| 摘要: | 中風是患者失能及死亡的主要原因之一，而肩關節疼痛則是中風患者最常見的併發症之一，疼痛可能影響患者執行日常活動或是復健運動，嚴重更會干擾睡眠、引發焦慮或疲憊，造成患者的預後不佳。
針灸止痛效果被世界衛生組織及各國所接受，2010年系統性回顧的文獻指出：針灸對於中風後復健有其治療效益，可作為中風患者一個安全且經濟實惠的治療方式。而過去研究證實電刺激對於中風後的肩關節疼痛及角度受限有所幫助，但少有研究探討電針與電刺激的療效差異，因此本研究將探討電針與穴位電刺激治療對於中風患者肩關節疼痛的療效是否有差異。
本研究收案對象為中風後6個月內出現肩關節疼痛的患者，預計收案48人，隨機分配到電針組、穴位電刺激組及偽針組(每組各16人)。電針組與電刺激組在患肢肩?、巨骨兩穴位上給予電針或電刺激治療，偽針組則是偽針不加電。在治療前後評估患者疼痛程度、肩關節活動度、上肢動作功能等。統計上以重複測量變異數分析比較不同時期各組間是否有差異。
本研究結果顯示2週的治療結束後，電針組與電刺激組疼痛有明顯的改善，且與偽針組相比有顯著差異；而在肩關節活動角度上，雖然電針組與電刺激組治療後角度均有明顯增加，但僅電針組與偽針組在增加百分比上達統計顯著意義；在日常生活功能與上肢動作功能方面，三組治療後均有明顯進步，但組間比較並無差異。因此，電針治療可做為中風後肩關節疼痛的另一治療選擇。
Stroke is responsible for one of the main causes to result in patients' disability and death. Shoulder pain has been reported to be one of the most common complications after stroke. Pain may interfere with ADLs and rehabilitation programs, interrupt sleep, and contribute to depression and fatigue, and cause poor prognosis.
Pain alleviation (analgesia) by acupuncture has been accepted by World Health Organization (WHO) and many countries. At 2010 systematic review for acupuncture, the majority (80%) of the randomized clinical trials demonstrate that acupuncture may be effective in the treatment of poststroke rehabilitation, and thus providing a safe and economical method for treating stroke patients. In the past, electric stimulation (ES) were used in pain controled and ROM increased, and its showed positive effect. However, there were no study discussed the difference between electroacupuncture (EA) and ES in pain relief. The aim of this study is to identify the efficacy of EA and TEAS in reducing shoulder pain in stroke patients.
The inclusion criteria are (1) Stroke within 6 months from onset, (2) Hemiplegia with shoulder pain in the affected side. We included 48 stroke patients, and randomized to one of the three groups (EA, TEAS, and sham group). Subjects in the EA group or TEAS group received electro-acupuncture or electric stimulation on the Juanyu (Li15) & Jugu (Li16) for 20 minutes. In the sham group, we give Park's sham devices on the same points. Before and after treatment, we evaluate the muscle tone, pain degree, shoulder pain-free range of motion (ROM), motor ability of upper extremity. Descriptive statistics were provided as mean ± standard deviation for continuous variables while the number of cases and percentages were used for nominal variables. Repeated measures of analysis of variance was used to determine whether a statistically significant difference using SPSS followed by post hoc tests. The between-subjects factor was the "3 groups" and the within-subject factor was the "3 time intervals." A p value <0.05 was considered statistically significant.
In our study, the results showed that pain improved in the EA group and TEAS group after 2 weeks treatment, and significantly better than those in the sham group. Shoulder ROM limitation significantly decreased in the EA group and TEAS group, however, only subjects in the EA group improved more than those in the sham group. All subjects got improvement in the ADLs and upper extremity motor function, but no difference between the three groups. According to our study, EA treatment may be a good choice for hemiplegia shoulder pain. |
