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Journal of Health Science 2012 Vol. 21 No. 6

1176

¢âÕ‡¢à“‡ ◊ËÕ¡„ÀâºŸâªÉ«¬ ‚¥¬®– Õπ∑à“ÕÕ°°”≈—ß°“¬

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‡ª√’¬∫‡∑’¬∫°àÕπ·≈–À≈—ß‡¢â“√—∫∫√‘°“√∑’Ë§≈‘π‘°¢âÕ‡¢à“

‡ ◊ËÕ¡

3. ·®°·ºàπæ—∫§«“¡√Ÿâ·≈–°“√ÕÕ°°”≈—ß°“¬

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4. Õ∫√¡„Àâ§«“¡√Ÿâ‡°’Ë¬«°—∫¢âÕ‡¢à“‡ ◊ËÕ¡·°àºŸâªÉ«¬

‚¥¬·æ∑¬å·≈– Õπ∑à“ÕÕ°°”≈—ß°“¬°≈â“¡‡π◊ÈÕμâπ¢“

¥â“πÀπâ“ 2 ∑à“§◊Õ∑à“π—Ëß‡À¬’¬¥‡¢à“°√–¥°¢âÕ‡∑â“ ·≈–

∑à“‡°√Áß°¥‡¢à“

5. ºŸâªÉ«¬°≈—∫¡“∑’ËÀâÕßμ√«® ·æ∑¬å∑∫∑«π§«“¡√Ÿâ

∑à“ÕÕ°°”≈—ß¢âÕ‡¢à“‡ ◊ËÕ¡·°àºŸâªÉ«¬‡ªìπ√“¬∫ÿ§§≈¢≥–

μ√«®√—°…“ºŸâªÉ«¬‚¥¬„ÀâºŸâªÉ«¬∑”∑à“ÕÕ°°”≈—ß°“¬„Àâ¥Ÿ Õ’°§√—Èß‡æ◊ËÕμ√«® Õ∫§«“¡∂Ÿ°μâÕß¢Õß∑à“ÕÕ°°”≈—ß°“¬

∑’ËºŸâªÉ«¬∑”

6. π—¥ºŸâªÉ«¬¡“μ‘¥μ“¡°“√√—°…“∑ÿ° 1 ‡¥◊Õπ ‡ªìπ

‡«≈“ 3 ‡¥◊Õπ‚¥¬∑∫∑«π§«“¡√Ÿâ·≈–∑à“ÕÕ°°”≈—ß°“¬

·°àºŸâªÉ«¬∑ÿ°§√—Èß∑’Ë¡“μ‘¥μ“¡°“√√—°…“·≈–„ÀâºŸâªÉ«¬π”

¡ÿ¥∫—π∑÷°°“√ÕÕ°°”≈—ß°“¬¡“„Àâ¥Ÿ∑ÿ°§√—Èß‡æ◊ËÕμ√«®¥Ÿ

§«“¡ ¡Ë”‡ ¡Õ¢Õß°“√ÕÕ°°”≈—ß°“¬∑’ËºŸâªÉ«¬∑”

7. §√∫ 3 ‡¥◊Õπª√–‡¡‘πº≈°“√√—°…“¥â«¬·∫∫

ª√–‡¡‘πÕ“°“√¢âÕ‡¢à“‡ ◊ËÕ¡¢Õß Modified WOMAC

°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ ∂‘μ‘‡™‘ßæ√√≥π“ „™â®”π«π√âÕ¬≈–

