肌肉骨骼疾病之輔助與另類療法的使用：病患與復健科專業人員的態度與互動經驗

Use of Complementary and Alternative Medicine for Musculoskeletal Disorders: Attitudes of and Interactions between Patients and Rehabilitation Professionals

沈佩瑩(Pei-Yin Shen)

指導教授 ： 丁志音

國立臺灣大學/公共衛生學院/衛生政策與管理研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.01878

摘要

背景：肌肉骨骼系統疾病包含了所有因姿勢不良、過度使用、外力撞擊或退化引起的肌肉骨骼傷害，此類疾病有高比例的醫療需求。在多元的健康照護體系中，相當高比例的肌肉骨骼疼痛患者基於對正統西醫的效果不滿意，轉而使用輔助另類療法以期望達到緩解症狀、治療疾病的功效，然而，只有部分患者會與專業醫事人員討論或諮詢。過去輔助另類療法的研究多著重於分析患者的使用率和使用型態，較少深入探討醫病互動的經驗。

目標：本研究之目的在於：(1)了解肌肉骨骼系統疾病患者使用輔助另類療法的現況與相關影響因素；(2)探討復健科醫事人員對輔助另類療法與患者使用輔助另類療法的態度，以及相關學習經驗；(3)檢視復健科醫事人員與患者針對輔助另類療法的醫病互動情形。

方法：本研究為一橫斷性研究，研究對象為20歲以上肌肉骨骼系統疾病患者，有效樣本共352人，以結構性問卷調查過去一年輔助另類療法之使用經驗與醫病互動經驗。此外，本研究亦針對14位復健科醫師與物理治療師進行深度訪談，以了解醫事人員對於輔助另類療法與患者使用輔助另類療法的看法，以及學習或治療經驗。

結果：研究發現，85.6%的肌肉骨骼系統疾病患者於受訪前一年使用了至少一種樣式的輔助另類療法，使用的樣式以痠痛貼布(54.1%)居多，其次為推拿(39.9%)及針灸(36.0%)等。社會人口特質對於輔助另類療法的使用及醫病互動經驗並無顯著的影響，但疾病種類與求醫偏好則與輔助另類療法的使用經驗有較強的關係，儘管疾病種類與求醫偏好對醫病互動經驗無顯著影響，但在醫病互動的對象上則具有顯著差異。復健科醫事人員對輔助另類療法的態度偏向中立，部分對於輔助另類療法學習及治療經驗較多的醫事人員比較會和患者討論使用經驗，但多數患者於受訪前一年和復健科醫事人員並無討論或諮詢上的互動。

結論：肌肉骨骼系統疾病患者對輔助另類療法的使用相當普遍，然而對於輔助另類療法的使用經驗，醫病雙方卻少有互動。復健科醫事人員應更加注意患者使用輔助另類療法的情形，並了解患者常用之輔助另類療法的療效與安全性，透過主動與患者互動並提供相關的諮詢建議，有助於確保患者的醫療照護安全及品質。

關鍵字

肌肉骨骼系統疾病 ； 復健 ； 輔助另類療法 ； 醫病互動 ； 揭露

並列摘要

Background: Musculoskeletal disorders, including injuries caused by faulty posture, overuse, forced impact or degeneration, are in great medical demands. In a pluralistic health care system, a very high proportion of musculoskeletal patients prone to use complementary and alternative medicine (CAM) due to dissatisfaction with orthodox medicine. However, only very limited number of patients would disclose their experiences of CAM use and consult rehabilitation medicine professionals. While previous studies have foucused on the prevalence and types of use, very few have considered the experience of physician-patient communication, which is critical to safeguard safety and quality of use.

Objectives: This study aims to (1) investigate patients’ use of CAM and its correlates, (2) explore rehabilitation medical professionals' attitudes toward CAM and patients’ CAM use, and their own learning of CAM, and (3) examine CAM-related interactions between medical professionals, and patients.

Methods: This study applies a cross-sectional mixed-method design. A structured questionnaire was used to tap adult musculoskeletal patients’ (n=352) experiences of CAM use and their communication of which with medical professionals in the past year. In addition, in-depth interviews were conducted to 14 rehabilitation clinicians and physical therapists to explore the perceptions of and the positions they held towards patients’ behavior and their own CAM-related practices.

Results: 85.6% of respondents reported ever use of CAM use in the past year. The most popular modalities used by these patients were medicinal patches (54.1%), massage body manipulation (39.9%) and acupuncture (36.0%). Although socio-demographic characteristics associated weakly with CAM use, types and anatomical location of musculoskeletal diseases and medical care preferences correlated more strongly with the experience of CAM use. While these factors were somewhat irrelevant to patient-physician interactions concerning CAM use in general, which, however, were significantly associated with to whom the patients chose to consult the use of CAM. The results of qualitative data analysis show that most rehabilitation physicians took a neutral stance on CAM. Physicians with more experiences in CAM learning and treatments were more likely to discuss the CAM use with their patients. However, most CAM users failed to communicate with their physicians about their practices.

Conclusion: Despite commonly used and involving a wide range of modalities, CAM use in physical therapy has been a topic far less brought up during patient-physician interactions. It is suggested that professionals in rehabilitation and physician therapy should pay greater attention to this issue, enhance their own understanding of potential benefits and harms inherent in commonly used CAM, and can actively communicate with their patients and provide advice to assure the safety and quality of care.

並列關鍵字

musculoskeletal disorders ； rehabilitation ； complementary and alternative medicine ； physician-patient communication ； disclosure

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