某安養機構照顧者肌肉骨骼傷害之調查

The investigation of musculoskeletal injuries of caregivers in a certain disability services setting

葉爾煒(Er-Wei Yeh)

指導教授 ： 呂志維

高雄醫學大學/健康科學院/職業安全衛生研究所/碩士(2004年)

摘要

安養機構之照護人員必需長時間、重複的以不自然的姿勢幫失能者進行翻身、換尿布、洗澡、餵食、輔助上下床及治療等作業活動，容易造成肌肉骨骼的傷害。
研究目的為瞭解安養機構失能照護人員作業及肌肉骨骼偒害之情形及可能的影響因子，本研究主要採問卷為主，作業觀察及記錄為輔，以發覺從事該作業時所可能的其他危害。
本研究共計蒐集有效問卷52份，分析結果發現受訪者自述身體各部位不適者計有42位受訪者回答有肌肉骨骼不適的情形，佔了81.0％，其中受訪者自覺身體各部位肌肉骨骼不適的發生頻率及百分比以下背部的34次為最高，佔了65.4%，其次依序為肩部的25次(48.1%)、手/手腕的24次(46.2%)、脖子的17次(32.7%)有較高的不適比例。
研究結果發現，受訪者所使用的慣用手、每日平均工作時數及工作時間內有否休息與受訪者肌肉骨骼傷害程度有顯著相關(P<0.05)。以問卷為依據，MSDs及BRIEF檢核表分析結果顯示，BRIEF檢核表在背部(100%)、頸部(100%)、左手/手腕(100%)及右手/手腕(95.8%)有較高的敏感度，而MSDs檢核表則在背部、下肢部位(100%)有較好的敏感度。
由問卷與BRIEF檢核表對肌肉骨骼傷害之Paired t-test結果顯示，在α=0.05的情形下，BRIEF檢核表在頸部、右肩膀、右及右手、左右手肘及背部等部位所檢核出之結果與問卷之結果在統計上無顯著的差異；由問卷與MSDs檢核表對肌肉骨骼傷害之Paired t-test結果顯示，MSDs檢核表在左、右手、右及左手肘及背部等部位所檢核出之結果與問卷之結果在統計上無顯著的差異；兩種檢核表在背部、手/手腕及手肘等部位與問卷調查之結果較為一致，而BRIEF檢核表又似乎較MSDs檢核表更佳，與之前由敏感度比較得到BRIEF檢核表有較佳的結果相符合。
肌肉骨骼傷害問卷(NMQ)與肌肉骨骼傷害人因工程檢核表(MSDs)及人因工程因素基準線風險認定檢核表(BRIEF)應用於安養機構之分析結果，肌肉骨骼傷害問卷(NMQ)與MSDs及BRIEF兩種檢核表在使用範圍涵蓋面上，肌肉骨骼傷害問卷與人因工程因素基準線風險認定檢核表(BRIEF)要優於肌肉骨骼傷害人因工程檢核表(MSDs)；另外，對安養機構照護作業人因危害評核的詳細程度上，由於人因工程因素基準線風險認定檢核表(BRIEF)評估至各項動作單元的姿勢、施力、期間及頻率，故較為詳細。肌肉骨骼傷害人因工程檢核表(MSDs)，因其評估動作較為概括性，如若硬將其細分成各部位評估，易發生錯誤且分類困難，況且其評估週期亦較長，故在詳細程度上不若人因工程因素基準線風險認定檢核表(BRIEF)精細。

關鍵字

安養機構 ； 肌肉骨骼傷害 ； 問卷調查 ； 工作分析

並列摘要

The caregivers of disability service settings need to help patients turning over, change diaper, take a shower, feed on, assist get on and get off the bed, and treat in repeat, unnatural posture for a long time which easily causes themselves musculoskeletal injuries.
The purpose of this research is to understand and record the situation and possible factors of musculoskeletal injuries of caregivers in disability service settings. The methods of research was conducted mainly by questionnaires and musculoskeletal disorders checklist (MSDs) and Baseline Risk Identification of Ergonomic Factors checklist (BRIEF) and assisted by operation observation and record to discover the other damages of such operations.
In this research, 52 valid questionnaires were retrieved. Analysis showed, in self-reported, 42 interviewees expressed certain musculoskeletal injuries, occupying 81.0% of all effective questionnaires. Among the frequency of injuries in different body parts, 34 expressed injuries in lower back, 65.4%; followed by 25 injuries in shoulder, 48.1%, 24 injuries in hand/wrist, 46.2%, and 17 injuries in neck, 32.7%.
Research results showed there existed a significant correlation (P<0.05) between the musculoskeletal injuries with the used hand, daily average working hours, and whether rest was taken in working hours. According to questionnaires, the results of MSDs and BRIEF examination form showed that BRIEF examination form has a higher sensitivity in back (100%), neck (100%), left hand/wrist (100%), and right hand/wrist (95.8%) and MSDs examination form has the better sensitivity in back and legs (100%).
The pair t-test result of questionnaires and BRIEF examination form showed, under α=0.05, there is no obvious statistical difference of the examination results and the questionnaire results in injuries in neck, right shoulder, right and left hands, right and left elbows, and back. The pair t-test result of questionnaires and MSDs examination form showed that there is no obvious statistical difference of the examination results and the questionnaire results in injuries in right and left hands, right and left elbows, and back. The two examination forms have consistent results with questionnaires in back, hand/wrist and elbow. BRIEF examination form seems better than MSDs examination form. It matched with the past sensitivity result that BRIEF examination form achieved better results.
The analysis result of applying Nordic Musculoskeletal Questionnaire (NMQ), Musculoskeletal Disorders checklist (MSDs) and Baseline Risk Identification of Ergonomic Factors checklist (BRIEF) to rest homes showed that NMQ and BRIEF are better than MSDs in the scope of usage. Besides, since BRIEF had evaluated the posture, force, period, and frequency of each unit of movement, it has a more detailed result in the ergonomic risk evaluation. MSDs has a more general movement evaluation, so, if it was partitioned into detail evaluation, it is easy to make mistakes and is difficult in classification. Also, it has a longer period of evaluation, MSDs is not so detailed as BRIEF.

並列關鍵字

Disability services setting ； Musculoskeletal injuries ； Questionnaire survey ； Job analysis

參考文獻

中文文獻：

江嘉凌,2001;中部某教學醫院行政人員肌肉骨骼疾病盛行率及其影響因素之研究,中國醫藥學院環境醫學研究所碩士論文

行政院勞工安全衛生研究所，1996；“半導體製造業重複性工作傷害之現場評估與改善”，行政院勞委會勞工安全衛生研究所八十五年度委託研究報告，IOSH85-H326

行政院勞工安全衛生研究所，1998；“肌肉骨骼傷害人因工程檢核表使用手冊”。IOSH84-T-002。

行政院勞工安全衛生研究所，2000；“攝影記者下背痛傷害評估研究”，行政院勞委會勞工安全衛生研究所八十九年度委託研究報告，IOSH89-H331。