DOI QR코드

DOI QR Code

비특이성 경부통 환자의 경부통/경부기능장애와 상지 기능장애 간의 상관성

The Association Between Neck Pain/Disability and Upper Limb Disability in Patients with Non-Specific Neck Pain

  • 장현정 (대전대학교 대학원 물리치료학과) ;
  • 김선엽 (대전대학교 물리치료학과) ;
  • 전재국 (서울우리들 병원 물리치료실) ;
  • 신의주 (서울우리들 병원 물리치료실)
  • Jang, Hyun-Jeon (Dept. of Physical Therapy, College of Natural Science, The Graduate School, Daejeon University) ;
  • Kim, Suhn-Yeop (Dept. of Physical Therapy, College of Natural Science, Daejeon University) ;
  • Jeon, Jae-Guk (Dept of Physical Therapy, Seoul Wooridul Hospital) ;
  • Shin, Eui-Ju (Dept of Physical Therapy, Seoul Wooridul Hospital)
  • 투고 : 2013.03.25
  • 심사 : 2013.06.07
  • 발행 : 2013.06.30

초록

본 연구는 비특이성 경부통 환자의 경부통증수준과 상지 기능장애간에 상관성을 알아보고자 실시하였다. 경부통증과 경부기능장애는 Northwick Park Neck Pain Questionnaire(NPQ)로 상지 기능장애는 상지기능장애 설문지(disabilities of arm, shoulder, hand questionnaire; DASH)를 이용하여 평가하였다. 잠재적인 교란변수로 작용할 수 있는 심리학적 변수는 통증 자아효능감(Pain Self Efficacy; PES)과 공포회피반응 설문지(fear-avoidence beliefs questionnaire; FABQ)를 이용하여 측정하였다. 분석 결과, NPQ 점수와 DASH 점수는 피어슨 상관 계수가 0.628점의 양의 상관관계가 있었으며, PES과 FABQ 점수와도 유의한 상관성을 나타내었다. 이 결과를 통해 경부통 환자의 경부통 및 경부기능장애 수준과 상지 기능장애 수준 간에 상관성이 나타날 수 있음을 알 수 있었다. 또한 통증에 대한 부정적인 인식과 공포회피반응이 심한 환자의 경우 상지 기능평가에 직접적인 영향을 줄 수 있는 것으로 확인되었다. 이에 경부통 환자의 관리 시 상지 기능장애와 심리학적 요인을 평가하여야만 할 것이다.

The purpose of this study was to investigate the relationship between neck pain and upper limb disability in patients with non-specific neck pain (n=132) recruited from physiotherapy departments in the Korea. Baseline neck pain/disability was measured using the Northwick Park Neck Pain Questionnaire (NPQ) and upper limb disability was measured using the Disabilities of Arm, Shoulder, Hand questionnaire (DASH). A range of baseline psychosocial variables were measured as potential confounding variables. Pairwise analysis revealed a positive correlation between NPQ score and DASH score (Pearsons' r=0.628, p<0.05). This study provides preliminary evidence that patients with severe neck pain/disability also report severe upper limb disability. The presence of severe neck pain or low pain self efficacy and high fear-avoidence beliefs questionnaire should clinicians towards a careful examination of upper limb function in patients presenting with neck pain. Our data suggest the upper limb disability may need to be addressed as part of the neck management process.

