下肢肌力訓練對全人工膝關節術後病人早期活動恢復與生活品質之成效

背景：退化性膝關節炎病人在接受手術後因傷口疼痛、身體功能性降低及焦慮的情緒影響生活品質程度，且缺乏長期、居家式、持續的運動課程。目的：檢視下肢肌力訓練活動對全人工膝關節置換術病人手術後膝關節活動恢復、生活品質及焦慮的成效。研究設計：採類實驗性雙組前、後測研究設計。研究方法：研究對象為年滿20歲，接受全人工膝關節置換手術，依病人住院順序以抽籤方式進行簡單隨機取樣。實驗組(n=100)除病房常規活動衛教外再給予下肢肌力訓練活動指導，對照組（n=100）則接受病房常規活動衛教。測量工具包括：SF-36生活品質量表膝關節功能評估量表（KOOS；Knee Injury and Osteoarthritis Outcome Score）、焦慮視覺類比量表(Visual Analogue Scale, VAS)和研究對象基本屬性與醫療相關變項。資料收集時間為病人手術前進行前測，並於手術後第三個月進行後測。結果：二組病人在全人工膝關手術三個月後之生活品質、膝關節功能、彎曲角度及焦慮情形皆有顯著改善，且實驗組優於對照組(所有p<.001)。手術後實驗組膝關節彎曲角度大於45度者達100%，對照組為91%，顯示人工膝關節置換手術後持續的肌力訓練運動有助於術後早期病人疼痛的改善與增加膝關節彎曲角度與生活品質。結論與臨床應用：本研究證實術後持續的肌力復健運動有助於改善病人術後早期的生活品質與膝關節活動恢復情形，建議醫護人員於照顧接受全人工膝關手術後病人時，能納入出院活動指導項目，提供返家持續的復健計畫參考之一。

關鍵字

肌力訓練；人工膝關節；生活品質；焦慮

並列摘要

Background: Patients of knee of osteoarthritis after surgery had experienced, physical function decrease and anxiety affect the quality of life level . They lack of long-term, home-style, and continuous exercise classes Aim: The purpose of this study was to examine the effectiveness of lower extremity strength training on OA patients’ knee activity recovery, anxiety and quality of live underwent total knee replacement. Design: The quasi-experimental design was conducted. Methods: Using a purposive sampling to collect participants’ data. Eligible sample recruited from a hospital in Tainan. Inclusion criteria were above 20 old, and will be received total knee replacement (TKR). Outcome measurements included the Knee injury and osteoarthritis outcome score（KOOS）, SF-36 and single item anxiety level (Visual Analogue Scale, VAS) , disease related data, and personal demographics. Participants were distributed into with a lower extremity strength training group (experimental group, n=100) or with usual care group (control group, n=100). We examined outcome indicators before surgery and follow up at three months after TKR. Results: Two groups of patients received TKR three months later, the quality of life, knee function, knee bending angle and anxiety significantly improved, and the experimental group than the control group (all p <.001). After surgery, the knee bending angle greater than 45 degrees by up to 100% of the experimental group, the control group was 91%, indicating persistent strength training exercise can help improve and increase the bending angle and quality of life after TKR surgery. Conclusions: The study confirmed that after sustained muscle rehabilitation exercise helps to improve the early effects of quality of life and activity recovery, let the medical staff to care patient of received total knee replacement, provide continuous rehabilitation plan to return home.