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【論文摘要】Physical Exercise Interventions for Patients With Epilepsy: The Systematic Review Using the International Classification of Functioning, Disability and Health (ICF)

Background and Purpose: Several studies evaluating physical exercise interventions in people with epilepsy had been conducted over the past 30 years. However, a systematic assessment of the quality and strength of the evidence in support of these interventions was lacking. Therefore, the purpose of this systematic review was to examine the benefits and drawback of physical exercise intervention to people with epilepsy. Methods: The following databases: PubMed, Medline, IEEE, PEDro, Google scholar and other three Chinese databases: NDLTD, TRCCS, CEPS from 1990 to 2020 were searched with keywords including physical exercise, epilepsy, and seizure. One reviewer scored quality of each study by Physiotherapy Evidence Database scale (PEDro scale) and classified the level by the Oxford Centre for Evidence-Based Medicine (CEBM) level of evidence. Furthermore, this study used International Classification of Functioning, Disability, and Health (ICF) to classify outcomes domains. Results: Six studies met the inclusion criteria. Two studies were randomized controlled trial and 4 studies were non-randomized controlled study. CEBM levels of evidence for those studies were as follows: 2 studies were at Level 2 and 4 were at Level 3. The scores of the PEDro scale were from 1 to 4. Within the 'body functions' domain, the physical exercise intervention improved the mental, respiratory and movement related function of people with epilepsy. Within the 'activity and participation' domain, the physical exercise improved the learning and internal relationship. Conclusion: Adverse effects caused by physical exercise were not identified in those studies. Those studies also reported that physical exercise was beneficial for promoting somatic, psychological, and social health. However, the sample size was still small and limited. Clinical Relevance: Physical exercise is feasible for patients with epilepsy. Physical exercise intervention might help them to have positive impact on the body function, activity, and participation. Future study is warrant.

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【論文摘要】The Immediate and Lasting Effects of Strain Counterstrain Technique on Trigger Points or Tender Points: A Systematic Review and Meta-analysis

Background and Purpose: Strain counterstrain (SCS), also known as positional release, is an indirect osteopathic manipulative technique to relieve musculoskeletal pain and dysfunction such as myofascial trigger points. SCS begins by identifying specific tender points related to musculoskeletal pain and dysfunction, and then the practitioner positions the patient in the position-of-comfort which is typically obtained by shortening tissues around tender points for 90 seconds. The purpose of this study was to investigate the immediate and lasting effects of SCS technique on trigger points or tender points. Methods: Three databases (Pubmed, ScienceDirect, and Google Scholar) were searched and articles were included if met the following criteria: (1) subjects were randomly assigned to one of treatment groups; (2) subjects with identified trigger points or tender points; (3) the intervention group received either SCS technique alone or SCS technique combined with other treatment which was the same as control group; (4) the control group received no treatment, sham treatment, or other treatment which not contained SCS technique; (5) outcome measures contained visual analog scale (VAS) of pain intensity or pressure pain threshold (PPT) of trigger points or tender points. Results: A total of ten studies were included and analyzed. Immediately after single or multiple sessions of treatment, there was significant improvement of both VAS (standardized mean difference [SMD] = -1.85, p ＜ 0.0001) and PPT (SMD = 1.08, p ＜ 0.0001) in the intervention group compared with the control group. Moreover, 1-4 weeks after the end of multiple sessions of treatment, there was significant improvement of VAS (SMD = -0.56, p = 0.02) but no significant improvement of PPT (SMD = 0.97, p = 0.08) in the intervention group compared with the control group. Conclusion: This meta-analysis indicated that there were both immediate and lasting effects of SCS technique on significantly decreasing VAS and there was immediate effect of SCS technique on significantly increasing PPT. Clinical Relevance: This meta-analysis suggests that SCS technique can decrease pain intensity and sensitivity of trigger points or tender points.

