加護中心護理人員常要協助病人翻身。當重複性動作若施力不當或負荷過重易導致傷害，因而產生肌肉骨骼疾病 ( MSD) ，護理師 MSD在世界各國普遍存在，被認為是一種代價高昂的職業傷害。因此瞭解分析肌肉骨骼疾病勞工之人因性危害因子，可以協助擬定合宜的預防措施。期望藉由此研究調查人因性危害現況，本研究主要目的為探討加護中心護理師人員基本資料、運動習慣與罹患肌肉骨骼疾病症狀之關係；以及加護中心護理師執行翻身動作時運用影像軟體分析頸部及腰部角度、及OWAS評估量表危害得分分析與罹患肌肉骨骼疾病症狀之關係。
本研究針對某醫學中心加護中心工作6個月以上護理人員進行調查，運用「北歐肌肉骨骼系統問卷調查表」調查受試者骨骼肌肉不適現況。拍攝護理師執行翻身動作，應用動作分析軟體(Kinovea) 進行影像分析及OWAS (Ovako Working Posture Analysis System)人因評估量表評分，依身體部位分為頭頸、背部、手臂、腿部及重量等5個因子，進行編碼評分，再將5個項目以影像軟體協助量測角度，分析動作危害得分與骨骼肌肉不適之關係。受試者的數據做以下統計分析：描述性統計分析受試者的基本資料特性及分布、使用Mann-Whitney U test及Chi-square Test及斯皮爾曼相關係數 (spearman) 分別檢驗基本資料、女性身高分組、Kinovea角度以及OWAS之平均總分與對應之肌肉骨骼症狀調查表分數之關聯程度。
結果顯示加護中心護理人員罹患肌肉骨骼疾病發生率，曾發生疼痛情形之發生率達42.6%，若包含未達2週之個案則達80.9%。護理人員年齡愈高及在加護中心的工作總年資越多時，症狀的嚴重程度也會越高，Z檢定達顯著水準，在頸部的Kinovea角度越大時，下背的不適情形則會越低，達顯著負相關（r = -.29，p =.046），OWAS行動等級(Action Categories, AC/Action Level, AL)得分情形，52名100% 均為：AC3/AL3，姿勢有顯著的危害/應儘快採取改善行動。在頭頸OWAS及背部OWAS得分與頸部、上背及下背不適情形均無明顯相關性。身高超過162cm的女性則在左肩或右肩部位都有相對較高的不適。
本研究加護中心護理師肌肉骨骼疾病發生率，包含頸部及腰部疼痛與國內外研究結果相符。運動則需較長時間且定期專業的運動訓練，才能對於預防或改善肌肉骨骼傷害有成效，關節疼痛會影響工作關節活動度，故有疼痛問題者關節活動角度較小。OWAS評估結果所有個案得分之相似度高，加上與頸部、腰部角度與不適情形均無關聯，只能用於評估翻身動作整體風險，無法用來區分護理師個別動作風險。然而應用影像分析結果及OWAS結果進行回饋，幫助修正高風險動作仍具其參考價值。建議未來研究延伸，可持續應用動作分析軟體分析人員高風險翻身動作，運用關節活動度推測肌肉骨骼疾病之發生率。開發可提供動作分析風險預測之軟體，應用於人員執行翻身動作時回饋風險分析結果及改善建議。

Intensive care unit (ICU) nurses often have to help reposition patients. Improper force application or excessive load in repetitive actions tends to cause injury, thereby resulting in musculoskeletal disorders (MSD). MSDs are widespread in nurses globally and are considered to be high-cost occupational injuries. Therefore, understanding and analyzing the ergonomic risk factors of MSD can help formulate suitable preventive measures. Hence, the present study aimed to investigate the current status of ergonomic hazards. The primary objective was to examine the relationship between general information, exercise habits, and MSD symptoms in ICU nurses and the relationship between neck and waist angles during repositioning in nurses using image software analysis, Ovako working posture analysis system (OWAS) hazard score, and MSD symptoms.
