臺灣博碩士論文加值系統

下背痛雖然不像癌症如此致死，但是對人的生活品質影響卻非常鉅大，47%到90%的病人終其一生至少有一次因下背痛而困擾。比起糖尿病、高血壓等慢性病，大部分的人常常輕忽下背痛的嚴重性與影響。其實一般人雖然不會因為下背痛而致死，但是下背痛所影響的層面非常廣，尤其對生活品質的影響甚劇。
慢性下背痛都是從急性下背痛延伸而來的，而且大約30%的急性下背痛會轉為慢性。並且這些病人所耗費的是超過80%以上的醫療費用。慢性下背痛的研究中包括以下四個面向：包括疾病的嚴重度、對情緒上的衝擊、因為慢性下背痛而產生的殘障、以及接下來的生活品質影響。下背痛有許多促成的危險因子。慢性下背痛的風險分析可分為生活品質、心理部分、工作相關部分、疼痛部分、生理部分等五大部分。其中包含殘障指數(Oswestry Disability Index，ODI)，疼痛分數(Pain assessment of visual analog scale，P-VAS)，生活品質問卷(SF-36)，中國人健康問卷十二題版(CHQ-12)，憂鬱症問卷(Goldberg Depression Scale, GDS)等問卷。
本研究利用複迴歸與分群技術計算各問卷與慢性下背痛以及生活品質之間的關係，得到發生慢性下背痛的閾值。包括殘障指數分數大於30、生活品質問卷分數小於375、中國人健康問卷分數大於等於2、憂鬱症問卷分數大於等於18，都具有顯著意義(P<0.01)。利用以上的分數最為變數，預測病人得到慢性下背痛的機會(R2=0.39)，其中包括一年中平均疼痛分數、感覺到麻痛的程度、社會功能(SF-SF)、以及中國人健康問卷等四個變項，其可解釋的程度較高(p<0.1)。並且利用殘障指數、中國人健康問卷與疼痛分數作為慢性下背痛生活品質的預測(R2=0.59)。發現若以上的問卷分數都接近正常，得到慢性下背痛的機會非常小。
大部份病人(>80%)每次疼痛不會超過一星期。生產次數與BMI都是慢性下背痛的重要因子，多產婦與體重過重的病人較易得到慢性下背痛。吸煙是下背痛的危險因子，但是慢性下背痛與非慢性下背痛之間差異不大(p>0.1)。慢性下背痛病人喝茶或是咖啡等的量比非慢性下背痛病人要多，並且具有顯著意義(p<0.1)。運動與休閒的時間，慢性下背痛比非慢性下背痛要少，並且具有顯著差異(p<0.01)，所以規律的運動與適當的休閒可以減少慢性下背痛的機會。

Not like cancers that will cause the people die, it will be influence the quality of life of the patients with low back pain (LBP). At least 47% to 90% people will get low back pain in whole of his life. Most people ignored the influence and the impacts of the health that cause by the LBP. Actually, people will not die because of the LBP. But it will influence widely, especial the quality of life (QOL).
The chronic LBP usually comes from acute stage. About 30% LBP patients will spend more than 80% of the costs that used on low back pain. The researches of chronic LBP will focus 4 aims: The severity of disease, the impact of the emotion, the disability that cause by LBP, and the influences of the QOL. The LBP has many risk factors and these assessments of the chronic LBP divides into 5 parts: the QOL, psychological factors, work relates, pain relates, physical factors. The Oswestry Disability Index, (ODI), Pain assessment of visual analog scale (P-VAS), 36-item short-form health survey (SF-36), Chinese Health Questionnaire (CHQ-12) are included.
The data were for evaluating and finding the correlations between the quality of life, some scales and chronic LBP with multiple linear regressions and clustering technologies. The thresholds of these scales that define the chronic LBP are also presented. It included that ODI≧30, SF-36<375, CHQ-12≧2, GDS≧18 with significance (p<0.01). Build a model with these scales to predict the chance of being chronic LBP (R2=0.39). Including year-mean pain scale, the grades of feeling numbness, social functioning factor of SF-36 (SF-SF) and CHQ-12, these can well predict the chronic LBP with significance (p<0.1). And the ODI, CHQ-12 and P-VAS can present the QOL who has LBP (R2=0.59). We can almost confirm that the patient is only acute LBP if all of these scales remain near normal.
Most patients (>80%) with LBP will not last for more than 7 days. The times of pregnant and BMI are both of the most important risk factors. The patients will more easy to have chronic LBP if you delivered the baby more than 3 times and BMI is higher than normal. Smoking is also another risk factors but there is no significant different between the chronic and acute LBP (p>0.1). Chronic LBP drink more tea or coffee than acute LBP with significant different (p<0.01). The less exercise and entertainments with chronic LBP compares with acute LBP and it is significant different (p<0.01). So it will decrease the chance of getting chronic LBP with regular exercise and proper entertainment.

1 緒論 --------------------------------------------- 1
1.1 研究背景 ----------------------------------------- 1
1.2 研究動機 ----------------------------------------- 3
1.3 研究目的 ----------------------------------------- 4
1.4 研究觀念架構與流程 ------------------------------- 5
1.5 研究問題與預期結果 ------------------------------- 7
2 文獻探討 ----------------------------------------- 8
2.1 下背痛的定義 ------------------------------------- 8
2.2 下背痛的危險因子 -------------------------------- 10
2.3 下背痛疾病分類系統與評估量表--------------------- 15
3 研究方法與設計 ---------------------------------- 26
3.1 研究主題與問題描述------------------------------- 26
3.2 問卷設計與說明 ---------------------------------- 27
3.3 問卷基本資料 ------------------------------------ 32
3.4 病人資料收集與分析 ------------------------------ 35
3.5 複迴歸 ------------------------------------------ 35
3.6 集群分析----------------------------------------- 39
4 結果 -------------------------------------------- 41
4.1 收集之病患基本資料------------------------------- 41
4.2 健康行為----------------------------------------- 51
4.3 疼痛分數----------------------------------------- 56
4.4 Oswestry Disability Index (ODI) ----------------- 60
4.5 Short Form Health Survey 36 (SF-36) ------------- 62
4.6 中國人健康問卷十二題版(CHQ) --------------------- 81
4.7 Goldberg Depression Scale (GDS) ----------------- 83
4.8 複迴歸模式 -------------------------------------- 85
4.9 分群結果 ---------------------------------------- 92
5 討論 -------------------------------------------- 96
5.1 問卷基本資料 ------------------------------------ 96
5.2 病患基本資料 ------------------------------------ 98
5.3 健康行為 --------------------------------------- 102
5.4 疼痛分數---------------------------------------- 104
5.5 Oswestry Disability Index (ODI) ---------------- 107
5.6 Short Form Health Survey 36 (SF-36) ------------ 108
5.7 中國人健康問卷十二題版(CHQ) -------------------- 114
5.8 Goldberg Depression Scale (GDS) ---------------- 116
5.9 複迴歸模式 ------------------------------------- 117
5.10 分群結果 --------------------------------------- 120
6 結論 ------------------------------------------- 122
6.1 基本資料 --------------------------------------- 123
6.2 分數系統與閾值---------------------------------- 125
6.3 複迴歸與分群 ----------------------------------- 127
6.4 結語 ------------------------------------------- 129
7 參考文獻 --------------------------------------- 130
8 問卷 ------------------------------------------- 139

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