穴位按壓對中老年骨性膝關節病人之身體症狀和心理社會功能成效

The Effect of Acupressure on Outcomes of Physical Symptoms and Psychosocial Functions for Middle-Aged and Older Patient with Knee Osteoarthritis

背景：西醫無法解決所有骨性膝關節炎病人的膝蓋疼痛及行動不便，故病人常尋求中醫來改善症狀。因此，本研究旨在探討穴位按壓對中老年病人骨性膝關節炎之身體症狀和心理社會功能成效。 方法：本研究是類實驗性不等組前後測研究設計，方便取樣北部某醫院骨科門診大於50歲有疼痛症狀，且X光片診斷為第1至2級退化性膝關節炎病人。實驗組接受「穴位按壓及股四頭肌訓練」護理指導(n = 20)，對照組(n = 18)接受「股四頭肌訓練」護理指導，以膝部骨性關節炎醫療照護成效量表及疼痛視覺量表測量成效。 結果：顯示兩組的量表總分、次量表分數及疼痛視覺量表分數均隨著月數的增加而顯著下降(p< .001)。而實驗組與對照組在接受介入措施後疼痛、日常活動與症狀、行動功能、情緒功能及社會參與功能和疼痛10分視覺量表分數皆無顯著差異。 結論：穴位按壓對骨性膝關節未顯示有照護成效，但股四頭肌訓練有顯著照護成效。未來研究可採事先檢力分析的實驗性研究，並監控病人自我穴位按壓實施狀況，來建立穴位按壓對中老年骨性膝關節病人之身體症狀與心理社會功能成效。

Background: Western medicine has its limitation in solving knee pain and mobility disorder of patients with knee osteoarthritis. Thus, patients often seek traditional Chinese medicine to improve symptoms. This study was to explore the effect of acupressure on outcomes of physical symptoms and psychosocial functions for patients with knee osteoarthritis. Methods: This was an unequal quasi-experimental study design with a pre-test and two post-tests. The convenience sample was from an orthopedic clinic at a hospital in northern Taiwan. Patients, who aged over 50 years with pain and diagnosed with the second and third degree knee osteoarthritis by X-ray, were recruited. The experimental group received the acupressure and quadriceps training program (n = 20), while the control group (n = 18) received the quadriceps-training program. The Outcome Measurement Instrument for Medical Care of Knee Osteoarthritis and the Visual Analogue Scale of pain were used. Results: The total score and subscores of the Outcome Measurement Instrument for Medical Care and Visual Analogue Scale of pain significantly decreased over time (p < .001). Subscores of pain, activities of daily living and symptoms, mobility function, emotional function, and social participation function and pain scores of Visual Analogue Scale did not differ between groups. Conclusion: The acupressure program did not have effects but the quadriceps-training program had significant effects on outcomes. Future studies might use an experimental study with a priori power analysis and monitor the actual implementation status of the intervention for validating the effect of acupressure for patients with knee osteoarthritis.