In the present study, nurses who worked in the ICU for ≥6 months in a medical center were surveyed and the Nordic Musculoskeletal Questionnaire was used to collect participant information regarding musculoskeletal discomfort. The repositioning movements of nurses were photographed. Kinovea (www.kinovea.org) was used for image analysis, and the OWAS ergonomic evaluation scale was used for scoring. The body sites were divided into five factors (head, back, arms, legs, and weight) for coded scoring. Subsequently, image software was employed to measure the angles of the five items and analyze the relationship between movement hazard scores and musculoskeletal discomfort. Participant data was used for the following statistical analysis: descriptive statistical analysis was conducted on participant general information characteristics and distribution and Mann–Whitney U test, Chi-square test, and Spearman correlation coefficient were used to test the correlation between general information, women's height groups, Kinovea angle, and mean total OWAS and musculoskeletal symptom scale scores.
The results show the prevalence of MSD in ICU nurses; the prevalence of pain in the case was 42.6% and 80.9% if participants with pain for <2 weeks were included. Symptom severity was higher in older nurses and those with longer work experience in the intensive care unit; the Z test showed its significance. If the neck Kinovea angle was greater, lower back discomfort was lower and this was significantly negatively correlated (r = –0.29, p = 0.046). Regarding OWAS action categories (AC)/action level (AL) score, 52 participants had a 100% score (AC2/AL3) and had significant posture hazard/improvement measures that should be performed immediately. Head and back OWAS scores were not significantly correlated with neck, upper back, and lower back discomfort. Women with height >162 cm had relatively great left or right shoulder discomfort.
In this study, MSD incidence in ICU nurses, including neck and waist pain, was consistent with the results of other Taiwanese and overseas studies. Longer exercise duration and periodic professional exercise training are needed to prevent or improve MSD. The joint pain will affect working joint mobility. Therefore, the joint mobility angle is lower in patients with pain. The OWAS evaluation results showed that all patients had similar scores. Additionally, the neck and waist angles were not correlated with discomfort and can only be used to assess the overall risk of repositioning movements, not to determine the risk of individual actions in nurses. However, using the image analysis and OWAS results for feedback and to help correct high-risk actions still has reference value. Future studies employ movement analysis software to analyze high-risk repositioning movements and use joint mobility to estimate MSD incidence. Developing software for movement analysis and risk prediction can be used to provide feedback on the risk analysis results during repositioning movements in nurses and lead to improvements in recommendations.

行政院勞工委員會（2013）．勞工安全衛生法施行細則修正草案(民國 102 年 11 月 25 日)。https://www.lawbank.com.tw/news/NewsContent.aspx?NID=115806.00
李正隆（2016， 6月30日）．重複性作業促發肌肉骨骼傷病預防宣導會。chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://labor.chcg.gov.tw/files/9_1050630_3.%E9%87%8D%E8%A4%87%E6%80%A7%E4%BD%9C%E6%A5%AD%E4%BF%83%E7%99%BC%E8%82%8C%E8%82%89%E9%AA%A8%E9%AA%BC%E5%82%B7%E7%97%85%E9%A0%90%E9%98%B2%E5%AE%A3%E5%B0%8E%E6%9C%83.pdf
周佩君、陳意超 、吳欣儀 （2021）．應用人因工程預防照顧服務員肌肉骨骼傷害．健康促進研究與實務, 4(2), 7-15。https://doi.org/10.29442/hprp.202107_4(2).0002
卓鑫誼、林美妘、黃卉君、曾宜芳、林庭揚、王炳森、張哲源、王湘慧（2018）．【論文摘要】皮拉提斯對成人慢性下背痛之疼痛指數改善成效之系統性回顧．物理治療，43(4)，330-331。https://doi.org/10.6215/FJPT.201812.P26
柯惠文、阮祺文、張秀如 （2011）．護理人員與病患照護服務員下背痛之相關因素探討．秀傳醫學雜誌，10(1&2) ， 69-80。
陳怡如、王月雲、施玉雙、方月燕（2019）．運動於緩解護理從業人員下背痛之成效．高雄護理雜誌，36(3)，1-14。https://doi.org/10.6692/KJN.201912_36(3).0001
袁素娟、賴慶祥 、翁毓菁 、 張英娥、李秋香 、郭憲文 （2014）．伸展操介入改善臨床護理人員肌肉骨骼不適症狀之成效 ．中山醫學雜誌， 24（2），c21-30。
粘秋桂、 柯德鑫（1996）．護理人員下背痛及其職業相關危險因子之調查．中華職業醫學雜誌, 3(1), 37-44. https://doi.org/10.30027/cjom.199601.0002
黃郁潔、許峻賓、曾妍琇（2020）．【論文摘要】某地區醫院人員下背痛衛教介入之成效．物理治療，45(2)，174-174。https://doi.org/10.6215/FJPT.202006.P50
勞動部（2010）．職業安全衛生法施行細則 (民國 109 年 02 月 27 日修正). Retrieved 06.10 from https://laws.mol.gov.tw/FLAW/FLAWDAT0201.aspx?id=FL015014
勞動部勞動及職業安全衛生研究所（2014）．人因工程肌肉骨骼傷病預防指引．勞動部勞動及職業安全衛生研究所。chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://si.secda.info/stchang/wp-content/uploads/2014/10/0.pdf
葉啟信、 劉睿宇、劉倩秀 （2022）． 機構照顧者移位作業時肌肉骨骼疼痛與肩背生理負荷之探討．中華職業醫學雜誌，29（4） ，277-288.