·≈–§à“‡©≈’Ë¬

∂‘μ‘‡™‘ß«‘‡§√“–Àå „™â paired student t-test ·≈–

Wilcoxon signed ranks test „π°“√‡ª√’¬∫‡∑’¬∫

§«“¡·μ°μà“ß¢Õß¢âÕ¡Ÿ≈∑’Ë‰¥â°àÕπ·≈–À≈—ß∑”°“√»÷°…“

º≈°“√»÷°…“

æ∫«à“¡’ºŸâ‡¢â“√à«¡°“√»÷°…“∑—ÈßÀ¡¥ 30 §π ¡’ºŸâ ‰¡à

¡“μ‘¥μ“¡°“√√—°…“‡¡◊ËÕ§√∫ 3 ‡¥◊Õπ®”π«π 3 §π ®÷ß

‡À≈◊ÕºŸâ∑’Ë‡¢â“√à«¡°“√»÷°…“§√∫μ“¡‡°≥±å ®”π«π 27

§π·∫àß‡ªìπ™“¬ 8 §π À≠‘ß 19 §π Õ“¬ÿ‡©≈’Ë¬ 58 ªï

§à“¥—™π’¡«≈°“¬‡©≈’Ë¬ 26.8 ¡’ºŸâªÉ«¬∑’Ë‰¥â√—∫°“√«‘π‘®©—¬

«à“‡ªìπ‚√§¢âÕ‡¢à“‡ ◊ËÕ¡¢â“ß¢«“®”π«π 11 §π ¢â“ß´â“¬

®”π«π 6 §π ·≈–∑—Èß Õß¢â“ß®”π«π 10 §π ‚¥¬¡’

¢âÕ¡Ÿ≈∑—Ë«‰ª¥—ßπ’È

º≈°“√ª√–‡¡‘πÕ“°“√¢âÕ‡¢à“‡ ◊ËÕ¡¥â«¬·∫∫ª√–‡¡‘π Modified WOMAC æ∫«à“ √–¥—∫§«“¡ª«¥‡¢à“≈¥≈ß

·≈–√–¥—∫§«“¡ “¡“√∂„π°“√„™âß“π¢âÕ‡¢à“¥’¢÷Èπ·μ°

μà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘μ‘ (p 0.004, p<0.001 μ“¡

≈”¥—∫) √–¥—∫Õ“°“√¢âÕΩó¥ ¢âÕμ÷ß≈¥≈ß·μà‰¡à¡’§«“¡

μ“√“ß∑’Ë 1 ¢âÕ¡Ÿ≈∑—Ë«‰ª¢Õß°≈ÿà¡μ—«Õ¬à“ß (n=27 §π)

¢âÕ¡Ÿ≈ ®”π«π (§π) √âÕ¬≈–

Õ“¬ÿ (ªï)

40-49 6 22.2

50-69 18 66.7

>70 3 11.1

§à“¥—™π’¡«≈°“¬ BMI (°°./¡²)

≤ 24.9 17 63.0

≥ 25 10 37.0

Õ“™’æ

∑”π“ ∑”‰√à 10 37.0

√—∫√“™°“√ 5 18.5

·¡à∫â“π 12 44.5

√–¥—∫°“√»÷°…“

ª√–∂¡»÷°…“ 18 66.7

¡—∏¬¡»÷°…“ 7 25.9

ª√‘≠≠“μ√’ 2 7.4

§à“√–¥—∫§«“¡√ÿπ·√ß¢Õß°“√‡ ◊ËÕ¡¢Õß‡¢à“μ“¡√–∫∫‡§·Õ≈

(Kellgren-Lawrence)

√–¥—∫ 1 (¡’ªÿÉ¡°√–¥Ÿ°ßÕ°‡≈Á°πâÕ¬ 3 11.1

´÷Ëß¡’π—¬ ”§—≠∑“ß§≈‘π‘°πâÕ¬)

√–¥—∫ 2-3 (¡’ªÿÉ¡°√–¥Ÿ°ßÕ° 21 77.8

™—¥‡®π·≈–™àÕß¢âÕ·§∫≈ßª“π°≈“ß)

√–¥—∫ 4 (¡’ªÿÉ¡°√–¥Ÿ°ßÕ° 3 11.1

™—¥‡®π√à«¡°—∫™àÕß¢âÕ·§∫≈ß

√ÿπ·√ß·≈–¡’‡π◊ÈÕ°√–¥Ÿ°„μâ

°√–¥Ÿ°ÕàÕπ°√–¥â“ß)

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1178

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§π §‘¥‡ªìπ√âÕ¬≈– 48.14 ‰¡à¢Õ√—∫¬“≈¥Õ“°“√ª«¥‡¢à“

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μâ“π°“√Õ—°‡ ∫∑’Ë‰¡à„™à ‡μ’¬√Õ¬¥å‡À¡◊Õπ∑’Ë‡§¬‰¥â√—∫¡“

