雙人協同進行移位作業時對肌肉骨骼負荷之影響分析

研究背景：隨著台灣及全球人口高齡化趨勢日益顯著，第一線長期照護人員在臨床工作中，頻繁執行個案移位等高負荷搬運作業。現有文獻指出，長期從事此類重複性工作易導致下背痛及其他搬運相關肌肉骨骼傷害，嚴重影響照護人員的職業健康與人力永續。本研究旨在針對臨床常用的多元移位輔具，探討其於不同作業情境下對照護人員肌肉骨骼負荷的影響。研究方法：本研究招募28位健康大學生為受試者，在身體肢段黏貼反光標記，結合三維動作分析系統與測力板，同步擷取雙人協同移位個案作業時動作軌跡數據。移位條件包括兩種床面高度（44 公分與 55 公分）及五種移位策略：徒手移位、移位板、移位帶、懸吊移位系統及限制空間徒手移位。後續運用逆向動力學計算各關節角度與關節力矩，進一步推估照護人員於不同條件下的肌肉骨骼負荷。所有資料以雙因子重複量數變異數分析（Two-way Repeated Measures ANOVA）檢定，顯著水準設定為 α = 0.05。 結果：結果顯示，移位方法為影響照護人員下肢生物力學負荷的主要因素（p < 0.001），床面高度及其與移位策略的交互作用則未達顯著。五種移位策略中，徒手移位產生最大關節反作用力與力矩，膝關節伸展力矩高達1.2牛頓*公尺/公斤，髖關節伸展力矩高達2.8牛頓*公尺/公斤，對操作者肌群構成極高負荷；相對地，懸吊移位系統能將所有關節負荷降至最低，與日常走路負荷相當。此外，所有手動移位策略均呈現明顯的左右負荷不對稱，其中膝關節與髖關節的力矩差異最高可達 80%。結論：移位策略明顯影響關節受力與力矩。使用懸吊移位輔具能將關節負荷降至最低，建議將其納入照護標準作業流程，作為處理無自主站立能力個案之首選，有助於保障照護人員職業安全並促進長照服務的永續發展。

Background:With the rapidly aging population in Taiwan and worldwide, frontline long-term care (LTC) workers frequently perform high-load tasks such as patient transfers in clinical settings. Existing literature indicates that prolonged engagement in such repetitive tasks increases the risk of lower back pain and other musculoskeletal disorders, significantly affecting caregivers’ occupational health and workforce sustainability. This study aimed to investigate the effects of commonly used patient transfer assistive devices on musculoskeletal load among caregivers under different working conditions.Methods:Twenty-eight healthy university students participated in this study. Reflective markers were attached to body segments, and a three-dimensional motion capture system combined with force plates was used to simultaneously record kinematic and kinetic data during two-person cooperative patient transfers. Transfer conditions included two bed heights (44 cm and 55 cm) and five transfer strategies: manual transfer, transfer board, transfer belt, overhead suspension system, and manual transfer in a restricted space. Inverse dynamics were applied to calculate joint angles and joint moments, estimating the musculoskeletal load on caregivers under each condition. Data were analyzed using two-way repeated measures ANOVA, with a significance level of α = 0.05. Results:Analysis revealed that the transfer method was the primary factor affecting lower-limb biomechanical load (p < 0.001), whereas bed height and its interaction with transfer strategy were not significant. Among the five strategies, manual transfer generated the highest joint reaction forces and torques, with knee extension torque reaching 1.2 N·m/kg and hip extension torque reaching 2.8 N·m/kg, imposing substantial load on the operator’s musculature. In contrast, the suspended transfer system minimized joint loads across all joints, comparable to the load experienced during normal walking. Additionally, all manual transfer strategies exhibited significant left–right load asymmetry, with torque differences in the knee and hip joints reaching up to 80%.Conclusions:Transfer strategy significantly influences joint forces and torques. The use of suspended transfer devices can minimize joint load and is recommended as the preferred method for handling patients without independent standing ability. Implementing such devices in standard care procedures may enhance caregiver occupational safety and promote the sustainable development of long-term care services.