隨著高齡社會來臨，高齡者慢性疾病以及身體機能衰退比率逐漸增加。研究指出退化性關節炎是是全球常見慢性病中比例最高的，其疼痛和影響行動能力的症狀對於患者身心以及經濟帶來沉重負擔並且嚴重影響生活品質。退化性關節炎多發生在承重關節，其中膝關節的內側由於承受體重與行走時的衝擊是最常發生退化性膝關節炎的部位之一。對於初期的退化性膝關節炎患者來說，減少膝關節受力以及透過運動增強肌力是改善症狀的根本方式；而運動時搭配輔具類產品則能減緩疼痛以提高患者意願或持續時間。但長時間使用輔具使用可能造成不適甚至更糟的副作用。考量以上因素，本研究的目標包含 (1)發展出能減少內側應力的創新輔助裝置； (2)使用該輔助裝置能減緩退化性膝關節炎帶來的疼痛； (3)該輔助裝置不會妨礙膝關節以及周邊肌肉活動以增加舒適性。
為了設計創新的退化性膝關節炎輔助裝置，本研究的設計階段透過分析調查現有退化性膝關節炎輔具以及使用焦點團體法找出設計元素；以協同設計產生設計概念並以型態分析表進一步提煉出最終設計，最後依照該設計製作原型產品。至於評估實驗對應研究目的共分為三部分，客觀評估以影像分析步態資料測量膝蓋額狀面力臂長度作為內外側受力分布的間接判斷，並以成對樣本t檢定做穿戴輔具前後比較；主觀評估方面則使用視覺模擬量表作為膝蓋疼痛強度評分方式，並以成對樣本t檢定做穿戴輔具前後比較，最後同樣以視覺模擬量表作為原型產品是否符合設計準則的評分方式。
實驗結果顯示本研究設計的創新退化性關節炎輔助裝置於減少雙腿膝關節內側受力有顯著效果(p=0.003<0.05, p=0.006<0.05)，設計準則的滿意度也有達到一定標準；至於疼痛減緩效果目前未達顯著水準(p=0.383>0.05)，未來仍需進行更長時間的實驗來評估疼痛減緩以及減少副作用功效。

In aging society, chronic diseases and physical function decline ratio gradually increases. Researches has indicated that osteoarthritis is the most common among chronic diseases around the world. The painful and disabling symptoms of knee osteoarthritis brings mental, physical and economy burdens to patient and largely lowers quality of life. Osteoarthritis usually occurs in weight bearing joints, and mostly in medial knee joint since it bears most of the loading during gait. For early osteoarthritis, unloading and increase muscle strength through exercise is the most fundamental way. Also, use assisting devices while exercising can relief pain and increase willingness of patient or expand the duration. However, long-term use of assisting device may cause discomfort or even worse side effects. Hence, the purpose of this study includes (1) Develop an innovative assisting device that can reduce medial knee loading; (2) This device can relief knee pain caused by OA; (3) It will not restrict knee and peripheral muscle movement and thus increase comfort.
To design an innovative assisting device, this research obtains design criterions through reviewing existing products and expert focus group. According to these criterions, design concepts are generated in co-design activity and converged into one final design with morphological charts. Finally, prototype are built according to final design. As for evaluation experiment, it is divided into three parts according to research purposes. Objective evaluation uses image process to analyze gait data and calculates frontal plane lever arm magnitude as indirect assessment of medial to lateral knee loading. Medial knee loading variations then analyzed with paired samples t-test. As for subjective evaluation, visual analogue scale is used to present pain intensity before and after using the device. Pain intensity variation then analyzed with paired samples t-test. Last, VAS is also used in design criterion evaluation to present satisfaction scores.
The result of experiences shows this innovative assisting device can significantly reduce medial knee loading of both legs (p=0.003<0.05, p=0.006<0.05), the satisfaction score of design criterions are also acceptable. However, the result of pain relieving was not significant (p=0.383>0.05) and long-term experiments are needed to further evaluate its efficacy on pain relieving and reducing side effects.

