[[alternative]]Testing efficacy of biofeedback interventions for postoperative anxiety ,wound pain, and pain during continuous passive motion exercise in patients with a total knee replacement.

[[abstract]]本研究目的為探討生物回饋介入措施對改善膝關節置換術後傷口疼痛、焦慮與接受continuous passive motion (CPM)復健運動時疼痛的成效。本研究屬類實驗型研究設計。以方便取樣，於北部某醫學中心的骨專科病房，收集符合選樣條件之關節置換術後病患共66人以隨機分配方式，將接受膝關節置換手術病患分為實驗組及控制組各33人。實驗組病患於手術前一日，接受生物回饋肌肉鬆弛治療方式的教學。於術後第1天即開始實施生物回饋介入措施，配合CPM訓練同步執行生物回饋放鬆訓練，每日2次，每次30分鐘，實施至術後第5天終止，藉由儀器回饋影像訓練病患放鬆技巧。控制組病患為僅接受一般常規治療照護包括：接受CPM復健運動每日2次，每次30分鐘。對所有參與者進行下列資料收集，於每次進行CPM訓練前及完成CPM訓練時以疼痛視覺量表測量當下的疼痛情形，並於術後第一天至五天晚上以台灣版簡易疼痛量表與貝氏焦慮量表評估病患該天疼痛與焦慮情形，藉以評估生物回饋介入措施對改善膝骨性關節炎病患在膝關節置換手術後傷口疼痛與焦慮之成效。結果發現，膝關節置換術後病患有明顯之焦慮(控制組:7.5±5.3:實驗組: 5.2±3.1)；與傷口疼痛(控制組: 6.4±1.9: 實驗組:6.6±1.8)之情形，且執行CPM時會加重傷口疼痛情形(控制組:7.3±1.9:實驗組: 5.9±1.8)。Generalized Estimating Equations統計結果顯示接受生物回饋介入措施可減輕術後焦慮，其總分(ß=-1.136~-4.268)，整體傷口疼痛，(ß=-0.023，p=0.00)及疼痛影響 (ß=-0.383，p=0.121)，以術後三日內疼痛影響程度的潛在效益。研究結果顯示接受生物回饋介入措施可緩和進行CPM時之疼痛程度(ß=-1.11，p=0.00)，且減輕疼痛之成效以手術當日與術後1-2日最為顯著。在執行CPM的遵從性方面，兩組病患執行CPM的遵從性未有顯著差異。期盼本研究結果能提供第一線臨床護理人員照護關節置手術病患之參考。[[abstract]]This study was designed to investigate bio-feedback intervention to reduce postoperative pain and anxiety, and knee pain during continuous passive motion (CPM) of rehabilitation exercise for patents received total knee replacement surgery. This study was a experimental study design. A convenient sample of 66 total knee replacement patients who met the elegibility criteria were recruited from a medical center in Taipei. Participants were randomly assigned to ether a control ( n =33 ) or a intervention group ( n =33 ). The intervention group received a muscle relaxation training with a biobeedback mechine prior to the surgey. The participants in the control group received a usual care. The results showed that knee replacement patients had great degree of anxiety (control group: 7.5±5.3; intervention group: 5.2±3.1), and wound pain (control group: 6.4±1.9: intervention group: 6.6±1.8), and their levels of pain were aggregated (control group: 7.3±1.9: intervention group: 5.9±1.8)during the continuous passive motion knee rehabilitation exercise . The results of Generalized Estimating Equations showed that biofeedback muscle relaxation intervention had potential to reduce postoperative anxiety (ß=-1.136~-4.268), pain (ß=-0.023，p<0.001) and pain affecting to their daily life ((ß=-0.383，p=0.12) for patients reveived a total knee replacement, and biofeedback muscle relaxation intervention eased pataints’ pain during the rehabilitation exercise(ß=-1.11，p