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æ“√“‡´μ“¡Õ≈°àÕπ‡ªìπ¢π“π·√°μ“¡§”·π–π”¢Õß

√“™«‘∑¬“≈—¬·æ∑¬åÕÕ√å‚∏ªî¥‘° å·Ààßª√–‡∑»‰∑¬ ‰¡àæ∫

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§≥–⁽⁶⁾ Deyle GD ·≈–§≥–⁽⁷⁾ Petrella RJ ·≈–§≥–⁽⁸⁾ π‘¿“«√√≥ »√’√—μπ«ÿ≤‘⁽¹⁰⁾ ·≈–°“√»÷°…“¢Õß®‘√«√√≥

μ—π«—≤π–·≈–§≥–⁽¹¹⁾ ®ÿ¥‡¥àπ¢Õß°“√»÷°…“π’È§◊Õ 1. °“√

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μ‘¥μ“¡°“√√—°…“Õ¬à“ßμàÕ‡π◊ËÕß·≈–‡ªìπ√–∫∫ 2. ¡’°“√

μ‘¥μ“¡∂÷ß§«“¡ ¡Ë”‡ ¡Õ„π°“√ÕÕ°°”≈—ß°“¬‡°’Ë¬«°—∫

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∑à“‰¡à¬“°®π‡°‘π‰ª 4. ¢âÕ¥’°“√¥Ÿ·≈ºŸâªÉ«¬‚√§¢âÕ‡¢à“

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√“¬Õ◊Ëπ ¡’°“√·π–π”°—π·≈–°—π ∑”„ÀâºŸâªÉ«¬¡’°”≈—ß„®

·≈–¡’°“√ªØ‘∫—μ‘μ—«‡°’Ë¬«°—∫‚√§¥’¢÷Èπ 5. ¡’°“√·π–π”

°“√ªØ‘∫—μ‘μ—«∑’Ë‡À¡“– ¡ ”À√—∫ºŸâªÉ«¬¢âÕ‡¢à“‡ ◊ËÕ¡

§«∫§Ÿà‰ª°—∫°“√ÕÕ°°”≈—ß°“¬´÷Ëß®–‡æ‘Ë¡ª√– ‘∑∏‘º≈¢Õß

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§◊Õ 1. æ∫«à“¡’ºŸâªÉ«¬∫“ß√“¬‚¥¬‡©æ“–ºŸâªÉ«¬∑’ËÕ“¬ÿ¡“°

¬—ß∑”∑à“ÕÕ°°”≈—ß°“¬¢âÕ‡¢à“‡ ◊ËÕ¡‰¡à∂Ÿ°μâÕßÀ≈—ß°≈—∫

¡“μ‘¥μ“¡°“√√—°…“§√—Èß∑’Ë Õß·¡â«à“®–‰¥â¡’§”·π–π”

‡ªìπ√“¬∫ÿ§§≈®“°·æ∑¬å·≈–„ÀâºŸâªÉ«¬∑”„Àâ¥Ÿ°àÕπ°≈—∫

μ“√“ß∑’Ë 2 §–·ππª√–‡¡‘πÕ“°“√¢âÕ‡¢à“‡ ◊ËÕ¡¥â«¬·∫∫ª√–‡¡‘π Modified WOMAC °àÕπ·≈–À≈—ß‡¢â“√—∫∫√‘°“√∑’Ë§≈‘π‘°¢âÕ‡¢à“‡ ◊ËÕ¡

§–·ππª√–‡¡‘π¢âÕ‡¢à“‡©≈’Ë¬°àÕπ §–·ππª√–‡¡‘π¢âÕ‡¢à“‡©≈’Ë¬À≈—ß

°“√ª√–‡¡‘πÕ“°“√¢âÕ‡¢à“ p-value

‡¢â“√—∫∫√‘°“√∑’Ë§≈‘π‘°¢âÕ‡¢à“‡ ◊ËÕ¡ ‡¢â“√—∫∫√‘°“√∑’Ë§≈‘π‘°¢âÕ‡¢à“‡ ◊ËÕ¡

Õ“°“√ª«¥‡¢à“ 11.11 5.33 0.004^a

Õ“°“√¢âÕΩó¥ 3.88 2.44 0.11^a

√–¥—∫ “¡“√∂„π°“√„™âß“π¢âÕ‡¢à“ 42.00 17.92 <0.001^b

a„™â ∂‘μ‘ paired t-test

b„™â ∂‘μ‘ Wilcoxon signed rank test

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∫â“π ¥—ßπ—Èπ∑ÿ°§√—Èß∑’ËºŸâªÉ«¬¡“μ‘¥μ“¡°“√√—°…“®–μâÕß

