2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646152摘要：在下背痛此一議題中，臨床治療與基礎研究脫節，本研究嘗試連結二者，為臨床常用之測試手法找到科學證據，並依據所得之科學證據幫助發展臨床之預防與治療工作。不良脊柱姿勢是年輕族群下背痛的重要危險因子，臨床上治療師常施行垂直下壓測試(Vertical Compression Test)觀察病患脊柱反應的方式，依照個別情況加以矯正得到良好姿勢(Ideal Posture)進而改善背痛，然而皆未有研究佐證。本研究之目的為：1.藉下壓力量在不同姿勢中之傳遞現象，探討以生物力學測量參數來客觀地紀錄垂直下壓測試的結果，並進一步以生物力學之動力學(Kinetic analysis)與運動學(Kinematic analysis)參數數值來描述良好姿勢；2.探討不確定性下背痛(non-specific low back pain)患者相關生物力學參數之改變，作為臨床上對於不確定性下背痛患者的診斷鑑別工具；3.根據檢測結果，施予姿勢調整，並探討療效。本研究將分三年進行：第一年先進行文獻回顧，並以無背痛症狀者為對象，在三種不同姿勢下，確立垂直下壓測試之生物力學測量參數能夠區辨不同姿勢的依據，並獲得良好姿勢之相關生物力學測量數值，為後續研究建立參考值；第二年與第三年則探討不確定性下背痛病患與無背痛症狀者在自然安靜站立姿勢(natural quiet standingposture) 與直立姿勢(erect posture)之生物力學測量參數之表現，以作為鑑別不確定性下背痛病患之參考；最後依據上述結果，驗證對不確定性背痛病患，探討臨床上以姿勢調整治療方式之療效，包括生物力學參數與背部功能、生活品質，發展日後不確定性下背痛病患之預防與治療療效的指引。<br> Abstract: It is difficult to link the clinical tests and treatment skills with research evidencein low back pain. This study intends to find the scientific rationale of the verticalcompression test (VCT) for lumbar posture which is commonly used in clinicalpractice and to develop further prevention and treatment plan based on the evidence.Faulty spinopelvic posture is the most important factor leading to non-specific lowback pain (NSLBP) or serious back problems. Even without research evidence,clinicians usually assess spinopelvic posture by applying a vertical compression forcemanually on patient’s shoulders to feel the force transmition and to observe thechange of spinopelvic posture and adjusting it to an ideal posture to alleviate backpain. Therefore, the purposes of this study are as follows: 1. To check the differencein biomechanical parameters among natural quiet standing posture, erect (ideal)posture and swayback posture by applying a vertical compression to asymptomaticsubjects.We evaluate whether biomechanical posture evaluation distinguish differentpostures or not. 2. To compare the difference between the postures of NSLBP patientsand pain-free subjects in natural quiet standing posture and erect (ideal) posture. 3. Toanalyze the biomechanical effectiveness of spinopelvic postural adjustment andtraining in NSLBP patients.In the first year, we will recruit 40 asymptomatic subjects and compare thedifferences among their three different postures (natural standing, erect, andsway-back postures) in biomechanical parameters under VCT.We will also try to setup the biomechanical value of ideal posture in kinetic and kinematic parameters. Inthe second and third years, we will evaluate 40 NSLBP patients with thebiomechanical measurements and compare them with the asymptomatic subjects fromthe first year. These 40 patients with NSLBP will be randomized into interventionand reference groups, intervention group will receive spinopelvic postural adjustmenttraining for 3 months. Comprehensive evaluation will be performed includingbiomechnical measurements with kinetic and kinematic parameters, low back functionwith Oswestry Disability Index and quality of life withWorld Health OrganizationQuality of Life Questionnaire-Abbreviated Version (WHOQOL-BREF) for thesubjects of two groups. Evaluation will be executed before and immediately afterthe intervention, and follow up 3 months later after the intervention.The expected results are an evidence-based clinic spinopelvic posture test,biomechanical parameters for ideal posture, and a spinopelvic postural adjustmentprotocol for NSLBP patients.下背痛姿勢垂直下壓測試low back painposturevertical compression test