Bertelsen, M. L., Jensen, J. F., Nielsen, M. H., Nielsen, R. O., & Rasmussen, S. (2013). Footstrike patterns among novice runners wearing a conventional, neutral running shoe. Gait & posture, 38(2), 354–356. https://doi-org.autorpa.ndmctsgh.edu.tw/10.1016/j.gaitpost.2012.11.022
Centers for Disease Control and Prevention. (2020, February 12, 2020). Work-Related Musculoskeletal Disorders & Ergonomics. Centers for Disease Control and Prevention. Retrieved 06.10 from https://www.cdc.gov/workplacehealthpromotion/health-strategies/musculoskeletal-disorders/index.html
Damsted, C., Larsen, L. H., & Nielsen, R. O. (2015). Reliability of video-based identification of footstrike pattern and video time frame at initial contact in recreational runners. Gait Posture, 42(1), 32-35. https://doi.org/10.1016/j.gaitpost.2015.01.029
Du, J., Zhang, L., Xu, C., & Qiao, J. (2021). Relationship Between the Exposure to Occupation-related Psychosocial and Physical Exertion and Upper Body Musculoskeletal Diseases in Hospital Nurses: A Systematic Review and Meta-analysis. Asian Nursing Research, 15(3), 163-173. https://doi.org/10.1016/j.anr.2021.03.003
Engels, J. A., van der Gulden, J. W., Senden, T. F., Kolk, J. J., & Binkhorst, R. A. (1998). The effects of an ergonomic-educational course. Postural load, perceived physical exertion, and biomechanical errors in nursing. International Archives of Occupational and Environmental Health, 71(5), 336-342. https://doi.org/10.1007/s004200050289
Elwardany, S. , El-Sayed, W. & Ali, M. (2015) Reliability of Kinovea Computer Program in Measuring Cervical Range of Motion in Sagittal Plane. Open Access Library Journal, 2, 1-10. doi: 10.4236/oalib.1101916.
European Agency for Safety and Health at Work (2019, 15/11/2019). Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU. Retrieved 06.01 from https://osha.europa.eu/en/publications/summary-msds-facts-and-figures-overview-prevalence-costs-and-demographics-msds-europe
Gómez-Galán, M., Pérez-Alonso, J., Callejón-Ferre Á, J., & López-Martínez, J. (2017). Musculoskeletal disorders: OWAS review. Industrial Health, 55(4), 314-337. https://doi.org/10.2486/indhealth.2016-0191
Hansraj, K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international 25, 277-279.
Hönl, A. K., Jantz, F., & Möckel, L. (2023). [Pain, analgesic intake and mental health of German intensive care unit nurses]. Med Klin Intensivmed Notfmed, 118(1), 45-53. https://doi.org/10.1007/s00063-021-00880-7 (Schmerzen, Schmerzmitteleinnahme und mentale Gesundheit von Intensivpflegenden in Deutschland.)