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【論文摘要】Effect of Muscle Relaxing Techniques Based on Different Biomechanics for Athletes' Functional Flat Feet

Background and Purpose: Functional flat feet due to imbalanced muscle tightness is a common foot deformity in athletes. Limitation of ankle dorsiflexion caused by calf muscles tightness will increase injury occurrence and impact sports performance. With the concept of different biomechanics, stretching exercise (SE: parallel force to the muscle) and foam roller (FR: compression force to the muscle) have been confirmed their effects for muscle relax. The widely used cupping therapy (CT: lifting force to the muscle), however, has not yet been proved its effect for muscle relax as FR and SE. Therefore, the purpose of this study was to investigate the effects of CT, FR and SE on improving athletes' functional flat feet. Methods: Twenty-seven college athletes (age: 22.07 ± 1.71 y/o) with functional flat feet were recruited and randomly assigned to three groups: CT (n = 9), FR (n = 9) and SE (n = 9). They received CT, FR or SE for 10 minutes per session, three sessions a week for two weeks. The foot arch height (both in the weight bearing and non-weight bearing positions), range of ankle dorsiflexion, and single-leg vertical jump were evaluated by an independent rater at baseline, immediately after the first intervention (T1), and after the sixth intervention (T2). Results: Among the three groups, the foot arch height in the non-weight bearing position of CT and SE groups increased significantly between baseline and T1 by the Friedman test (p ＜ 0.05). The range of ankle dorsiflexion of SE group showed statistically significant improvement at T1 and T2 by the Friedman test (p ＜ 0.05). However, the performance of single-leg vertical jump sustained among there groups based on the Friedman test. Unexpectedly, there was no significant time effect for the foot arch height in the non-weight bearing position, range of ankle dorsiflexion, and single-leg vertical jump among three groups examined by the Kruskal Wallis test. Conclusion: Considering the small sample and short intervention in this study, CT may provide similar effect as FR and SE on the improvement of functional flat feet. Clinical Relevance: Without negatively impact functional performance, the cupping therapy may be an option for athletes with functional flat feet to release calf muscle and maintain better foot arch during exercises.

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【論文摘要】The Effect of Footwear, Intrinsic Foot Exercises, and Kinesio Taping on Adult Flatfoot: A Systematic Review

Background and Purpose: Adult flatfoot is a chronic musculoskeletal deformity causing pain and injury to the lower limbs. Non-invasive approaches are usually used by practitioners to correct or prevent excessive foot pronation. Three widely used interventions are footwear, intrinsic foot exercises, and Kinesio taping. There were many debates about the effectiveness of these interventions on adult flatfoot. Therefore, the purpose of this study was to systematically investigate the effects of footwear, intrinsic foot exercises, and Kinesio taping for adult flatfoot. Methods: The databases including PubMed, Medline, Web of Science, and Cochrane were used to identify the articles through May 2020. The critical inclusion criteria were developed following the PICOS (patient, intervention, comparison, outcome, and setting) rule. The randomized control trial studies focused on adult flatfoot that evaluated the effect of footwear, intrinsic foot exercises or Kinesio taping on foot structure, and pain was included. Footwear in this study was the internal inserts (insoles) or the external inserts (orthoses), which redistributed the load and deformities correction. Results: There were a total of 775 articles in the first search. According to the PICOS rule, we then finalized 12 articles for three targeted interventions: footwear, intrinsic foot exercises, and Kinesio taping (5, 5, 2, respectively). Overall, the extracted articles showed significant effects of footwear and intrinsic foot exercises on improving foot structure and releasing foot pain. Additionally, the effects of footwear and intrinsic foot exercises were considered to be relatively long lasting (2-8 weeks after the interventions). Contrary, Kinesio taping showed no significant effect on the foot posture index at 24 hours after the intervention. However, the use of Kinesio tape to keep foot alignment has been obtained the attention of researchers just recently and needs to be explored further. Conclusion: In terms of preventing excessive foot pronation, both footwear and intrinsic foot exercises might have the effect on reducing foot pain and improving foot posture. Further network meta-analysis examining the effect of these non-invasive interventions could address the optimal treatment. Clinical Relevance: This systematic review provided reference information for practitioners to design better treatments for the adult flatfoot.

