復健運動對膝關節置換術病人的疼痛、關節功能與生活品質之成效探討

Effect of Rehabilitation Exercise on Pain, Joint Function, and Quality of Life in Patients Following Knee Replacement

10.6142/VGHN.202106_38(2).0002

張瑞燕(Jui-Yen Chang)；吳佳蓉(Chia-Jung Wu)；李子晴(Tzu-Ching Lee)；陳正豐(Cheng-Fong Chen)；林麗華(Li-Hwa Lin)

退化性關節炎 ； 足部復健腳踏器 ； 連續被動運動器 ； 疼痛 ； 關節功能 ； degenerative arthritis ； foot rehabilitation pedal ； continuous passive motion (CPM) ； pain ； joint function

榮總護理

38卷2期（2021 / 06 / 01）

120 - 132

繁體中文

本研究旨在探討復健運動對膝關節置換術後病人膝關節的疼痛、關節功能及生活品質之成效。採類實驗研究設計，研究對象為北部某醫學中心骨科病房，首次接受單側膝關節置換手術的病人，實驗組及對照組各收集80人；實驗組接受足部復健腳踏器復健運動，對照組則採連續被動運動器常規照護。以疼痛視覺類比量表、膝關節損傷和骨關節炎評分表及台灣簡明版世界衛生組織生活品質問卷為研究工具，於手術前、出院前與術後30天進行資料收集與分析。研究結果發現，實驗組疼痛分數由術前6.28（SD=4.94）下降至術後30天的2.63（SD=1.12），關節功能由90.95（SD =26.53）上升至111.76（SD =13.64），生活品質則是從65.78（SD =14.23）增加至66.81（SD =12.71）；對照組疼痛分數由術前5.35（SD =1.86）下降至術後30天的3.06（SD =2.28），關節功能從91.1（SD =17.91）上升至104.65（SD =19.22），生活品質由61.95（SD =13.63） 增加至67.81（SD =11.79）。兩組的疼痛指數、關節功能及生活品質手術前至術後30天的變化，使用獨立樣本t檢定，除了生活品質外，結果顯示有統計上的顯著意義（p ＜ .001），代表實驗組使用足部復健腳踏器復健運動，相較於對照組採連續被動運動器常規照護，有較好的疼痛控制及術後膝關節功能的恢復，但兩組在生活品質的表現上沒有顯著的差異。臨床建議膝關節術後採用足部復健腳踏器，執行術後復健運動，以減輕疼痛並提升關節功能。

This study aimed to explore the effects of rehabilitation exercise on knee pain, joint function, and quality of life in patients who received a knee replacement. This study used an experimental research design wherein research participants were recruited from the orthopedic ward of a medical center in Northern Taiwan, and the focus was patients who received unilateral knee replacement surgery for the first time. The experimental and control groups were each assigned 80 patients. The experimental group received foot rehabilitation exercises with a pedaled device, whereas the control group engaged in passive exercise and received routine care. Additionally, the visual analog scale for pain, the knee joint injury and osteoarthritis scale, and Taiwan's concise version of the World Health Organization's quality of life questionnaire were the research tools used to collect data before surgery, before discharge, and 30 days after surgery. The average pain score of the experimental group decreased from 6.28 (SD=4.94) before surgery to 2.63 (SD=1.12) 30 days after surgery, and the average joint function score increased from 90.95 (SD=26.53) before surgery to 111.76 (SD=13.64) after surgery. The average quality scores increased from 65.78 (SD=14.23) before surgery to 66.81 (SD=12.71) 30 days after surgery, whereas the pain score of the control group decreased from 5.35 (SD=1.86) to 3.06 (SD=2.28), joint function increased from 91.1 (SD=17.91) to 104.65 (SD=19.22), and quality of life increased from 61.95 (SD=13.63) to 67.81 (SD=11.79), all for the same period. The changes in pain index, joint function, and quality of life of the two groups from before surgery to 30 days after surgery were determined using an independent sample t test. Except for that on quality of life, these differences were statistically significant between the groups (p＜ .001). The experimental group's use of foot rehabilitation exercises with a foot pedal for partial rehabilitation resulted in better pain control and recovery of knee joint function after surgery compared with the outcomes of the control group, which received conventional care with the continual use of passive exercise equipment. However, the two groups exhibited no significant difference in quality of life. Foot rehabilitation pedals should be used as part of postoperative rehabilitation exercises after knee joint surgery to relieve pain and improve joint function.