Arden, N., & Nevitt, M. C. (2006). Osteoarthritis: epidemiology. Best practice & research Clinical rheumatology, 20(1), 3-25.
Arendt-Nielsen, L., Nie, H., Laursen, M. B., Laursen, B. S., Madeleine, P., Simonsen, O. H., & Graven-Nielsen, T. (2010). Sensitization in patients with painful knee osteoarthritis. Pain, 149(3), 573-581.
Baliunas, A., Hurwitz, D., Ryals, A., Karrar, A., Case, J., Block, J., & Andriacchi, T. (2002). Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis and cartilage, 10(7), 573-579.
Basford, J. R., & Johnson, S. J. (2002). Form may be as important as function in orthotic acceptance: a case report. Archives of physical medicine and rehabilitation, 83(3), 433-435.
Bauer, D., Hunter, D., Abramson, S., Attur, M., Corr, M., Felson, D., . . . Lane, N. (2006). Classification of osteoarthritis biomarkers: a proposed approach. Osteoarthritis and cartilage, 14(8), 723-727.
Beaudreuil, J., Bendaya, S., Faucher, M., Coudeyre, E., Ribinik, P., Revel, M., & Rannou, F. (2009). Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis. Joint Bone Spine, 76(6), 629-636.
Bellamy, N. (1989). Pain assessment in osteoarthritis: experience with the WOMAC osteoarthritis index. Paper presented at the Seminars in arthritis and rheumatism.
Bijlsma, J. W., Berenbaum, F., & Lafeber, F. P. (2011). Osteoarthritis: an update with relevance for clinical practice. The Lancet, 377(9783), 2115-2126.
Blackburn, T. A., & Craig, E. (1980). Knee anatomy. Physical therapy, 60(12), 1556-1560.
Bradley, S. M., & Hernandez, C. R. (2011). Geriatric assistive devices. American family physician, 84(4).
Breivik, H., Borchgrevink, P., Allen, S., Rosseland, L., Romundstad, L., Hals, E. B., . . . Stubhaug, A. (2008). Assessment of pain. British journal of anaesthesia, 101(1), 17-24.
Carlsson, A. M. (1983). Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain, 16(1), 87-101.
Conaghan, P. G., Dickson, J., & Grant, R. L. (2008). Care and management of osteoarthritis in adults: summary of NICE guidance. British Medical Journal (BMJ), 336(7642), 502-503.
Corti, M. C., & Rigon, C. (2003). Epidemiology of osteoarthritis: prevalence, risk factors and functional impact. Aging clinical and experimental research, 15(5), 359-363.
Costigan, P. A., Deluzio, K. J., & Wyss, U. P. (2002). Knee and hip kinetics during normal stair climbing. Gait & posture, 16(1), 31-37.
D’Lima, D. D., Patil, S., Steklov, N., & Colwell Jr, C. W. (2011). The 2011 ABJS Nicolas Andry Award:‘Lab’-in-a-knee: in vivo knee forces, kinematics, and contact analysis. Clinical Orthopaedics and Related Research®, 469(10), 2953-2970.
De Bruin, E. D., Hartmann, A., Uebelhart, D., Murer, K., & Zijlstra, W. (2008). Wearable systems for monitoring mobility-related activities in older people: a systematic review. Clinical rehabilitation, 22(10-11), 878-895.
Deyle, G. D., Henderson, N. E., Matekel, R. L., Ryder, M. G., Garber, M. B., & Allison, S. C. (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Annals of internal medicine, 132(3), 173-181.
Dieppe, P. A., & Lohmander, L. S. (2005). Pathogenesis and management of pain in osteoarthritis. The Lancet, 365(9463), 965-973.
Dobson, F., Hinman, R., Roos, E. M., Abbott, J., Stratford, P., Davis, A., . . . Thumboo, J. (2013). OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis and cartilage, 21(8), 1042-1052.
