- 學位論文
以生理訊號及量表探討頸椎牽引之角度偏移對療效的影響
Influence of angle on the biosignals and curative effect index during the treatment of cervical traction
摘要
頸肩疼痛，是現代人常出現的問題。如長期姿勢不良，就容易造成一些骨骼、肌肉或神經上的病症。這樣的問題，當造成人們生活不便，進而使生活品質下降。機械式頸椎牽引，是目前臨床上對於頸肩疼痛的首要保守治療方式；雖然頸椎牽引在臨床上已被廣泛的使用，但頸椎牽引的療效一直未被有效的評估，主要原因是治療過程中具有許多參數會影響治療效果，如牽引角度、牽引的力量、牽引姿勢等，都會影響治療效果。而目前針對頸椎牽引療效的研究探討上，多以視覺類比刻度尺(visual-analogue scale；VAS)進行評估，但由於每位病患對於疼痛認知的不同，會使得評估上出現誤差，所以如何以更客觀方式評估療效是為一課題。因此，本研究目的將分為兩部進行探討。第一部分，將探討牽引時角度變異對頸椎牽引療效影響；第二部分，將藉由擷取心電訊號，針對頸椎牽引之療效進行進一步的相關性探討。故，本研究將監測在治療中的牽引角度變異，並量測治療前後VAS、頸部關節活動度(Cervical Range of Motion ,CROM)，再配合頸部殘疾指數(Neck Disability Index ,NDI)進行牽引角度對療效影響的分析。以及利用心電圖(Electrocardiography；ECG)探討治療前後心律變異度的改變(Heart Rate Variability ,HRV)，並針對相關參數與療效探討。本研究臨床收案有效樣本為39人(男性16位、女性23位)，其中對照組26人(男性11位、女性15位)；實驗組13人(男性5位、女性8位)，經由統計分析發現，患有頸部疼痛而需要頸椎牽引治療的患者，在治療過程中有無牽引角變異，在VAS值上確實會產生顯著差異(P=0.049)。治療中沒有牽引角度改變的患者疼痛改善程度是優於有角度改變的患者。以及心律變異度分析在頸部疼痛病患治療前後確實會有所改變。推測當患者的疼痛減緩時，就可能伴隨著副交感神經的激活、心率降低，故疼痛的緩解可能導致高頻功率增加、心率的下降。
並列摘要
Neck pain is a very common problem. It could reduce the quality of life since it is the symptom of muscular or spinal illness. Mechanical traction is often being used as a treatment for neck pain in the conservative physical therapy; nevertheless, there are many factors that could affect the curative outcomes, including the angle of traction and the force of traction. The study of this treatment has often been questioned, because inconclusive evidence can be drawn about whether a specific traction modality for back or neck pain is effective, or whether it is more efficacious than other treatments. Conversely, there is no clear evidence that shows Mechanical traction is an ineffective therapy for back and neck pain. At present, Visual-Analogue Scale (VAS) is the main method used to assess the clinical curative effect. In fact, the pain is based rather on personal feelings than on facts. Consequently, it is a question about how to quantify these curative outcomes in the objectivity. Therefore, we will monitor the change of angle of traction in the course of a treatment. We evaluated cervical pain and self-perceived disability on VAS and Neck Disability Index and cervical active range of motion. We also used ECG to assist the study on the relation between parameter and questionnaire. In short, the purpose of this study is to investigate the effect of the change in angle of traction for intermittent cervical traction. In addition, we want to use ECG to see the effects in patients with questionnaire. All the procedures were approved by TMU-Joint Institutional Review Board, and all the participants signed their written informed consents. Thirty nine patients with neck pain participated in this study; the patients had been referred by physicians for outpatient physical therapy evaluation and intervention. Patients were to divide into two groups: treatment group (n=13, mean age 48.5±11.0) and control group (n=26, mean age 48.5±11.0). This pilot study shows that there is a significant difference between the groups for VAS; the control group’s VAS was significantly higher than the VAS of the treatment group. It also shows that patients who have a change in angle are significantly higher on the VAS than patients who do not have change in angle during the treatment. The Heart Rate Variability (HRV) also shows a significant difference after the treatment. We conjecture that, when the patients' neck pain decreases, it induces parasympathetic activity, and the heart rate decreases, therefore the less neck pain may reflect on the raise of high frequency power and decrease in heart rate. In Summary, through the analysis of HRV, patients with neck pain can provide physiological information for the clinical studies and treatments.