不同振動模式對於退化性膝關節炎患者在局部振動介入後的立即性效益

Abstract

背景： 膝關節炎（Knee Osteoarthritis, OA）影響全球約8,670萬人，是導致老年人疼痛與失能的主要退化性疾病之一。然而，目前文獻主要集中於探討不同振動頻率的選擇，針對連續模式及間歇模式振動對於不同神經肌肉功能成效的比較則較少有研究討論。 研究目的：探討連續振動模式與間歇振動模式對膝關節骨關節炎患者在多項神經肌肉功能之立即效應。 研究設計：交叉設計研究 研究方法：本研究共由台北慈濟醫院招募了40位診斷為膝關節炎的參與者並隨機分為兩組。第一組先接受連續模式振動，後接受間歇模式振動；第二組則相反。所有受試者皆在患側股內側肌接受連續與間歇模式各兩分鐘的振動介入。量測內容包含基本資料及振動介入前後的各項臨床成效評估。統計分析採用單因子重複量數變異數分析比較振動介入前、連續模式振動後及間歇模式振動後對疼痛、肌力、膝關節位置覺、血流動力學及功能表現的影響。此外，也會使用配對樣本t檢定比較連續與介歇振動模式下組織循環的差異。統計顯著水準設定為p < 0.05。 結果：連續模式振動相比於間歇模式振動，能增加股內側肌的微循環與背內側前額葉皮層的活化程度；而間歇模式振動則相較於連續模式振動，更能降低關節位置覺測試中的絕對誤差值。 結論：本研究成果發現連續模式與間歇模式的振動介入在施作兩分鐘後能立即改善膝骨關節炎患者的神經肌肉功能，且對於微循環不佳的問題，建議使用連續模式振動；而針對本體感覺缺損的問題，則更適合使用間歇模式振動。依據個別臨床症狀選擇合適的局部肌肉振動模式，對於精準復健可能具有潛在的應用價值。

Background: Knee osteoarthritis (OA) affects 86.7 million people worldwide and is a leading degenerative disease that causes pain and disability in older adults. However, current literature primarily focuses on selecting different vibration frequencies, with few studies investigating the differences between continuous mode and intermittent mode vibrations to enhance various neuromuscular functions. Purpose: To investigate the immediate effects of continuous and intermittent mode local muscle vibration (LMV) on multiple neuromuscular functions in individuals with knee OA. Design: Crossover design study Methods: A total of 40 participants diagnosed with knee OA were recruited from Taipei Tzu Chi Hospital. Participants were randomized into two intervention arms. Arm 1 first performed continuous mode vibration, followed by intermittent mode vibration, while arm 2 performed the opposite sequence. All participants received continuous and intermittent mode local muscle vibration for two minutes that targeted the vastus medialis on the affected side. Measurements included basic demographic information and clinical outcomes assessed before and after the vibration interventions. One-way repeated measures ANOVA was used to compare the differences in pain, muscle power, knee joint position sense, hemodynamic data, and functional performance among baseline, continuous mode, and intermittent mode vibration. In addition, a paired t-test was used to compare muscle hemodynamic responses between the continuous and intermittent vibration modes. The level of statistical significance was set at p < 0.05. Results: The microcirculation in the vastus medialis and dorsal medial prefrontal cortex (DMPFC) activation of continuous mode vibration increased compared to intermittent mode vibrations. Meanwhile, the absolute error value in the joint position sense test of intermittent mode vibration decreased compared to continuous mode vibrations. Conclusions: Both continuous and intermittent modes after two minutes of vibration immediately improve neuromuscular functions in knee OA. Continuous mode vibration may be more suited for microcirculation, while intermittent mode may be more suited for proprioception. Personalized mode selection of local muscle vibration that addresses specific clinical symptoms may have potential in precision rehabilitation.