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【論文摘要】高流量鼻管氧氣治療結合運動介入對慢性阻塞型肺病患者之心肺適能及生活品質影響之系統性回顧

背景與目的：呼吸系統疾病根據發生機轉之不同可分為慢性阻塞型和限制型肺病，其中以慢性阻塞型肺病最為常見，常因呼吸道阻塞、肺實質破壞、老化等因素造成病人肺功能低下，無法輕鬆的從空氣中獲得足夠的氧氣以供應身體的需求因而導致組織缺氧致死。目前已證實使用低流量鼻管氧氣治療對於慢性阻塞型肺病患者可以幫助降低呼吸困難、增加存活率和生活品質。但較嚴重者仍須考慮使用高流量（＞ 15 L/min）管氧氣治療。運動介入對於慢性阻塞型肺病患者有助於體能提升並改善生活品質，然而目前對於高流量氧氣治療結合急慢性運動介入之效益仍未清楚，因此本研究目的為利用系統性回顧方式探討高流量鼻管氧氣治療搭配運動介入對慢性阻塞型肺病患者之心肺適能及生活品質的影響。方法：由PubMed資料庫利用關鍵詞合併搜尋從2010年至2020年內的所有中、英文獻，其中所有文獻須符合以下關鍵字：高流量鼻管氧氣治療（high-flow nasal cannula oxygen therapy）、慢性阻塞型肺部疾病（chronic obstructive pulmonary disease）和運動（exercise），並排除輕度慢性阻塞型肺疾病。文獻皆為臨床實驗（clinical trial）型並用物理治療實證資料庫量表（Physiotherapy Evidence Database, PEDro）評定文獻品質等級。結果：經關鍵字搜尋並符合篩選條件共4篇英文文獻，所有納入文獻經由PEDro品質分級介於4～9分，屬中度至高度實證等級。2篇文獻顯示結合長期運動訓練和高流量氧氣治療可降低患者伯格式量表分數改善呼吸困難指數、1篇文獻結果可提升pH、PaO_2、HCO_3^−、降低PaCO_2使血液動脈氣體產生變化、其中2篇文獻顯示可增加6分鐘行走距離並延長運動測試時間提升心肺適能表現、3篇文獻結果可增加生活品質表現。然而有1篇文獻顯示在提供高流量鼻管氧氣治療下，患者僅做急性的運動介入並無法得到心肺適能或提高生活品質的立即性效應，且急性運動介入時間間隔太長（＞ 48小時）將無法產生任何好處。結論：高流量鼻管氧氣治療搭配長期運動訓練可改善患者自覺呼吸困難指數、血液動脈氣體表現、提升心肺適能及生活品質，然而急性運動如間隔時間太長即不能產生立即性好處，於運動介入時需隨時留意患者能忍受之運動強度及呼吸困難指數方能安全配合高流量鼻管氧氣治療同步介入。本文獻回顧僅限縮納入中重度阻塞型肺部疾病患者進行探討，也因此在文獻篇幅上稍顯不足，日後可放寬篩選條件產生更多文獻數進行更完整的分析。臨床意義：本系統性回顧顯示高流量鼻管氧氣治療伴隨長期運動訓練對於中重度慢性阻塞型肺部疾病患者有幫助，可改善患者日常生活表現、提升心肺適能並降低呼吸困難指數，在臨床上可搭配長期有氧運動訓練而非急性運動介入較能輔助高流量氧氣治療得到更多好處。

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【論文摘要】The One-Leg Standing Test in Typically Developing Children: A Systematic Review and Meta-analysis

