Thesis or Dissertation 成人脳性麻痺アテトーゼ型患者における疼痛の質とTENSの効果の関係

高木, 健志

2015-03-25
Description
【目的】アテトーゼ型脳性麻痺患者の腰痛に対しTENSを行うと対象により効果に差が出現し,疹痛の質が影響していることが考えられる.本研究は疹痛の質的評価法(SF-MPQ-2)の信頼性・妥当性の確認と,疹痛の質とTENSの効果との関係を明らかにすることを目的とした.【方法】成人アテトーゼ型脳性麻痺患者8名を対象とし,級内相関係数ICC(1.1), Cronbachα係数,NRSとのピアソン積率相関係数を算出した. TENSの効果と疹痛の質の関係は,アテトーゼ型患者の腰痛にTENSとSham刺激を行い,即時効果をSF-MPQ-2にて評価した.統計学的処理はSF-MPQ-2の各スコアを従属変数とし,介入方法と介入前後を対応のある因子とした二元配置分散分析を行った.【結果】SF-MPQ-2は高い信頼性と中等度の妥当性が確認された.SF-MPQ-2によって評価検討すると,疹痛の質によりTENSの効果に差が出現した.【考察】疹痛の質によりTENSの効果に差が出現する為,TENSを行う前にSF-MPQ-2による疹痛の質的評価を行う事が重要であることが示唆された.
[Purpose] Patients with athetoid cerebral palsy typically have low back pain, and the low back pain manifests in different forms, such as continuous or intermittent pain. While the revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2) is used to evaluate the quality of pain, its reliability and validity has not yet been tested in patients with athetoid cerebral palsy and low back pain. Hence, we aimed to examine the test-retest reliability, internal consistency, and criterion-related validity of the SF-MPQ-2 in patients with athetoid cerebral palsy and low back pain and elucidate the relationship between quality of pain and the effect of transcutaneous electrical nerve stimulation (TENS). [Methods] Eight adult patients with athetoid cerebral palsy and low back pain participated in this study. We used the test-retest method (lntraclass Correlation Coefficient,ICC) for reliability assessment and the internal consistency reliability coefficients (Cronbach's alpha coefficient) for the SF-MPQ-2 total and subscale scores. Validity was evaluated by examining the associations between the SF-MPQ-2 total and subscale scores and numeric rating scale. To assess the relationship between quality of pain and the effect of TENS, we used a crossover study design wherein all subjects underwent two different procedure―TENS and sham TENS―to compare the immediate effect by SF-MPQ-2. [Result] We confirmed high reliability and moderate validity of the SF-MPQ-2. The effect of TENS showed different results based on the SF-MPQ-2 subscale. [Conclusion] As the effect of TENS is influenced by the quality of pain, it is important to evaluate the quality of pain by SF-MPQ-2 before performing TENS.
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