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≈¥°“√„™â¬“≈¥ª«¥≈ß‰¥â∂÷ß√âÕ¬≈– 48.14 ´÷Ëß®–™à«¬

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‰¥â∂Ÿ°μâÕß·≈– ¡Ë”‡ ¡Õ√«¡∑—Èß¡’°“√·π–π”°“√ªØ‘∫—μ‘

μ—«∑’Ë‡À¡“– ¡ ”À√—∫ºŸâªÉ«¬¢âÕ‡¢à“‡ ◊ËÕ¡∑ÿ°§√—Èß∑’ËºŸâªÉ«¬

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μ‘¥μ“¡°“√√—°…“·≈–°“√¡’ ¡ÿ¥∫—π∑÷°°“√ÕÕ°°”≈—ß-

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3. John CR. AAOS evidence-based clinical practice guideline for osteoarthritis. ¡ª∑:¡ªæ; 2008.

4. Lange AK, Vanwanseele B, Fiatarone Singh MA.

Strengthening for treatment of osteoarthritis of the knee.

A systematic review. Arthritis and Rheumatism (Ar- thritis Care & Research) 2008;59(10):1488-94.

5. Roddy E, Zhang W, Doherty M. Aerobic walking or strengthening exercise for osteoarthritis of the knee?

A systematic review. Ann Rheum Dis 2005;64:544-8.

6. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis,Part II:OARSI evidence-based, expert consensus guidelines.

Osteoarthritis Cartilage 2008;16(2):137-62.

7. Deyle GD, Alisson SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a random- ized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical Therapy 2005;85(12):1301-17.

8. Petrella RJ, Bartha C. Home based exercise therapy for older patients with knee osteoarthritis: a randomised controlled trial. J Rheumatol 2000;27:2215-21.

9. Kellgern JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheu Dis 1957;16:494-501.

10. π‘¿“«√√≥ »√’√—μπ“«ÿ≤‘. º≈¢Õß‚ª√·°√¡°“√∫√‘À“√¢âÕ‡¢à“

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√—°…“‚√§¢âÕ‡¢à“‡ ◊ËÕ¡. ¡ª∑: ¡ªæ; 2549.

2. √“™«‘∑¬“≈—¬ÕÕ√å‚∏ªî¥‘° å·Ààßª√–‡∑»‰∑¬. ·π«∑“ß‡«™- ªØ‘∫—μ‘°“√√—°…“‚√§¢âÕ‡¢à“‡ ◊ËÕ¡. ¡ª∑:¡ªæ; 2553.

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Abstract Effectiveness of Knee Osteoarthritis Treatment in the Knee Osteoarthritis Clinic with Quadriceps Exercise Program

Chanchai Tidchom

Department of Orthopedic, Mukdahan Hospital Journal of Health Science 2012; 21:1174-81.

Knee osteoarthritis is largely found in elderly populations of Thailand and causes difficulties in performing their daily living activities. The important part of treatment knee osteoarthritis is exercise for knee osteoarthritis. The objective of this study was to evaluate the effectiveness of treatment in patients with knee osteoarthritis after receiving remedial quadriceps exercise from the Knee Osteoarthritis Clinic. This study was a pre-experimental design one-group pretest posttest design. Thirty subjects diagnosed with knee osteoarthritis were selected by random sampling. The level of deterioration of the patients’ knees was assessed using the Modified WOMAC. The patients were then given a guideline and an instruction about self-care activities and exercise.

The results after three months demonstrated statistically significant improvements in knee pain levels and functions, (p 0.004, p < 0.001, respectively). Their knee stiffness decreased, but showing statistically significance level (p 0.11).

Key words: knee osteoarthritis, quadriceps exercise, radiography