Hignett, S. (1996). Postural analysis of nursing work. Applied Ergonomics, 27(3), 171-176. https://doi.org/10.1016/0003-6870(96)00005-1
Ji, X., Hettiarachchige, R. O., Littman, A. L. E., & Piovesan, D. (2023). Using Digital Human Modelling to Evaluate the Risk of Musculoskeletal Injury for Workers in the Healthcare Industry. Sensors (Basel), 23(5). https://doi.org/10.3390/s23052781
Karhu, O., Kansi, P., & Kuorinka, I. (1977). Correcting working postures in industry: A practical method for analysis. Appl Ergon, 8(4), 199-201. https://doi.org/10.1016/0003-6870(77)90164-8
Kuorinka, I., Jonsson, B., Kilbom, A., Vinterberg, H., Biering-Sørensen, F., Andersson, G., & Jørgensen, K. (1987). Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon, 18(3), 233-237. https://doi.org/10.1016/0003-6870(87)90010-x
Lee, Y. H., & Chiou, W. K. (1995). Ergonomic analysis of working posture in nursing personnel: example of modified Ovako Working Analysis System application. Research in Nursing & Health, 18(1), 67-75. https://doi.org/10.1002/nur.4770180109
Mathew, J., Vanlalpeki, T., & Nair, G. (2017). Gait Evaluation of Institutionalized Elders – A Feasibility Study. Journal of Gerontology, 31, 71-83.
Nelson, A., Matz, M., Chen, F., Siddharthan, K., Lloyd, J., & Fragala, G. (2006). Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. International Journal of Nursing Studies, 43(6), 717-733. https://doi.org/10.1016/j.ijnurstu.2005.09.004
Puig-Diví, A., Escalona-Marfil, C., Padullés-Riu, J. M., Busquets, A., Padullés-Chando, X., & Marcos-Ruiz, D. (2019). Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. PLoS One, 14(6), e0216448. https://doi.org/10.1371/journal.pone.0216448
Rasmussen, C. D. N., Lindberg, N. K., Ravn, M. H., Jørgensen, M. B., Søgaard, K., & Holtermann, A. (2017). Processes, barriers and facilitators to implementation of a participatory ergonomics program among eldercare workers. Applied Ergonomics, 58, 491-499. https://doi.org/10.1016/j.apergo.2016.08.009
Sezgin, D., & Esin, M. N. (2015). Predisposing factors for musculoskeletal symptoms in intensive care unit nurses. International Nursing Review, 62(1), 92-101. https://doi.org/10.1111/inr.12157
Soler-Font, M., Ramada, J. M., van Zon, S. K. R., Almansa, J., Bültmann, U., & Serra, C. (2019). Multifaceted intervention for the prevention and management of musculoskeletal pain in nursing staff: Results of a cluster randomized controlled trial. PLoS One, 14(11), e0225198. https://doi.org/10.1371/journal.pone.0225198
Takala, E. P., Pehkonen, I., Forsman, M., Hansson, G., Mathiassen, S. E., Neumann, W. P., Sjøgaard, G., Veiersted, K. B., Westgaard, R. H., & Winkel, J. (2010). Systematic evaluation of observational methods assessing biomechanical exposures at work. Scandinavian Journal of Work, Environment & Health, 36(1), 3-24. https://doi.org/10.5271/sjweh.2876
World Health Organization, W. H. O. (2022). Musculoskeletal health. Retrieved 06.11 from https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
Yan, P., Yang, Y., Zhang, L., Li, F., Huang, A., Wang, Y., Dai, Y., & Yao, H. (2018). Correlation analysis between work-related musculoskeletal disorders and the nursing practice environment, quality of life, and social support in the nursing professionals. Medicine (Baltimore), 97(9), e0026. https://doi.org/10.1097/md.0000000000010026
Yang, S., Lu, J., Zeng, J., Wang, L., & Li, Y. (2019). Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders Among Intensive Care Unit Nurses in China. workplace health & safety, 67(6), 275-287. https://doi.org/10.1177/2165079918809107
Yoshida, R., Yasuda, T., & Kuruma, H. (2022). Analysis of cervical and upper thoracic spinal segmental rotation angles during end-range neck rotation: Comparison with and without neck pain. Journal of Manual & Manipulative Therapy, 30(6), 328-333. https://doi.org/10.1080/10669817.2022.2056309