Fang, M. A., Heiney, C., Yentes, J. M., Harada, N. D., Masih, S., & Perell-Gerson, K. L. (2015). Effects of Contralateral Versus Ipsilateral Cane Use on Gait in People with Knee Osteoarthritis. PM&R, 7(4), 400-406.
Felson, D. T. (2006). Osteoarthritis of the knee. New England Journal of Medicine, 354(8), 841-848.
Felson, D. T., Lawrence, R. C., Dieppe, P. A., Hirsch, R., Helmick, C. G., Jordan, J. M., . . . Zhang, Y. (2000). Osteoarthritis: new insights. Part 1: the disease and its risk factors. Annals of internal medicine, 133(8), 635-646.
Felson, D. T., Lawrence, R. C., Hochberg, M. C., McAlindon, T., Dieppe, P. A., Minor, M. A., . . . Weinberger, M. (2000). Osteoarthritis: new insights. Part 2: treatment approaches. Annals of internal medicine, 133(9), 726-737.
Foley, D., Ancoli-Israel, S., Britz, P., & Walsh, J. (2004). Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. Journal of psychosomatic research, 56(5), 497-502.
Garip, Y., Güler, T., & Tuncer, Ö. B. (2016). Fatigue Among Elderly Patients with Knee Osteoarthritis and Its Association with Functional Status, Depression and Quality of Life. Ankara Medical Journal, 16(1).
Herr, H. (2009). Exoskeletons and orthoses: classification, design challenges and future directions. Journal of neuroengineering and rehabilitation, 6(1), 1.
Hunt, M. A., Birmingham, T. B., Giffin, J. R., & Jenkyn, T. R. (2006). Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis. Journal of biomechanics, 39(12), 2213-2220.
Hurley, B. F., & Roth, S. M. (2000). Strength training in the elderly. Sports Medicine, 30(4), 249-268.
Hurley, M. V. (1999). The role of muscle weakness in the pathogenesis of osteoarthritis. Rheumatic Disease Clinics of North America, 25(2), 283-298.
Kaufman, K. R., Hughes, C., Morrey, B. F., Morrey, M., & An, K.-N. (2001). Gait characteristics of patients with knee osteoarthritis. Journal of biomechanics, 34(7), 907-915.
Kraus, V. B., Blanco, F., Englund, M., Karsdal, M., & Lohmander, L. (2015). Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis and cartilage, 23(8), 1233-1241.
Krueger, R. A. (2006). Is it a focus group? Tips on how to tell. Journal of Wound Ostomy & Continence Nursing, 33(4), 363-366.
Kutzner, I., Heinlein, B., Graichen, F., Bender, A., Rohlmann, A., Halder, A., . . . Bergmann, G. (2010). Loading of the knee joint during activities of daily living measured in vivo in five subjects. Journal of biomechanics, 43(11), 2164-2173.
Lafeber, F. P., Intema, F., Van Roermund, P. M., & Marijnissen, A. C. (2006). Unloading joints to treat osteoarthritis, including joint distraction. Current opinion in rheumatology, 18(5), 519-525.
Lloyd, D. G., & Buchanan, T. S. (2001). Strategies of muscular support of varus and valgus isometric loads at the human knee. Journal of biomechanics, 34(10), 1257-1267.
Lo, C.-H., Tseng, K. C., & Chu, C.-H. (2010). One-Step QFD based 3D morphological charts for concept generation of product variant design. Expert Systems with Applications, 37(11), 7351-7363.
Mündermann, A., Dyrby, C. O., Hurwitz, D. E., Sharma, L., & Andriacchi, T. P. (2004). Potential strategies to reduce medial compartment loading in patients with knee osteoarthritis of varying severity: reduced walking speed. Arthritis & Rheumatism, 50(4), 1172-1178.
Mach, D., Rogers, S., Sabino, M., Luger, N., Schwei, M., Pomonis, J., . . . O’leary, P. (2002). Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. Neuroscience, 113(1), 155-166.