Background and Purpose: The one leg standing (OLS) test is widely used as a static balance test in pediatric rehabilitation. The purposes of this study were to provide an overview of the OLS test in children who were developing typically and explore gender differences in the performance of OLS due to different test protocols. Methods: A systematic English literature search was conducted through multiple search engines (PubMed, Scopus, and Medline) using the following keywords (children OR development) AND (＂one leg standing＂ OR ＂single leg standing＂ OR ＂single limb＂ OR ＂unipedal＂ OR ＂static balance＂) AND (time OR norm OR reference OR ＂center of pressure＂). The critical appraisal skills programmer checklists (https://casp-uk.net/casp-tools-checklists/) was used for quality assessment of included studies, and ＂the Oxford Levels of Evidence 2＂ (https://www. cebm.net/index.aspx?o=5653) guidelines were used to determine their level of evidence. The characteristics of participants and test procedures were discussed according to the timed measurement or the center of pressure (COP) excursions measurement respectively. The meta-analyses of effect size between genders were conducted in different types of protocols for children with similar age group. Results: Out of 31 included studies, 3 studies used the ＂not touch the floor＂ protocol (17%) and 7 used the ＂arms by sides＂ protocol (39%) for COP measurements, while 4 studies used ＂stork position＂ (25%) and 8 ＂hands on hips＂ (50%) in the timed measurements. In addition, the results of the clinimetric properties of the OLS among different protocols were limited. Conclusions: The results suggest that more researches for the impacts and reliability of different protocols for the OLS test are necessary in the future. Clinical Relevance: The reviewed study suggests that pediatric physical therapist should utilize OLS as outcomes carefully.

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【論文摘要】體外電磁治療儀對壓力型尿失禁婦女影響之系統性回顧

背景與目的：尿失禁常發生在婦女自然產後、骨盆腔手術造成骨盆底肌傷害、鬆弛等進而直接影響到患者生活品質的表現，雖然凱格爾運動可改善應力型尿失禁的症狀，然而對於較嚴重者仍須尋求昂貴的侵入式手術治療。體外電磁治療儀為近年發展的非侵入式輔助療法，然而目前對於介入方式仍未釐清。因此本研究目的為利用系統性回顧方法探討體外電磁治療儀對壓力型尿失禁婦女的影響。方法：由PubMed資料庫，利用關鍵詞合併收尋從2010年至2020年10年內的所有中、英文獻，其中所有文獻必須符合關鍵詞：體外電磁治療儀（extracorporeal magnetic innervation）、壓力型尿失禁（stress urinary incontinence）及婦女（woman），並排除急迫型及混合型尿失禁兩類。此外，所有文獻皆為臨床實驗（clinical trial）研究且符合標準的文獻以物理治療實證資料庫量表（Physiotherapy Evidence Database, PEDro）評定文獻等級。結果：經關鍵詞搜尋符合篩選標準共有4篇英文文獻，所有文獻經由PEDro品質分級介於4～9分，屬中至高度之實證等級。文獻整理顯示針對壓力型尿失禁婦女可提升骨盆底肌最大自主收縮能力改善患者的骨盆底肌肌力、增加自我效能感量表分數使自我感知增加、減少1小時棉墊重量減緩漏尿量、減少尿失禁症狀困擾量表分數提升生活品質以及減少貝克抑鬱量表分數降低憂鬱程度。文獻回顧顯示，療程介入頻率至少每週3次，每次45分鐘連續4週；至多每週3次，每次45分鐘連續8週，電磁波頻率需介於5～50Hz/sec，電磁波介入強度為患者的20～100最大忍受值範圍，2篇文獻顯示體外電磁治療儀於第四週可提升患者的自我效能感及生活品質分數，1篇文獻指出介入第六週後可開始減少漏尿量（下降2.8g），其中2篇文獻顯示6～8週介入後可增加骨盆底肌最大自主收縮能力（EMG增加130μV）。結論：非侵入性的體外電磁治療儀可改善壓力型尿失禁婦女的症狀，包括強化骨盆底肌的收縮力來降低尿失禁的頻率及漏尿量並改善生活品質。治療介入時需考量患者能忍受之強度及電磁波頻率方能安全搭配骨盆底肌收縮使用。本文獻回顧可納入文獻篇數較少，未來須有更多體外電磁治療儀相關臨床實驗文獻方可進行更詳細的分析。臨床意義：本系統性回顧顯示體外電磁治療儀可以改善壓力型尿失禁的問題，提升患者日常生活表現，幫助分娩後婦女的肌肉力量提升並可早期回到職場，在臨床上可搭配骨盆底肌訓練同時使用，做為壓力型尿失禁婦女的非侵入性輔助治療之一。

