[[alternative]]Exploring the Effectiveness of Heating Pad and Stretching Exercises for Relieving Shoulder and Neck Pain Caused by Prone Position After Pneumatic Retinopexy

[[abstract]]背景:視網膜剝離是眼科急症之一，嚴重會導致失明，氣體視網膜固定術術後執行趴臥姿勢可增加手術成功率，降低後囊性白內障發生率。目的:長時間趴臥容易造成肩頸痠痛，故本研究之目的在探討氣體視網膜固定術術後趴臥病人，接受熱敷與伸展運動緩解肩頸痠痛之成效。方法:研究採類實驗性研究設計，經方便取樣方式，選取北部某醫學中心眼科病房接受氣體視網膜固定術術後趴臥病人，共收案68名，分為實驗組與對照組。實驗組接受熱敷與伸展運動，對照組接受常規護理，兩組於術後當天及術後第一天、第四天以疼痛視覺類比尺度量表(VAS)及台灣版－簡易疼痛量表(BPI-T)，進行三次資料收集。結果：本研究納入統計分析共68人，包括實驗組33人(平均56.31歲，男性54.5%)及對照組35人(平均60.77歲，男性48.6%)。經Paired-sample t-test分析，肩頸痠痛程度及困擾程度，達顯著差異（p< .000）；以generalized estimating equation分析顯示實驗組與對照組在疼痛程度與困擾程度之間達顯著差異(β=2.85, p=0.000)。隨著手術後時間的增加，熱敷與伸展運動改善實驗組肩頸痠痛程度與困擾程度較對照組來的顯著( p=0.000)。結論與建議:透過簡單且易執行的伸展運動訓練計畫，可以緩解氣體視網膜固定術術後趴臥病人肩頸痠痛程度與疼痛困擾程度，增加病人趴臥意願，進而促進疾病治癒，增加照護品質。[[abstract]]Background：Retinal detachment is one of the ophthalmologic emergencies, which can lead to blindness. Studies show that postoperative position facilitates the success of pneumatic retinopexy and reduces the incidence of posterior subcapsular cataract. On the other hand, maintaining prone position for a long time easily lead to neck and shoulder pain. Purpose：This study is aimed to investigate the effects of heating pad and stretching exercise in relieving neck and shoulder pain in patients post pneumatic retinopexy. Methods：This study employed a quasi-experimental design with a convenience sample of 68 patients received the pneumatic retinopexy in Taipei Taiwan from September 2017 to May 2018. The control group received usual nursing care, whereas the experiment group received local heating therapy and a stretch exercise program. The study outcomes were measured with the Visual Analogue Scale (VAS) and the Brief Pain Inventory-Taiwanese version (BPI-T) collected at the baseline, day 1, and day 4 post operation. Results：The data were analyzed with chi-square test, t-test, and generalized estimating equation (GEE) model. Finally, a total of 68 patients participated in this study, 33 in the stretching exercise group (a mean age of 56.31) and 35 in the control group (a mean age of 60.77). The paired-sample t tests show significant differences (p< 0.000) of the level of neck and shoulder pain and the degree of distress between two groups. In addition, GEE model shows significant differences in VAS scores and BPI-T scores between the two groups (β = 2.85, p= 0.000). As the surgery time increases, the effects of local heating and stretching exercise in reducing the degree of pain and distress in the experimental group were significantly higher than that of the control group ( p= 0.000). Conclusions/Implications for practice：The stretching exercise program is effective in relieving neck or shoulder pain and the degree of distress in post pneumatic retinopexy patients keeping a prone position. The exercise program also increases the patient’s willingness to maintain the prone position as ordered by surgeons to promote success rates of pneumatic retinopexy and the quality of care