{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390282680553760768.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.14900/cjpt.2014.0121"}},{"identifier":{"@type":"NAID","@value":"130005247735"}}],"dc:title":[{"@language":"ja","@value":"腰痛を有する脊柱変性後弯高齢者の腰痛特異的QOLに影響を及ぼす因子の検討"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"ja","@value":"【はじめに，目的】脊柱変性後弯は，脊柱可動域の減少（後屈制限），体幹伸筋群の筋力低下，腰痛の出現頻度が高く，加齢とともに増悪する傾向がありQOLを阻害するとされている。しかし，高齢者の脊柱変性後弯症に対する理学療法効果は一定の見解に至っておらず，客観的な体幹筋力評価をアウトカムに用いた報告も少ない。このことから，腰痛を呈する脊柱変性後弯高齢者の腰痛特異的QOL評価であるOswestry Disability Index（ODI）に対して，脊椎のアライメントや可動域，体幹筋力といった身体機能が及ぼす影響について検討することを目的とした。【方法】対象は当院脊椎外科・整形外科を受診した3ヶ月以上持続する腰痛を有する脊柱変性後弯症の女性高齢者30名（平均年齢77.2歳±5.43）とした。なお，脊柱の手術既往，重度の神経根症状，脊髄症状，その他重篤な合併症がある者は対象から除外した。評価項目は，年齢，BMI，腰痛動作時VAS，胸椎後弯角，腰椎前弯角，腰仙角，脊柱傾斜角，脊柱可動域（屈曲・伸展；Spinal Mouse），体幹筋力，10m最大歩行速度，自己効力感（GSES），腰痛特異的QOL（ODI）とした。体幹筋力は，徒手筋力測定器（モービィMT-100[酒井医療社製]；HHD）を用いて測定し，椅坐位にて屈曲筋力および伸展筋力を測定した。統計的解析は，ステップワイズ重回帰分析にてODIに対する影響因子を解析した。また，選択された影響因子と各評価項目の関係をスピアマンの順位相関係数（rs）で求めた。有意水準は全て5%とした。【結果】重回帰分析の結果，ODIへ有意に影響した因子は，脊柱傾斜角（標準偏回帰係数b=0.652；P＜0.01），動作時VAS（b=0.339；P＜0.05）であった。また，脊柱傾斜角は体幹伸展可動域（rs=0.919）と10m最大歩行速度（rs=0.722）と中等度以上の相関を認めた。動作時VASは体幹伸展筋力（rs=-0.735）と中等度以上の相関を認めた。【考察】腰痛に対する疾患特異的評価であるODIに影響を及ぼす因子は，脊柱傾斜角と動作時VASであることがわかった。脊柱変性後弯高齢者は機能低下やQOL低下をきたすことがあり，機能やQOLを向上させることがリハビリテーションの役割の一つであると考える。つまり影響力は中等度であるが，疼痛軽減と姿勢改善を目的とした理学療法介入が基本になると判断した。また，脊柱傾斜角は体幹伸展可動域や歩行速度と相関があり，疼痛は体幹伸展筋力と相関があることから，脊柱後弯症の高齢者に対しては脊柱後弯の程度や脊柱可動性，体幹筋力，歩行速度などの評価が重要であると考えた。ただし，本研究は横断研究であり，臨床において患者の機能やQOLには様々な因子が関与していることが考えられるため，今後は脊柱後弯や体幹筋力の改善をアウトカムとした前向き研究にて実際にQOL向上に影響する因子を確認する必要がある。【理学療法学研究としての意義】本研究において，腰痛を呈する脊柱変性後弯高齢者に対する理学療法介入の可能性が示された。脊柱変性後弯高齢者は脊柱傾斜（C7 plumb lineの前方偏位），腰痛，体幹伸展可動域の低下，歩行速度の低下をきたすため，それらの身体機能を評価し理学療法を実施することでよりQOLに反映する効率的なリハビリテーションが可能となると考える。体幹筋力評価を客観的に行っている施設は多くないが。HHDによる座位での簡便かつ正確な体幹筋力の測定は，短時間で腹臥位がとれない対象でも測定が可能なため，臨床における理学療法効果の判定に有用な評価バッテリーであると考える。"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410001205576351744","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000314366123"}],"foaf:name":[{"@language":"ja","@value":"対馬 栄輝"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"弘前大学大学院保健学研究科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410282680553760898","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000345240114"}],"foaf:name":[{"@language":"ja","@value":"白土 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純一"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"福島県立医科大学会津医療センター　リハビリテーション科"},{"@language":"ja","@value":"弘前大学大学院保健学研究科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410282680553760899","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000345240110"}],"foaf:name":[{"@language":"ja","@value":"遠藤 達矢"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"福島県立医科大学会津医療センター　リハビリテーション科"},{"@language":"ja","@value":"弘前大学大学院保健学研究科"}]}],"publication":{"prism:publicationName":[{"@language":"en","@value":"Congress of the Japanese Physical Therapy Association"},{"@language":"ja","@value":"理学療法学Supplement"}],"dc:publisher":[{"@language":"en","@value":"Japanese Physical Therapy Association(Renamed Japanese Society of Physical Therapy)"},{"@language":"ja","@value":"日本理学療法士協会（現 一般社団法人日本理学療法学会連合）"}],"prism:publicationDate":"2015","prism:volume":"2014","prism:number":"0","prism:startingPage":"0121"},"availableAt":"2015","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E8%85%B0%E7%97%9B","dc:title":"腰痛"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%86%86%E8%83%8C","dc:title":"円背"},{"@id":"https://cir.nii.ac.jp/all?q=%E4%BD%93%E5%B9%B9%E7%AD%8B%E5%8A%9B","dc:title":"体幹筋力"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2001307607"},{"@type":"CIA","@value":"130005247735"}]}