推展工作場所頸肩運動之成效：不同模式之評估

Comparison of the Effectiveness of Different Health Promotion Exercise Programs for Work-related Shoulder and Neck Pain

本研究目的為針對肩頸痠痛者設計肩頸部運動課程，並評估三種介入模式對於減緩肩頸部疲勞之成效。依照執行運動課程的方式，可將受試者分為四組：對照組（39 人） 、自行運動組（56 人） 、集體運動一組（69 人）及集體運動二組（14 人） 。四組人員均先接受第一階段之基準線評估；除了對照組外，另 3 組成員參加講堂授課，然後進入 2 週之積極介入期，過後接受第二階段評估；在經過自行運動期後，接受第三階段評估。評估內容包括：問卷調查、上班前後之壓痛閾值與頸關節活動度測量。本研究結果顯示，在 1 週內肩頸痠痛人數比例、頸關節活動度及嚴重側之壓痛閾值上班前後之差異平均值上，4 組間各階段評估大多沒有統計上顯著差異。但以較嚴重側壓痛閾值之差值，第二階段是否小於第一階段之差值為指標，發現不同組間呈現顯著之差異；以對照組為 1，自行運動組差值減小之可能性為 1.39 倍（p>0.05） ，集體運動一組差值減小之可能性為 4.63 倍（p<0.05） ，而集體運動二組差值減小之可能性為 7.06 倍（p<0.05） ，顯示有運動劑量-反應之效應；而第三階段時則無如此明顯之效果。可見在企業體中，採集中上課與集體運動的方式，對減緩肩頸痠痛是有正面效果的，值得有關單位大力推行，由專人負責，將健康活動形成常模、制度化，長期經營。

The purposes of this study are to design an exercise program and to assess its effectiveness with three different health promotion exercise programs for work-related shoulder and neck pain. This study was carried out at an airline company. The employees in 5 departments were recruited. They were grouped by the models of intervention when they were in an intensive exercise period. There were 39 people in the reference group. People in the self-exercise group (n=56) were given an exercise program lecture and they carried out the program during their breaks. A physical therapist (PT) was available for answering questions about the program. Members in the team-exercise group 1 (n=69) performed the program once with a fixed daily schedule and under the supervision of a PT after the lecture was given. Members in the team-exercise group 2 (n=14) performed the program twice, with one of these times under the PT’s supervision after the lecture. There were 3 stages of evaluation, each including a modified Nordic questionnaire, pain threshold and cervical range of motion (CROM). The latter two were assessed twice before and after work in one day. The first stage of the evaluation was a baseline evaluation before the lecture, the second stage of the evaluation was done after the lecture and two weeks of intensive exercises, and the third stage of the evaluation was conducted after the second stage evaluation and one month of free exercises. The results showed that there was no significant difference among the four groups in the before/after work difference in pain threshold and CROM at each stage. Using the decrease in difference in pain threshold at the second stage as an improvement index, the odds ratios for the three exercise groups were 1.39, 4.63 (p<0.05), and 7.06 (p<0.05), respectively, when compared to the reference group. It showed a dose-response effect. It can be concluded that an intensive team-exercise program on sedentary workers is worthwhile because it promotes their health.