1. 柯幸芳,蔣玉滿,郭美玲(2018)。運用針灸對於降低全膝關節置換術後疼痛之成效─系統性文獻回顧。長庚護理，29(4)，503-516。
   連結：
2. 高傳真,高宗桂(2017)。膝關節骨性關節炎的功能測評法。臺灣中醫科學雜誌，9(2)，20-30。
   連結：
3. Barker, K. L.,Room, J.,Knight, R.,Dutton, S. J.,Toye, F.,Leal, J.,Kent, S.,Kenealy, N.,Schussel, M. M.,Collins, G.,Beard, D. J.,Price, A.,Underwood, M.,Drummond, A.,Cook, E.,Lamb, S. E.(2020).Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT.Health Technology Assessment,24(65),1-116.
4. Canovas, F.,Dagneaux, L.(2018).Quality of life after total knee arthroplasty.Orthopadeic & Traumatology. Surgery & Research,104(1S),41-46.
5. Ditton, E.,Johnson, S.,Hodyl, N.,Flynn, T.,Pollack, M.,Ribbons, K.,Walker, F. R.,Nilsson, M.(2020).Improving patient outcomes following total knee arthroplasty: Identifying rehabilitation pathways based on modifiable psychological risk and resilience factors.Frontiers in Psychology,29(11),1061.
6. Domínguez-Navarro, F.,Igual-Camacho, C.,Silvestre-Muñoz, A.,Roig-Casasús, S.,María Blasco, J.(2018).Effects of balance and proprioceptive training on total hip and knee replacement rehabilitation: A systematic review and meta-analysis.Gait & Posture,62,68-74.
7. Gunaratne, R.,Pratt, D. N.,Banda, J.,Fick, D. P.,Khan, R. J. K.,Robertson, B. W.(2017).Patient dissatisfaction following total knee arthroplasty: A systematic review of the literature.The Journal of Arthroplasty,32(12),3854-3860.
8. He, M. L.,Xiao, Z. M.,Lei, M.,Li, T. S.,Wu, H.,Liao, J.(2014).Continuous passive motion for preventing venous thromboembolism after total knee arthroplasty.Cochrane Database Systemic Review,7,1-47.
9. Hwang, H. F.,Liang, W. M.,Chiu, Y. N.,Lin, M. R.(2003).Suitability of the WHOQOL-BREF for community-dwelling older people in Taiwan.Age and Ageing,32(6),593-600.
10. Klem, N. R.,Smith, A.,O'Sullivan, P.,Dowsey, M. M.,Schütze, R.,Kent, P.,Choong, P. F.,Bunzli, S.(2020).What influences patient satisfaction after TKA? A qualitative investigation.Clinical Orthopaedics and Related Research,478(8),1850-1866.
11. Kutzner, I.,Heinlein, B.,Graichen, F.,Rohlmann, A.,Halder, A. M.,Beier, A.,Bergmann, G.(2012).Loading of the knee joint during ergometer cycling: Telemetric in vivo data.Journal of Orthopaedic & Sports Physical Therapy,42(12),1032-1038.
12. Lin, Y. H.,Lee, S. Y.,Su, W. R.,Kao, C. C.,Tai, T. W.,Chen, T. B.(2018).Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement.Journal of Clinical Nursing,27(9-10),1836-1845.
13. Oktas, B.,Vergili, O.(2018).The effect of intensive exercise program and kinesiotaping following total knee arthroplasty on functional recovery of patients.Journal of Orthopaedic Surgery and Research,13(1),233.
14. Ramlall, Y.,Andrion, J. J. D.,Cameron, H. U.,Sawhney, M.(2019).Examining pain before and after primary total knee replacement (TKR): A retrospective chart review.International Journal of Orthopaedic and Trauma Nursing,34,43-47.
15. Roos, E. M.,Roos, H. P.,Lohmander, L. S.,Ekdahl, C.,Beynnon, B. D.(1998).Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure.Journal of Orthopaedic & Sports Physical Therapy,28(2),88-96.
16. Šťastný, E.,Trč, T.,Philippou, T.(2016).Rehabilitation after total knee and hip arthroplasty.Casopis Lekaru Ceskych,155(8),427-432.
17. Tay, M. L.,McGlashan, S. R.,Monk, A. P.,Young, S. W.(2021).Revision indications for medial unicompartmental knee arthroplasty: A systematic review.Archives of Orthopaedic and Trauma Surgery
18. Yang, Y.,Wang, J.,Dong, L.,Liu, A. F.,Zhang, X. Y.,Li, C. Y.(2021).The effect of continuous passive motion in patients treated with total knee arthroplasty for osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.American Journal of Physical Medicine & Rehabilitation
19. Yao, G.,Chung, C. W.,Yu, C. F.,Wang, J. D.(2002).Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version.Journal of Formos Medical Association,101(5),342-351.