8주간 동적 신경근 안정화 운동이 만성 요통을 가진 중년 여성의 기능적 장애, 균형, 근지구력, 움직임 공포증 및 통증에 미치는 영향 = The Effects of Dynamic Neuromuscular Stabilization Exercise for 8 Weeks on Functional Disability, Balance, Muscular Endurance, Kinesiophobia, and Pain in Middle-Aged Women with Chronic Low Back Pain

국문 초록 (Abstract)

본 연구는 만성 요통(Chronic low back pain)이 있는 중년 여성들을 대상으로 실시한 8주간의 동적 신경근 안정화 운동(Dynamic neuromuscular stabilization,DNS)이 기능적 장애, 균형, 근지구력, 움직임 공포증 및 통증에 미치는 영향을 검증하기 위해 실시하였다.
연구 대상자는 비특이적 요통(Non-specific low back pain)이 3개월 이상 지속되고, 한국어판 오스웨스트리 기능 장애 지수(Korean version of oswestry disability index, KODI)에서 20∼40%(백분율 기준)에 해당하는 50∼60세의 중년 여성 20명을 선정하였다. 선정된 연구 대상자를 동적 신경근 안정화 운동 그룹(Dynamic neruomuscular stabilization exercise group, DNSEG; n=10)과 코어 안정화 운동 그룹(Core stabilization exercise group, CSEG; n=10)으로 무작위 배정하여 각각 DNS 운동과 코어 안정화(Core Stabilization, CS) 운동을 8주간주 3회 시행하였다. 중재 효과는 기능적 장애(KODI), 균형 능력(힘판에서 눈을 감고 두 발 서기), 근지구력(비에링-소렌슨[Biering-Sorenson]), 움직임 공포증(Tampa scale of kinesiophobia[TSK]), 그리고 통증(Visual analgoue scale[VAS])을 평가하였다.
자료는 Window용 SPSS/PC 25.0 프로그램을 사용하여 분석하였으며, 정규성검정은 Shapiro-Wilk 검정으로, 동질성 검정은 독립표본 t-검정으로 확인하였다. 주요 분석은 반복 측정에 의한 이원 변량 분석(Two-way analysis of variance with repeated measures)으로 진행하였으며, 집단 내 차이는 단순 주효과 검증(Simple main analysis)을 Bonferroni 보정하여 사후 검정(Post hoc test)을 시행하였다. 통계적 유의수준은 α=.05로 설정하였다.
본 연구의 결과는 다음과 같다.

1. 중재 프로그램 적용 전ㆍ후간 기능적 장애의 KODI를 분석한 결과, 집단내 측정 시기에 따라 유의한 차이가 나타났다(p<.001). 사후검증 결과 DNSEG와 CSEG 모두 중재 후 기능적 장애 점수가 유의하게 감소하였다(p<.001, p<.001).

2. 중재 프로그램 적용 전ㆍ후간 균형 능력 중 압력 중심점의 타원 면적(Center of pressure ellipse)을 분석한 결과, 집단-내 측정 시기 및 시기×집단에따른 상호작용이 나타났다(p<.001, p=.017). 사후검증 결과 DNSEG와 CSEG 모두 중재 후 압력 중심점의 타원 면적이 유의하게 감소하였다(p<.001, p=.012).

3. 중재 프로그램 적용 전ㆍ후간 균형 능력 중 압력 중심점의 이동거리(Center of pressure displacement)를 분석한 결과, 집단-내 측정 시기 및 시기×집단에 따른 상호작용이 나타났다(p<.001, p=.020). 사후검증 결과 DNSEG에서중재 후 압력 중심점의 이동거리가 유의하게 감소하였다(p<.001).

4. 중재 프로그램 적용 전ㆍ후간 균형 능력 중 압력 중심점의 내ㆍ외측 진폭(Center of pressure amplitude medial/lateral)을 분석한 결과, 집단-내 측정 시기 및 시기×집단에 따른 상호작용이 나타났다(p=.006, p=.022). 사후검증 결과DNSEG에서 중재 후 압력 중심점의 내ㆍ외측 진폭이 유의하게 감소하였다(p<.001). 또한, 압력 중심점의 전ㆍ후측 진폭(Center of pressure amplitude anterior/posterior)을 분석한 결과, 측정 시기 및 시기×집단에 따른 상호작용이나타났다(p=.004, p=.018). 사후검증 결과 DNSEG에서 중재 후 압력 중심점의전ㆍ후측 진폭이 유의하게 감소하였다(p<.001).