키워드

참고문헌

  1. Ranney D, Wells R, Moore A, "Upper limb musculoskeletal disorders in highly repetitive industries: precise anatomical physical findings", Ergonomics, Vol. 38, No. 7, pp. 1408-1423, 1995. DOI: http://dx.doi.org/10.1080/00140139508925198
  2. Cote P, Cassidy JD, Carroll L. "The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults", Spine, Vol. 23, No. 15, pp. 1689-1698, 1998. DOI: http://dx.doi.org/10.1097/00007632-199808010-00015
  3. Carroll LJ, Hogg-Johnson S, van der Velde G, et al. "Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders" Spine, Vol. 33, No. 4, pp. 75-82. 2008. DOI: http://dx.doi.org/10.1097/BRS.0b013e31816445be
  4. McLean SM, Moffett JK, Sharp DM, et al. "An investigation to determine the association between neck pain and upper limb disability for patients with non-specific neck pain: a secondary analysis", Manual Therapy, Vol. 16, No. 5, pp. 434-439, 2011. DOI: http://dx.doi.org/10.1016/j.math.2011.01.003
  5. Rhee JM, Yoon T, Riew KD, "Cervical radiculopathy", The Journal of the American Academy of Orthopaedic Surgeons, Vol. 15, No. 8, pp. 486-494, 2007. https://doi.org/10.5435/00124635-200708000-00005
  6. Cunha AC, Burke TN, Franca FJ, et al. "Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial", Clinics, Vol. 63, No. 6, pp. 763-770, 2008. DOI: http://dx.doi.org/10.1590/S1807-59322008000600010
  7. Greening J, Lynn B. "Minor peripheral nerve injuries: an underestimated source of pain?", Manual Therapy, Vol. 3, No. 4, pp. 187-194, 1998. DOI: http://dx.doi.org/10.1016/S1356-689X(98)80047-7
  8. Frank AO, De Souza LH, Frank CA. "Neck pain and disability: a cross-sectional survey of the demographic and clinical characteristics of neck pain seen in a rheumatology clinic", International Journal of Clinical Practice, Vol. 59, No. 2, pp. 173-182. 2005. DOI: http://dx.doi.org/10.1111/j.1742-1241.2004.00237.x
  9. Daffner SD, Hilibrand AS, Hanscom BS, et al. "Impact of neck and arm pain on overall health status", Spine, Vol. 28, No. 17, pp. 2030-2035, 2003. DOI: http://dx.doi.org/10.1097/01.BRS.0000083325.27357.39
  10. Bot SD, van der Waal JM, Terwee CB, et al. "Predictors of outcome in neck and shoulder symptoms: a cohort study in general practice", Spine, Vol. 30, No. 16, pp. 459-470, 2005. https://doi.org/10.1097/01.brs.0000174279.44855.02
  11. Ha SM, Kwon OY, Yi CH, et al. "Effects of passive correction of scapular position on pain, proprioception, and range of motion in neck pain patients with bilateral scapular downward rotation syndrome", Manual Therapy, Vol. 16, No. 9, pp. 930-941, 2011.
  12. Lee KW, Seo HD, Jung KS, et al. "Reliability and Validity of Korean Northwick Park Neck Pain Qeustionnaire in Neck Pain Patients", Physical Therapy Korea, Vol. 17, No. 3, pp. 68-76, 2010.
  13. Lim JY, Lee HY, Song JH, et al. "Evaluation of the Reliability, Construct Validity, and Responsiveness of the Korean Version of the DASH", The Journal of the Korean Society for Surgery of the Hand, Vol. 10, No. 4, pp. 192-198, 2005.
  14. Bandura A, "Self efficacy: toward a unifying theory of behavior" Psychol Rev, Vol. 84, No.2, pp. 191-215, 1977. DOI: http://dx.doi.org/10.1037/0033-295X.84.2.191
  15. Asghari A, Nicholas MK. "Pain self-efficacy beliefs and pain behaviour. A prospective study", Pain, Vol. 94, No. 1, pp. 85-100. 2001. DOI: http://dx.doi.org/10.1016/S0304-3959(01)00344-X
  16. Waddell G, Newton M, Henderson I, et al. "A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability" Pain, Vol. 52, No. 2, pp. 157-168. 1993. DOI: http://dx.doi.org/10.1016/0304-3959(93)90127-B
  17. Joo MK, Kim TY, Kim JT, Kim SY. "Reliability and Validity of the Korean Version of the Fear-Avoidance Beliefs Questionnaire", Physical Therapy Korea, Vol. 16, No. 2, pp. 24-30, 2009.
  18. Von Korff M, Ormel J, Keefe FJ, et al. "Grading the severity of chronic pain." Pain, Vol. 50, No. 2, pp. 133-149, 2010. DOI: http://dx.doi.org/10.1016/0304-3959(92)90154-4
  19. McLean SM, Moffett JK, Sharp DM, et al, "An investigation to determine the association between neck pain and upper limb disability for patients with non-specific neck pain: a secondary analysis", Manual Therapy, Vol.16, No.5, pp.434-439, 2011. DOI: http://dx.doi.org/10.1016/j.math.2011.01.003
  20. Gorski JM, Schwartz LH. "Shoulder impingement presenting as neck pain", The Journal of Bone and Joint Surgery, Vol. 83, No. 4, pp. 635-638.
  21. Butler D. "The sensitive nervous system". Adelaide, Noigroup, 2001
  22. Hall T, Quintner J. "Responses to mechanical stimulation of the upper limb in painful cervical radiculopathy", The Australian Journal of Physiotherapy, Vol. 42, No. 4, pp. 277-285, 1996. https://doi.org/10.1016/S0004-9514(14)60392-5
  23. Smeets RJ, Wade D, Hidding A, et al, "The association of physical deconditioning and chronic low back pain: a hypothesisoriented systematic review", Disability and Rehabilitation, Vol. 28, No. 11, pp. 673-693, 2006. DOI: http://dx.doi.org/10.1080/09638280500264782
  24. Crombez G, Vlaeyen JW, Heuts PH, et al. "Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability", Pain, Vol. 80, No. 1-2, pp. 329-339, 1999. DOI: http://dx.doi.org/10.1016/S0304-3959(98)00229-2
  25. Denison E, Asenlof P, Lindberg P. "Self-efficacy, fear avoidance, and pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care", Pain, Vol. 111, No. 3, pp. 245-252, 2004. DOI: http://dx.doi.org/10.1016/j.pain.2004.07.001