肌貼貼紮對脛腓聯合關節關節功能的即時影響

Abstract

近年來，脛腓聯合關節傷害逐漸受到學界的重視，究其主因在於其有別於外踝扭傷的症狀，以及比後者需更長的回復運動時間。目前脛腓關節傷害的治療多使用高踝貼紮，但其臨床效應未曾有實證研究。因此，本研究主要目的為探討高踝貼紮對脛腓聯合關節功能的即時效應。其具體目標有二：(一)確立承重箭步測試器量測箭步距離之信、效度；(二)比較在高踝貼紮、偽貼紮、無貼紮等三種狀況下，脛腓聯合關節傷害者踝背屈能力與活動功能。 本研究為前瞻性、類實驗設計、單盲、前後測實驗，共分成兩部分。第1部分研究探討承重箭步測試器之信、效度，共徵召23名健康成人由2名施測者於同日與不同日使用承重箭步測試器進行承重箭步測試，計算施測者內與施測者間信度，並以電子量角器記錄的踝背屈角度為參考標準，計算效度。每次測試進行3回，取平均值來計算組內相關係數ICC(2,3)、ICC(3,3)、測量標準誤與最小可偵測變化值，以及使用皮爾森相關係數分析箭步距離與踝背屈角度之相關性。第2部分探討高踝貼紮對脛腓聯合關節傷害者關節功能的即時影響，共徵召12名脛腓聯合關節傷害者。受試者於隨機排序之高踝貼紮、偽貼紮、無貼紮等三種狀況下，進行踝背屈能力與活動功能的量測。量測變項包括以承重箭步測試器量測之箭步距離、以電子量角器量測全蹲時之踝背屈角度、以及填寫患者特化功能量表與本研究指定活動困難度分數。本研究以傅萊得曼等級檢定分析3種貼紮狀況下各變項。本研究顯著水準設定為α＝0.05，檢定力為power = 0.8。 本研究發現：(一)承重箭步測試器具有優異的效度和信度； (二)只有在高踝貼紮狀況下箭步距離會明顯變長，偽貼紮不會改變箭步距離；(三)全蹲時踝背屈角度2種貼紮狀況與無貼紮時無明顯差異；(四)高踝貼紮或偽貼紮下，患者特化功能量表分數較無貼紮狀況有改善；(五)高踝貼紮時，所有指定活動困難度較無貼紮狀況有明顯改善，而偽貼紮狀況時，則只有部分指定活動困難度較無貼紮狀況好。 本研究結果顯示承重箭步測試器為一可信且有效之踝背屈能力測量工具，未來可在臨床上作推廣，且使用肌貼做高踝貼紮可以即時改善踝背屈能力以及日常活動功能表現，可作為臨床脛腓聯合關節傷害之介入方法。本研究的貢獻在於研發之新型承重箭步測試器為一簡單操作、低成本、可信有效的客觀量化工具，並提供世界首度探討高踝貼紮效應的實證醫學等級IV的實證證據。未來研究方向可再進一步探討高踝貼紮的長期療效以及對脛腓聯合關節力學上改變的機轉。

Because of its different symptoms and longer recovery time from lateral ankle sprain, more and more researchers pay attention on ankle syndesmosis injury currently. Nowadays, using kinesio taping to restrict unnecessary motions is often used for treatment of ankle syndesmosis injury. However, no experimental study has conducted to examine its effects. Therefore, the purpose of this research was to examine the acute effect of ankle syndesmosis taping on joint function in individuals with ankle syndesmosis injury. There were two research objectives developed: 1) to examine the validity and reliability of the weight-bearing lunge test (WBLT) using a self-made lunge distance device mounted with a sliding board and 2) to evaluate ankle dorsiflexion capacity and functional activities in individuals with ankle syndesmosis injury for three different conditions. This study was a prospective, quasi-experimental, single-blind, and pre-and-post trial design. There were two parts of study in this research. For the first part of the present research, validity and reliability of the weight-bearing lunge test using a lunge distance device was investigated. The WBLT using a lunge distance device was assessed repetitively on the same day and different day by the same rater and on the same day by two different raters in 23 asymptomatic adults. Angle of ankle dorsiflexion was also measured using an electrogoniometer during the first trial of the WBLT. Three trials were obtained and averaged for statistical analyses. Intraclass correlation coefficient (ICC(2,3) and ICC(3,3)), standard error of measurement and minimal detectable change were calculated for intra-rater reliability on the same day and between different days as well as inter-rater reliability. Pearson’s correlation coefficient was calculated for correlation between lunge distance and angle of ankle dorsiflexion for examining the validity. For the second part of the present research, 12 adults with ankle syndesmosis injury were recruited. All participants underwent measurements for ankle dorsiflexion capacity and functional activities in random-order taping conditions including ankle syndesmosis taping, sham taping and no taping conditions. Outcome variables included lunge distance obtained from the WBLT, angle of ankle dorsiflexion obtained from the deep squat test, score of patient-specific functional scale (PSFS) and pre-selected activity difficulty score specifically designed for this research. Friedman tests were calculated to compare the differences in those outcome variables among 3 conditions. The significant level was set at α= 0.05 while the power was set at 0.8. The main results showed: 1) the WBLT using a lunge distance device had excellent validity and reliability, 2) the lunge distance was improved for the ankle syndesmosis taping condition but it is not the case for sham taping, 3) no significant differences in ankle dorsiflexion angle during deep squat among 3 conditions, 4) score of PSFS was improved for both ankle syndesmosis and sham taping conditions, and 5) all pre-selected activity difficulty score were improved for the ankle syndesmosis taping condition while only part of them got improved in the sham taping one. These results concluded that the lunge distance device was a valid and reliable device for measurement of ankle dorsiflexion capacity, which can be used for clinical evaluation and outcome measurement. Ankle sydesmosis taping immediately improved ankle dorsiflexion capacity and performance of functional activities in individuals with ankle syndesmosis injury, suggesting that ankle syndesmosis taping be a novel intervention to ankle syndesmosis injury. The present research highlights the function of lunge distance device and provides the first objective level IV evidence of Evidence-Based Medicine for the immediate effect of ankle syndesmosis taping. Future studies should be conducted to investigate its long-term effect and mechanism of ankle syndesmosis taping to ankle syndesmosis injury.