5. 중재 프로그램 적용 전ㆍ후간 균형 능력 중 압력 중심점의 속도(Center of pressure velocity)를 분석한 결과, 집단-내 측정 시기 및 시기×집단에 따른 상호작용이 나타났다(p<.001, p=.026). 사후검증 결과 DNSEG에서 중재 후 압력중심점의 속도가 유의하게 감소하였다(p<.001).

6. 중재 프로그램 적용 전ㆍ후간 근지구력의 비에링-소렌슨(Biering-Sorenson) 검사를 분석한 결과, 집단-내 측정 시기 및 시기×집단에 따른 상호작용이 나타났다(p<.001, p=.014). 사후검증 결과 DNSEG와 CSEG 모두 중재 후 비에링-소렌슨(Biering-Sorenson) 유지 시간이 유의하게 증가하였다(p<.001, p<.001).

7. 중재 프로그램 적용 전ㆍ후간 움직임 공포증의 TSK를 분석한 결과, 집단내 측정 시기에 따라 유의한 차이가 나타났다(p<.001). 사후검증 결과 DNSEG 와 CSEG 모두 중재 후 TSK가 유의하게 감소하였다(p<.001, p<.001).

8. 중재 프로그램 적용 전ㆍ후간 통증의 VAS를 분석한 결과, 집단-내 측정시기에 따라 유의한 차이가 나타났다(p<.001). 사후검증 결과 DNSEG와 CSEG 모두 중재 후 VAS가 유의하게 감소하였다(p<.001, p<.001).

결론적으로, DNS 운동과 CS 운동 모두 기능적 장애, 근지구력, 움직임 공포증, 그리고 통증 개선에 효과적인 것으로 나타났다. 그러나 균형 능력 향상 측면에서는 DNS 운동이 더 효과적인 것으로 나타났으며, 이는 만성 요통으로 인해 자세 조절(Postural control) 능력이 저하되고 일상생활 움직임에 어려움을겪는 중년 여성에게 임상적으로 유용한 중재가 될 수 있다고 생각한다.
향후 연구에서는 정적 균형 평가만으로는 일상생활에 필요한 동적 요소를 충분히 반영하기 어렵기 때문에, 중년 여성에게 적합한 동적 균형 평가를 포함하여 DNS 운동의 효과를 보다 정밀하게 검증할 필요가 있다. 또한, DNS 중재의일관된 효과 검증을 위해 표준화된 프로토콜 정립에 대한 지속적인 연구가 필요하다고 판단된다.

목차 (Table of Contents)

• I. 서 론 ···················································································································· 1
• 1. 연구의 필요성 ································································································ 1
• 2. 연구의 목적 ···································································································· 6
• 3. 연구의 가설 ······································································································ 7
• 4. 연구의 제한점 ·································································································· 8
• Ⅱ. 연구방법 ············································································································· 9
• 1. 연구 대상자 ······································································································ 9
• 2. 연구 절차 ········································································································ 11
• 3. 중재 방법 ········································································································ 12
• 1) 동적 신경근 안정화 운동 ········································································ 12
• 2) 코어 안정화 운동 ······················································································· 21
• 4. 측정 항목 및 방법 ························································································· 23
• 1) 신체 조성 ···································································································· 23
• 2) 기능적 장애 ································································································ 24
• 3) 균형 ··········································································································· 25
• 4) 근지구력 ···································································································· 26
• 5) 움직임 공포증 ···························································································· 27
• 6) 통증 ············································································································· 28
• 5. 자료처리 방법 ································································································ 29
• - ii -
• Ⅲ. 연구 결과 ········································································································· 30
• 1) 기능적 장애 ································································································ 30
• 2) 균형 능력 ···································································································· 32
• 3) 근지구력 ···································································································· 41
• 4) 움직임 공포증 ···························································································· 43
• 5) 통증 ··········································································································· 45
• Ⅳ. 논 의 ·············································································································· 47
• Ⅴ. 결 론 ·············································································································· 57
• 참 고 문 헌 ············································································································· 60
• ABSTRACT ·········································································································· 71