auditory biofeedback to train subjects with neck pain, and evaluated the improvement of sensorimotor function in six cervical movements (flexion/extension, right/left rotation, right/left side-bending) and self-estimated clinical symptoms. Purposes: To investigate the effects of postural correction biofeedback training on clinical symptoms for Clients with MNP. Methods: Twenty subjects with MNP were divided into control and training group randomly. Control group were instructed to do active cervical range of motion for placebo. Training group carried out postural correction biofeedback exercise for one trial an hour, total four hours training in a week. The changes of subjective parameters were assessed by related questionnaires before and after training. Objective parameters were evaluated by 6 degrees of freedom electromagnetic tracking system for head position in six cervical movements and calculated by Matlab for reposition error, including absolute error and variable error, movement unit, peak angular velocity, the percentage of time to peak angular velocity, and max range of motion before and after training. Furthermore, this present study investigated the association between the improvement of subjective and objective parameters, and determined the key factor that affected the change of objective parameters. Results: In subjective parameters, subjects who were intervened postural correction biofeedback training showed that the index of fear-avoidance belief questionnaire (FABQ) improved significantly (p<0.05). In objective parameters, reposition absolute error was improved significantly for training group in cervical flexion, extension, rotation to right and side-bending to left (p<0.05); reposition variable error was improved significantly for training group in cervical flexion, extension and rotation to left (p<0.05). The number of movement unit was significant decreased for control group in cervical extension, rotation to right and left (p<0.05). Maximum range of motion (ROM) was significant decreased for control group in cervical rotation to right (p<0.05). Besides, the improvement of reposition absolute error was positive correlates to the improvement of pain intensity, and it could explain 68% of variation of the improvement of pain intensity; the improvement of maximum ROM was negative correlates to the improvement of FABQ physical part, and it could explain 46% of variation of the improvement of FABQ physical part for training group. Conclusion: Postural correction biofeedback training could improve the sensorimotor function and further affect the clinical symptom of clients with MNP.

並列關鍵字

Mechanical neck pain ； postural correction biofeedback training ； reposition error ； variable error ； movement unit

參考文獻

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