만성 가쪽위관절융기염 환자에게 혈류 제한 훈련을 병합한 물리치료 중재가 통증, 구조적 변화, 기능, 심리?사회적 요인에 미치는 영향 = Effects of Blood Flow Restriction Training Combined With Conventional Physical Therapy on Pain, Muscle Architecture, Strength, Function, and Psychosocial Outcomes in Chronic Lateral Epicondylitis

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to investigate the effects of a physical therapy intervention combined with blood flow restriction (BFR) training on pain, structural changes (pennation angle), muscle strength, function, and psychosocial factors in patients with chronic lateral epicondylitis (LE).
Methods: This study was a randomized controlled trial. Twenty participants with chronic LE were randomly assigned to an experimental group (EG, n=10) or a control group (CG, n=10). Both groups received general physical therapy and a progressive exercise program (including concentric, eccentric, and isometric exercises) for 60 minutes, twice a week, for 6 weeks. The EG performed the exercise program with BFR applied to the upper arm (at 40~50% of Arterial Occlusion Pressure), while the CG performed the same exercises without BFR. Outcome measures included subjective pain (Numerical Pain Rating Scale [NPRS]), objective pain (pressure pain threshold [PPT]), structural changes (Pennation Angle [PA]), strength (Pain-free grip strength [PFGS], Wrist extensor strength [WES]), function (Patient-Rated Tennis Elbow Evaluation [PRTEE], Quick-Disabilities of the Arm, Shoulder and Hand [Q-DASH]), and psychosocial factors (Fear-Avoidance Beliefs Questionnaire [FABQ], and SF-12 Physical [PCS] and Mental [MCS] Component Summaries). All variables were assessed at baseline and after 6 weeks.
Results: After 6 weeks, both groups showed significant improvements in all dependent variables (all p<.05). In the between-group comparison of change scores, the EG demonstrated significantly greater improvements than the CG in elbow-specific function (PRTEE; p=.000), overall arm function (Quick-DASH; p=.025), fear-avoidance beliefs (FABQ; p=.039), and the physical component summary of quality of life (SF-12 PCS; p=.003). There were no significant between-group differences in pain (NPRS, PPT), pennation angle, strength (PFGS, WES), or the mental component summary of quality of life (SF-12 MCS) (all p>.05).
Conclusion: In conclusion, a 6-week physical therapy program combined with BFR training was significantly more effective in improving patient-rated function (PRTEE, Quick-DASH), reducing fear-avoidance beliefs (FABQ), and enhancing physical health-related quality of life (SF-12 PCS) compared to the same program without BFR. This improvement is likely driven by BFR training acting as a 'safe, low-load' exercise option, which reduces fear of movement and promotes patient-perceived functional recovery, even when objective strength gains are not yet statistically distinct. Therefore, BFR is a promising intervention, especially for patients whose high pain or fear-avoidance limits high-intensity exercise.

목차 (Table of Contents)

• 목 차 ⅰ
• 표 목 차 ⅳ
• 그림목차 ⅴ
• Ⅰ. 서 론 1
• Ⅱ. 연구 방법 4
• 1. 연구대상자 4
• 2. 연구 설계 및 절차 7
• 3. 중재 방법 9
• 1) 일반적 물리치료 9
• 2) 운동 프로그램 10
• 3) 혈류 제한 훈련(실험군) 14
• (1) 동맥 폐쇄 압력(Arterial occlusion pressure) 14
• 4. 평가 방법 19
• 1) 통증 수준 19
• (1) 주관적 통증 수준(Subjective pain intensity) 19
• (2) 압통 역치 측정(Objective pressure pain threshold) 20
• 2) 초음파 평가 22
• (1) 깃각(Pennation angle) 22
• 3) 근력 수준 25
• (1) 통증 없는 악력(Pain free grip strength) 25
• (2) 손목 폄근 근력(Wrist extensor strength) 27
• 4) 기능 수준 29
• (1) 팔꿈치 기능(Functional level of the elbow) 29
• (2) 전반적 팔 기능(Functional level of the upper extremity) ·· 30
• 5) 심리･사회적 요인 31
• (1) 공포 회피 반응(Fear-avoidance response) 31
• (2) 건강 관련 삶의 질(Health-related quality of life) 32
• 5. 분석 방법 33
• Ⅲ. 연구 결과 34
• 1. 연구대상자의 일반적 특성 34
• 2. 중재에 따른 종속변인의 변화 36
• 1) 통증 수준의 변화(Changes in pain levels) 36
• 2) 깃각의 변화(Changes in pennation angle levels) 38
• 3) 근력 수준의 변화(Changes in strength levels) 40
• 4) 기능 수준의 변화(Changes in function levels) 42
• 5) 심리･사회적 요인의 변화(Changes in psychosocial levels) 44
• Ⅳ. 고 찰 46
• Ⅴ. 결 론 49
• 참 고 문 헌 50
• 영 문 초 록 57
• 부 록 60
• <부록 1> 연구대상자용 동의서 60
• <부록 2> 증례 기록지(Case report form) 61
• <부록 3> 환자 평균 팔꿈치관절 가쪽위관절융기염 평가서(PRTEE) 62
• <부록 4> 빠른 팔, 어깨 및 손의 장애 설문지(Quick DASH) 63
• <부록 5> 건강 관련 삶의 질 평가서(SF-12) 64
• <부록 6> K-MMSE (Mini-Mental State Exam) 66
• 감 사 의 글 68