王榮德臺灣大學：職業醫學與工業衛生研究所李昕怡Lee, Hsin-YiHsin-YiLee2007-11-282018-06-292007-11-282018-06-292007http://ntur.lib.ntu.edu.tw//handle/246246/59861頸部酸痛是現代社會常見的健康問題，其中的高風險群之一乃是長時間維持固定肩頸姿勢的辦公室人員。因此，若能瞭解肩頸酸痛形成初期的生理變化，將有助於發展介入性措施來達到預防效果。 文獻指出本體感覺在維持關節穩定度上扮演著重要角色，在慢性頸痛患者中也發現本體感覺功能下降的現象，但此一變化卻與疼痛強度無關。因此，本研究目的在於探討頸部本體感覺與疼痛頻率與持續時間之間的相關性。採用超音波原理的動作分析器測量頭部位置，納入127位受試者來接受兩項的頸部本體感覺測試（原點再定位與目標值再定位），測量頸部屈曲/伸直、左/右旋轉的再定位表現，以絕對誤差來分析，另以問卷測量受試者的疼痛頻率、持續時間與強度。在以Mixed effect model控制年齡、性別、最大頸部運動角度的影響後，結果顯示原點再定位的誤差值與疼痛頻率有正相關，亦即疼痛頻率較高者其再定位能力越差；疼痛強度與持續時間則與本體感覺較無相關。 此外，從此一族群徵求39名受試著參加本體感覺運動訓練六週後發現，相對於控制組（33名受試者），運動組的受試者其頸部的再定位能力有顯著的進步且疼痛頻率亦有顯著下降，但在疼痛強度與失能指標上(neck disability index)則無明顯改變。此結果顯示每週一到兩次的本體感覺運動雖能有效改善頸部再定位的能力與疼痛頻率，卻未必能降低頸部疼痛強度與失能的程度。Neck pain is a major problem in modern society. Sedentary office workers face a particularly high-risk of developing neck pain because their neck and shoulders are generally static when they work. To prevent further progress, it is crucial to detect early signs of subclinical neck pain in order to allow prompt intervention. Since previous studies showed that proprioception is critical to the maintenance of joint stability under dynamic conditions, impairment of proprioception might be a predisposing factor in the development of clinical pain. Although impaired neck proprioception has been demonstrated in patients with chronic neck pain, previous studies have not consistently shown any association between pain intensity and proprioceptive performance. We therefore investigated whether temporal aspects of pain are associated with cervicocephalic kinesthetic sensibility. One hundred and twenty-seven adults with or without subclinical neck pain undertook two tasks, repositioning their heads to the neutral head position (Head-to-NHP) and target position (Head-to-Target) in sagittal and transverse plane. Absolute error was calculated from position data recorded by an ultrasound-based motion analysis system. Pain frequency, duration, and intensity were evaluated using a questionnaire. A mixed effects model was constructed to test the effect on reposition error by different pain factors, with age, gender and maximal cervical range of motion as covariates. A higher pain frequency was associated with greater reposition errors for all movement directions in the Head-to-NHP task. No consistent effect was observed for pain intensity or duration. We also recruited 72 subjects (39 in the exercise group, 33 in the control group) from the above population to investigate the effectiveness of an exercise program involving proprioceptive training and deep muscle training. After 6-week intervention, the exercise group showed a decrease of head repositioning errors in Head-to-NHP task and pain frequency. No significant change was found in pain intensity and neck disability index. These results indicated that a weekly proprioceptive training has a positive effect on head repositioning ability and pain frequency, but not necessarily effective on the pain intensity and disability level.中文摘要 ii ABSTRACT iii Chapter 1 Introduction 1 1.1 STUDY BACKGROUND 1 1.2 STUDY PURPOSE 4 1.3 STUDY HYPOTHESES 4 Chapter 2 Literature Review: Pain and Proprioception of the Cervical Region 5 2.1 PREVALENCE OF NECK PAIN IN INDUSTRIES OF TAIWAN 5 2.2 NECK PROPRIOCEPTION 6 2.3 NEUROBASIS OF SENSORY CONDUCTION 7 2.3.1 Neural pathway of proprioception sense 7 2.3.2 Nociception pathway 9 2.4 POSSIBLE INTERACTION OF PROPRIOCEPTION AND PAIN SYSTEMS 10 2.4.1 disturbance of primary receptors via secondary neurons 10 2.4.2 spinal or supraspinal modulations 11 2.5 METHODOLOGY OF TESTING THE NECK PROPRIOCEPTION 11 2.5.1 Position sense 12 2.5.2 Movement sense 13 2.5.3 Force sense 14 2.5.4 Response latency 15 2.6 PROPRIOCEPTIONAL CHANGE IN PATIENTS WITH NECK PAIN 16 2.7 POSSIBLE MECHANISMS FOR PAIN TO AFFECT NEUROMUSCULAR SYSTEM OF THE CERVICAL MUSCLES 17 2.7.1 Fusimotor-muscle spindle system 17 2.7.2 Compensatory activation of superficial muscle 22 2.7.3 Fear avoidance behavior 22 2.7.4 Motor planning 23 2.8 SUMMARY 24 Chapter 3 Association between Cervicocephalic Kinesthetic Sensibility and Frequency of Subclinical Neck Pain 25 3.1 METHODS 25 3.1.1 Participants 25 3.1.2 Pain characteristics 26 3.1.3 Instrumentation 26 3.1.4 Testing procedure 28 3.1.5 Statistical analysis 30 3.2 RESULTS 30 3.2.1 Demographics and pain characteristics 30 3.2.2 Repositioning errors during the two tasks 32 3.2.3 Relationship between pain characteristics and head repositioning errors 33 3.3 DISCUSSION 36 3.4 CONCLUSION 39 Chapter 4 Association between Neck Proprioception and Disability in Subjects with Different Levels of Neck Pain 40 4.1 SUBJECTS AND METHODS 40 4.2 STATISTICAL ANALYSIS 41 4.3 RESULTS 42 4.3.1 Relationship between head repositioning error and disability 44 4.4 DISCUSSION 47 4.5 CONCLUSION 47 Chapter 5 Effectiveness of Integrated Proprioceptive Training in Subjects with Mild Neck Pain 49 5.1 METHODS 50 5.1.1 Participants 50 5.1.2 Exercise program 51 5.1.3 Control group 52 5.2 OUTCOME MEASUREMENTS 52 5.2.1 Head repositioning accuracy 52 5.2.2 Pain characteristics and disability 52 5.2.3 Statistical analysis 53 5.3 RESULT 54 5.3.1 Subject characteristics and the reasons of drop out 54 5.4 DISCUSSION 59 5.5 CONCLUSION 61 Appendix I. Test-retest Reliability of Cervicocephalic Kinesthetic Sensibility in three cardinal plane 62 SUBJECTS 63 INSTRUMENTATION 63 PROCEDURE 63 DATA ANALYSIS 65 RESULTS 65 Head-to-NHP repositioning test 66 Head-to-target repositioning test 68 DISCUSSION 69 CONCLUSION 70 Appendix II. 肩頸酸痛評量 71 Appendix III. Cervical disability index 頸部失能指數 72 References 73994025 bytesapplication/pdfen-US頸部疼痛頸部本體感覺頭部再定位測試疼痛頻率介入性措施Neck painNeck proprioceptionNeck repositioning testPain frequencyInterventionthesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/59861/1/ntu-96-F87841017-1.pdf