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【論文摘要】以迷你臨床演練評量評估物理治療實習學生之學習成效

背景與目的：臨床教育被認為是入門（entry-level）物理治療教育計畫中不可或缺的一部分，提供實習學生在臨床環境下不斷學習；同時，臨床教師需要合適的臨床表現評估工具（clinical performance assessment tools）檢視實習學生的學習成效。迷你臨床演練評量（mini-clinical evaluation exercise, mini-CEX）屬於直接觀察且以工作場所為基礎（workplace-based assessments）的評估量表，可綜合評估學生在知識、技能與態度3個面向的表現，雖已大量運用於各醫事人員的養成訓練，然而在物理治療的臨床教育中，以mini-CEX評估學生在實習前後之學習成效的研究甚為稀少。因此，本研究目的利用mini-CEX檢視實習學生在實習前後的臨床表現及各面向的進步程度，以了解學生的學習狀況。方法：本研究收集自107年7月至108年4月間於新北市某醫學中心物理治療實習學生的分數進行分析，每位學生接受1天8小時、為期18週的訓練，四大專科（骨科、神經、小兒、心肺／床邊）中依照選填的兩項專科實習，並於半天交換科別；實習期初以筆試進行測驗，而mini-CEX則於期中（第6～7週）及期末（第13～14週）進行評量，為避免重複評估造成不同專科的分數相互影響，學生實習之兩項專科將避免於同一天進行mini-CEX，評估包含7個項目：醫療面談、身體檢查、操作技能、諮商衛教、臨床判斷、組織效能及人道專業。統計分析以描述性統計呈現mini-CEX於各專科分數，並使用魏克森符號等級檢定法比較四大專科在期中和期末的分數，統計之顯著差異訂為p ＜ 0.05。結果：共收取47位學生（骨科38位、神經36位、小兒8位、心肺／床邊12位），每位皆完成18週的實習。四大專科中，骨科、神經與心肺／床邊的分數表現，在mini-CEX的7個項目中皆達顯著進步（p = 0.000～0.030），小兒的分數僅在身體檢查（p = 0.024）、諮商衛教（p = 0.047）兩項達顯著進步，醫療面談、操作技能、臨床判斷、組織效能及人道專業等皆未達顯著差異（p = 0.059～1.000）；整體而言，實習學生在知識與技能面向的分數較低，而在人道專業的表現上可達到較高分數。結論：mini-CEX的評估結果發現，骨科、神經與心肺／床邊的臨床表現經過實習後皆有明顯進步，然而小兒在態度及技能面向未達顯著差異；此外，學生在態度及人道關懷的表現可獲得較高分數，在臨床知識、判斷及操作技能等方面需進一步加強。未來將收集更多樣本數進行分析，並探討是否存在影響因子。臨床意義：研究結果可提供臨床教師及學校老師對於實習學生在各專科中各面向的臨床表現參考，有利於臨床與校方老師在教學上就實習學生表現較弱的面向，進行有效的教學，以提升實習學生在物理治療臨床教學的學習效果。

