探討團體視訊及個人影音介入對護理人員頸肩關節活動度、疼痛強度、生活品質、職場疲勞程度影響

背景：護理人員因工作造成骨骼肌肉問題常見以頸肩與腰背為主，影響生理、工作效率、生活品質及睡眠。筋膜理論及跨理論模式指出伸展與缺血性按壓對於改善頸肩關節活動度與疼痛可能有效，但不同的傳遞方式尚未有研究深入探討。研究目的：本研究檢驗複合式居家影音式介入「伸展運動及自我瑜珈球按壓」，在「團體線上」與「個人影音」的不同傳遞模式下，對於頸肩關節活動度、頸肩疼痛程度、生活品質、職場疲勞度的效果。研究方法：本研究採類實驗設計，以台北某醫學中心一個月內有頸肩痠痛問題的護理人員為對象。將受試者依進案順序分為：「團體線上-伸展按壓組」與「個人影音-伸展按壓組」。團體組由研究人員帶領進行團體視訊運動處方，個人組則提供影音自我執行。運動處方為每週三次，每次35分鐘，共六次介入，健康日誌共紀錄14天。受試者進案後提供基本資料，並於介入開始前與完成介入後各填寫一次台灣簡明版生活品質量表與職場疲勞度問卷；每次執行介入前後測量頸、肩關節角度（包含：頸關節屈曲、頸關節伸展、頸關節側彎、肩關節屈曲及肩關節伸展）及頸肩疼痛強度評分；並於完成介入後的第一、二個月追蹤疼痛分數。研究結果：結果顯示（1）頸肩關節角度短期效果中，兩組幾乎均呈現當次的前後差異（ps < .05）；長期趨勢中，團體組於頸關節屈曲（β = 0.46，p < .001）及肩關節伸展達統計上顯著差異（β = 0.43，p < .001），個人組皆無顯著差異；（2）頸肩疼痛短期效果上，兩組每次介入達統計顯著差異（ps < .05）；長期趨勢中，兩組頸肩疼痛程度，隨著時間經過皆呈現顯著下降（團體組β = -0.24, p < .001，個人組β = - 0.20, p < .001）；（3）生活品質變化，兩組於生理範疇均達前後差異（團體組，t = 2.7, p = 0.01, d = 0.37，個人組t = -4.7, p < .001, d = 0.99）；（4）於職場疲勞程度兩組皆無達統計顯著差異。結論：複合式介入，不論有專人帶領或者研究者錄製的影音執行伸展與按壓動作，在遠端通訊軟體輔助使用之下，對於團體與個人組的頸肩關節角度、疼痛與生活品質的生理範疇均有改善。建議未來可透過線上視訊或運動影音推廣伸展與按壓，配合通訊軟體的每日貼文提醒，以改善頸肩關節角度與疼痛強度。

關鍵字

頸肩痠痛；伸展；關節活動度；自我瑜珈球按壓；筋膜理論

並列摘要

Background: Neck, shoulder, and lower back discomfort is nurses' most common skeletal muscle problem. Neck and shoulder pain affects the nurse’s physical function, work efficiency, quality of life, and sleep quality. Fascia and Transtheoretical Model indicated that stretch ischemia impression might improve the shoulder and neck soreness and joint mobility. However, different delivery methods have not been investigated. Purpose: This study aims to investigate the effect of group synchronous online learning or individual video intervention on neck and shoulder joint mobility, pain intensity, quality of life, and workplace fatigue among nurses. Methods: A quasi-experimental design was performed at a Medical Center in Northern Taiwan. Participants were front-line nurses in the hospital who reported shoulder and neck pain in a month. After recruitment, participants were assigned to two groups based on times sequence that groups synchronous online learning and individual video intervention. Group synchronous online learning was performed by the researcher, while individual video program group was performed by themselves. The intervention stretching video proceeds for 35 minutes three times a week for two weeks (a total of 6 times). Participants complete the health diary after the intervention for 14 days. Data were collected by self-administrated questionnaires (including demographic survey, a numerical rating scale for pain, Taiwan Simplified WHOQOL-BREF, and workplace fatigue questionnaire) and cervical joint activity meter (including cervical flexion, cervical extension, cervical lateral flexion, shoulder flexion, and shoulder extension). Result: Results showed that (1) regarding immediate effect of joint mobility, both groups showed significant improvement after every intervention (ps < .05). Two weeks after intervention, the group-video group showed improvement in cervical flexion (β = 0.46，p < .001) and shoulder extension (β = 0.43，p < .001). No significant changes showed in individual groups. (2) Pain scores showed significant improvement after each intervention for immediate (ps < .05) and long-term (group-learning: β = -0.24, p < .001; personal-video: β = - 0.20, p < .001) effects in both groups. (3) Physical domain of quality of life showed significant improvements in both groups (group-learning: p = 0.01, d = 0.37; personal-video: p < .001, d = 0.99). (4) Workplace fatigue level showed no significant in both group. Conclusion: Both group synchronous online groups and individual video programs combined with software showed effectiveness in the range of movement of the neck and shoulder, pain intensity, and physical domain in quality of life. We suggest stretching and ischemia compression through synchronous online or video programs with software messages reminder, improving neck and shoulder joint mobility and pain intensity.