陳秀熙臺灣大學：流行病學研究所謝麗貞Hsieh, Lisa, Li-ChenLisa, Li-ChenHsieh2007-11-272018-06-292007-11-272018-06-292005http://ntur.lib.ntu.edu.tw//handle/246246/56207疼痛是基層醫療最常見的症狀，也是人們最常遭受到的苦難。人們除利用醫藥物治療外，也尋求氣功穴道治療法以解除疼痛。特以實證醫學研究方法評估氣功穴道治療法在解除疼痛症候群上的療效。研究包括參部份:第一、疼痛及治療結果的評量工具。將國際通用標準的疼痛問卷及下背痛標準治療結果評估工具翻譯成中文，經信、效度之檢驗及臨床試驗，證明其對台灣民眾疼痛上的評估具有適用性。第二、利用該中文問卷，以實證醫學研究方法，復健治療為對照，比較氣功穴道治療在解除下背痛的療效；及以肌肉鬆弛劑加上止痛藥物為對照，比較氣功穴道治療在解除頭痛上的療效。結果顯示氣功穴道治療法在解除下背痛和頭痛上，為具統計上顯著差異的有效治療方法。第三、以經濟評估方法，復健治療為對照，估計醫療成本，分析氣功穴道治療法的相對成本比、相對成本效率比。以意願償付法，探討接受另類治療的族群對減輕不同程度的下背痛時，所意願償付的最高金額為利益，分析氣功穴道治療法的相對成本利益比。經濟評估結果顯示氣功穴道治療法，具較為有利的成本效率比和成本利益比。Pain is the major complaint in the primary medical care clinics and is the most commonly reported health problem that a large part of general population suffers from. Aside from occidental medications, people look for acupressure to alleviate the discomfort. Our study, aiming to investigate efficacy of acupressure in pain syndromes, includes three parts. Part 1: Standard pain outcome measures. Chinese versions of international standard pain measuring tools for low back pain are developed with proofs of reliability, validity, and adequacy and ability in distinguishing pain intensity and characters in Taiwanese people; Part 2: Studies to investigate the efficacy of acupressure in relieving pains in low back compared with that of physical therapy and in head with that of muscle relaxant in adding to analgesic medication are conducted by evidence-based medicine study designs. The results reveal that acupressure is a statistically significant efficacious pain relieving modality; and Part 3: Economic evaluations on acupressure, compared with physical therapy, are performed by cost estimates, cost-effectiveness analyses and cost-benefit analyses. While analyzing the cost-benefit, the “willingness to pay” approach is adopted for different percentage reductions for low back pain from a population who seek acupressure for pain relieving. Results show that acupressure is of lower costs and with cost effective and beneficial in pain syndromes.INTRODUCTION 1 PAIN AND PAIN MEASURES 6 ACUPRESSURE 11 1 PART ONE PAIN OUTCOME MEASURING TOOLS 16 1.1 Chinese Version of Short-Form McGill Pain Questionnaire 16 1.1.1 Permission 17 1.1.2 Translation 17 1.1.3 Method for Reliability and Validity Verification 18 1.1.4 Statistical Analysis Methods 19 1.1.5 Results of the Reliability and Validity ofthe Chinese Versions 20 1.1.6 Clinical Trail 20 1.1.6.1 Study Design and Participants 21 1.1.6.2 Outcome Measures 22 1.1.6.3 Interventions 23 1.1.6.4 Statistical Analysis Methods 23 1.1.6.5 Results of the Clinical Trial 24 1.1.7 Discussions 25 1.2 Chinese Version of Standard Outcome Measures 30 1.2.1 Permission 32 1.1.2 Translation 32 1.1.3 Method for Reliability and Validity Verification 33 1.1.4 Statistical Analysis Methods 34 1.1.5 Results of the Reliability and Validity of the Chinese Versions 34 1.1.6 Discussions 35 1.3 Pain Measurement for Headache 38 2 PART TWO EFFICACY INVESTIGATION BY EVIDENCE-BASED MEDICINE STUDY DESIGNS 39 2.1 Clinical Trials for Low Back Pain 39 2.1.1 The Pilot Clinical Trial for Low Back Pain 41 2.1.1.1 Materials and Methods 41 2.1.1.1.1 Study Design 41 2.1.1.1.2 Patient Selection Criteria 42 2.1.1.1.3 Randomization and Blinding Procedures 44 2.1.1.1.4 Interventions 45 2.1.1.1.5 Outcome Measures 45 2.1.1.2 Sample Sizes 46 2.1.1.3 Statistical Analysis Methods 47 2.1.1.4 Results of the Pilot Clinical Trial 48 2.1.1.5 Discussions 50 2.1.2 The Main Clinical Trial for Low Back Pain 55 2.1.2.1 Materials and Methods 55 2.1.2.1.1 Study Design 55 2.1.2.1.2 Patient Selection Criteria 57 2.1.2.1.3 Randomization and Blinding Procedures 58 2.1.2.1.4 Interventions 59 2.1.2.1.5 Outcome Measures 60 2.1.2.2 Sample Size Estimates 61 2.1.2.2.1 Sample Size Calculation based on Data from Pilot Trial 61 2.1.2.2.2 Sample Size Determination 62 2.1.2.3 Statistical Analysis Methods 62 2.1.2.4 Results of the Main Clinical Trial 63 2.1.2.5 Discussions 69 2.2 The Clinical Trial for Headache 76 2.2.1 Materials and Methods 78 2.2.1.1 Study Design 78 2.2.1.2 Patient Selection Criteria 79 2.2.1.3 Randomization and Blinding Procedures 80 2.2.1.4 Interventions 82 2.2.1.5 Outcome Measures 82 2.2.2 Sample Size Estimates 84 2.2.3 Statistical Analysis Methods 84 2.2.4 Results of Clinical Trial 85 2.2.5 Discussions 87 3 PART THREE ECONOMIC EVALUATIONS 94 3.1 Economic Evaluation Methods 94 3.2 Diagram of the Costs and Consequences for Economic Evaluation 97 3.3 Cost Estimates 98 3.3.1 Materials and Methods 99 3.3.2 Results of the Cost Estimates 100 3.3.3 Discussions 102 3.4 Willingness To Pay for Low Back Pain 104 3.4.1 Materials and Method 104 3.4.1.1 Hypothetical Scenario 104 3.4.1.2 Population Definition 105 3.4.1.3 Bid Amounts Determination 106 3.4.1.4 Random Assignments 106 3.4.1.5 Interviews and Data Collections 107 3.4.1.6 Questionnaires 108 3.4.2 Statistical Analysis Methods 108 3.4.3 Results of Willingness To Pay for Low Back Pain 110 3.4.4 Explanatory Variables to Willingness To Pay for Low Back Pain 112 3.4.5 Discussions 113 3.5 Calculation for the Economic Evaluation on Low Back Pain 119 3.5.1 Related cost ratio 119 3.5.2 Cost effectiveness analyses 120 3.5.3 Cost benefit analyses 123 3.6 Discussions 126 OVERALL DISCUSSION AND CONCLUSION 129 ACKNOWLEDGEMENTS 135 LIST OF FIGURES 138 LIST OF TABLES 139 LIST OF APPENDICES 143 REFERENCES 146 FIGURES 164 TABLES 168 APPENDICES 229en-US疼痛症候群氣功穴道治療評估工具實證醫學研究經濟評估Pain syndromesAcupressuremeasuring toolevidence-based medicine study designeconomic evaluationswillingness to paythesis