• 期刊

【論文摘要】運用品管圈手法提升髖／膝關節置換術後24小時內離床率－骨科及物理治療科跨科合作

背景與目的：接受髖／膝關節置換術患者，及早下床活動，可降低術後疼痛與腫脹，減少併發症產生，提高日常生活獨立程度，本院髖／膝關節置換術患者接受物理治療服務原由骨科醫師照會復健科醫師，復健科醫師開立醫囑後交由物理治療師執行物理治療介入服務，術後24小時內病患離床率僅為50%，故本篇運用品管圈手法提升接受髖／膝關節置換術病人於術後24小時內離床率，以提升照護品質及照護時效性。方法：本院物理治療科7人與骨科部主治醫師及專科護理師合作運用品管圈手法，經由特性要因圖找出影響術後24小時離床率的原因，利用現場實例佐證收案66人，進行真因驗證確認真因，並計算無法24小時內下床的真因比例，利用80／20法則進行對策介入。結果：經由特性要因圖找出9項要因，真因驗證如下：（1）復健科照會流程冗長（36.4%）、（2）照會後跨假日（36.4%）、（3）物理治療師人力不足（18.2%）。擬定對策進行改善計畫為：（1）與骨科部溝通與共識新照會流程、（2）術前可直接照會物理治療科，（3）使用line群組提昇照會時效、（4）術前給予病患衛教單加強病患對於運動重要性認知、（5）協調週六值班人員至骨科病房、（6）增設病房物理治療師早上時段。結論：透過品管圈手法，物理治療及早介入髖／膝關節置換術病患，術後24小時內離床率由50%提升到84%。臨床意義：跨科合作模式下，物理治療及早介入可使髖／膝關節關節置換術後病人及早離床，以提高病人日常生活的功能恢復。

• 期刊

【論文摘要】Effect of Fatigue on Reaction Time and Movement Time During Roundhouse Kick in Taekwondo Athletes

Background and Purpose: Taekwondo (TKD) is a combat sport emphasizing sophisticated kick skills. A successful attack depends on a quick response and speedy movement, both probably affected by the accumulation of fatigue. Therefore, this study aims to investigate the effect of fatigue on the reaction time and movement time during roundhouse kick in TKD athletes. Methods: Six TKD athletes (age: 19.7 ± 1.4 years, height: 168.8 ± 9.2 cm, weight: 58.6 ± 5.2 kg, 3 females) were recruited and underwent a simulated game test. The simulated game test included three 2-minute rounds, with a 1-minute inter-round break. In each round, participants were asked to conduct 30 roundhouse kicks according to the instructions displayed on the screen, and the instructions included the standing pose (right or left lead), kick leg (front or rear), and kick position (high, middle, and low). Bilateral hip and knee angles were measured using 6 inertial measurement units placed over lower thorax, sacrum, bilateral thighs, and bilateral legs. Reaction time was the interval between the instruction showed up and the kick leg taking off. The chambering phase was the interval between the kick leg taking off and maximum knee flexion. The attacking phase was the interval between maximum knee flexion and target impact. An analysis of variance (ANOVA) with repeated measures was used to investigate the effect of fatigue (round 1, 2, and 3) and kick position (high, middle, and low) on reaction time, chambering phase, and attacking phase. Results: All participants completed the simulated game test. In reaction time, none of fatigue main effect, position main effect, and the interaction there between were significant. In chambering time, a significant fatigue-position interaction was found (F = 17.59, p ＜ 0.01). Post-hoc analysis showed that the chambering phase in high kicks during round 3 (0.49 ± 0.22 s) was significantly longer than that during round 1 (0.46 ± 0.18 s, p ＜ 0.01) and round 2 (0.47 ± 0.20 s, p = 0.02). In attacking phase, a significant fatigue main effect was found (F = 8.42, p = 0.04). Post-hoc analysis showed that the attacking time during round 3 (0.11 ± 0.04 s) was marginally longer than round 1 (0.09 ± 0.03 s, p = 0.05). Conclusion: Our results showed that the chambering phase that featuring a quick flexion of hip and knee, was substantially slowed down during the last round, especially in high kicks. This might result from the fatigue of hip flexors. Besides, the attacking phase featuring a quick extension of knee was marginally longer during the last round. This probably resulted from the fatigue of knee extensors. Clinical Relevance: This study offers TKD coaches and athletes an important insight into the design of training programs and combat strategies.