- 學位論文
退化性膝關節炎之高齡患者接受短波治療對平衡能力的影響
The effects of shortwave thermotherapy on the balance performance in geriatric patients with knee osteoarthritis
摘要
臺灣於1993年邁入高齡化社會，對於多數年長者好發的膝關節退化問題，易造成疼痛僵硬、活動度下降，影響姿勢平衡與控制能力，造成跌倒及骨折問題之發生，亦或是年長者害怕再次跌倒，逐漸減少日常生活活動，進而導致高風險失能的現象產生。 針對退化性膝關節炎患者，一般保守治療方法，例如: 物理治療(短波治療)和藥物治療（非類固醇消炎止痛藥）…等;倘若患者膝關節嚴重退化、疼痛，而無法以保守療法處理，或影響生活之行動功能嚴重時，則需進一步開刀更換人工式膝關節改善。 此次研究，嘗試觀察並瞭解，20名65歲以上退化性膝關節炎患者，在接受復健處方之短波治療後，在減輕患者膝關節疼痛，並刺激本體感覺及平衡功能，系統部份以KAT-4000動作分析儀，用來測試並觀察患者，在不穩定性靜態與不穩定性動態的平衡指數變化，並瞭解退化性膝關節炎患者，包括在椅子上坐起、走路、上下樓梯…等日常生活平衡功能的影響。 本研究探討高齡者退化性膝關節炎，在測試前後之結果發現，包括在:WOMAC量表有關疼痛、僵硬感、日常活動執行之困難三項、關節角度、計時起走、上下樓梯、動靜態平衡之儀器分析，都有顯著之差異；而下肢髖、膝關節之肌肉力量，卻沒有顯著之差異性。 而在測試平衡功能相關之計時起走，與WOMAC量表之疼痛及日常活動執行之困難度，有中高程度的相關性；而靜態與動態平衡測試，與WOMAC三項量表，呈現無明顯之相關性。顯示疼痛及日常活動執行之困難，可能造成患有退化性膝關節炎高齡者，在日常生活中之平衡相關的問題，並且顯示其重要性。
並列摘要
Taiwan has already become a highly aged or senile society since 1993. Degeneration of the knee joint is a very common problem in elders. It is a major cause of knee osteoarthritis (OA) leading to pain, stiffness, limited mobility, and impaired postural control and balance. Poor balance is a major cause of fall in the elders, and may frequently result in fracture. Fears of recurrent falls may cause the elders gradually diminish normal daily activities, thus brings on highly risked disability. Traditional and conservative treatments for knee OA include physical therapy ( hydrocolator hot pack, ultrasound, shortwave [SW], electrotherapy, etc,) and oral medication (non-steroid anti-inflammatory drug, glucosamine, etc.)If the degeneration and pain have become so serious that conservative treatments will no longer suffice, or the daily living activities have been seriously hampered, arthroplasty maybe required to improve the condition. In this study, 20 patients with knee OA, age over 65, received short-wave treatment. We assessed its effects on pain reduction, proprioceptive stimulation, and balance functions before, during, and after the treatment. KAT-4000 had been used to test and measure the changes of the balance index in “unstable static” and “unstable dynamic” balance test. We also evaluated the performance in chair rising, level walking, up and down stairs, and others that are related to the balance function for the activity of daily living (ADL).Comparing the measurements before , during, and after the treatment, it was found that there were significant differences (p<0.05) in WOMAC tests (“pain”, “stiffness” and “ADL difficulty”), joint range of motion, both static and dynamic standing balance tests, time-up-and-go test, and up-and-down stairs. However, there were no significant differences in muscle strength either in the hip or in the knee. In one of the balance tests, the scores in “time-up-and-go test” had moderate to high degrees of correlation with the degrees of pain and ADL difficulty in WOMAC. However, there were no significant correlation between the scores in the “static” or “dynamic” balance tests and the WOMAC scores. These findings indicated that the pain intensity and ADL difficulty might cause significant and important problems with balance in daily life for elderly patients with knee OA.