Manal, K., Gardinier, E., Buchanan, T., & Snyder-Mackler, L. (2015). A more informed evaluation of medial compartment loading: the combined use of the knee adduction and flexor moments. Osteoarthritis and cartilage, 23(7), 1107-1111.
Mangione, K. K., Axen, K., & Haas, F. (1996). Mechanical unweighting effects on treadmill exercise and pain in elderly people with osteoarthritis of the knee. Physical therapy, 76(4), 387-394.
March, L. M., & Bachmeier, C. J. (1997). 10 Economics of osteoarthritis: a global perspective. Baillière's clinical rheumatology, 11(4), 817-834.
McAlindon, T., Formica, M., Schmid, C. H., & Fletcher, J. (2007). Changes in barometric pressure and ambient temperature influence osteoarthritis pain. The American journal of medicine, 120(5), 429-434.
Moe, R. H., Fernandes, L., & Østerås, N. (2012). Daily use of a cane for two months reduced pain and improved function in patients with knee osteoarthritis. Journal of physiotherapy, 58(2), 128.
Mundermann, A., Dyrby, C. O., D'Lima, D. D., Colwell, C. W., & Andriacchi, T. P. (2008). In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement. Journal of Orthopaedic Research, 26(9), 1167-1172.
Muro-de-la-Herran, A., Garcia-Zapirain, B., & Mendez-Zorrilla, A. (2014). Gait analysis methods: an overview of wearable and non-wearable systems, highlighting clinical applications. Sensors, 14(2), 3362-3394.
Murphy, S. L. (2009). Review of physical activity measurement using accelerometers in older adults: considerations for research design and conduct. Preventive medicine, 48(2), 108-114.
Musumeci, G., Aiello, F. C., Szychlinska, M. A., Di Rosa, M., Castrogiovanni, P., & Mobasheri, A. (2015). Osteoarthritis in the XXIst Century: Risk Factors and Behaviours that Influence Disease Onset and Progression. International journal of molecular sciences, 16(3), 6093-6112.
Nijs, J., Kosek, E., Van Oosterwijck, J., & Meeus, M. (2012). Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician, 15(3S), ES205-ES213.
Palmieri-Smith, R. M., & Thomas, A. C. (2009). A neuromuscular mechanism of posttraumatic osteoarthritis associated with ACL injury. Exercise and sport sciences reviews, 37(3), 147-153.
Pantelopoulos, A., & Bourbakis, N. G. (2010). A survey on wearable sensor-based systems for health monitoring and prognosis. Systems, Man, and Cybernetics, Part C: Applications and Reviews, IEEE Transactions on, 40(1), 1-12.
Peat, G., McCarney, R., & Croft, P. (2001). Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Annals of the rheumatic diseases, 60(2), 91-97.
Perneger, T. V., Whelton, P. K., & Klag, M. J. (1994). Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs. New England Journal of Medicine, 331(25), 1675-1679.
Porter, W. L., Mayton, A. G., & Moore, S. M. (2010). Pressure distribution on the anatomic landmarks of the knee and the effect of kneepads. Applied ergonomics, 42(1), 106-113.
Riddle, D. L., & Stratford, P. W. (2014). Knee pain during daily tasks, knee osteoarthritis severity, and widespread pain. Physical therapy, 94(4), 490-498.
Risberg, M. A., Holm, I., Steen, H., Eriksson, J., & Ekeland, A. (1999). The Effect of Knee Bracing After Anterior Cruciate Ligament Reconstruction A Prospective, Randomized Study with Two Years’ Follow-up. The American Journal of Sports Medicine, 27(1), 76-83.
Roos, E. M., Klässbo, M., & Lohmander, L. (1999). WOMAC Osteoarthritis Index: Reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Scandinavian journal of rheumatology, 28(4), 210-215.
Salaffi, F., Carotti, M., Stancati, A., & Grassi, W. (2005). Health-related quality of life in older adults with symptomatic hip and knee osteoarthritis: a comparison with matched healthy controls. Aging clinical and experimental research, 17(4), 255-263.
Sanders, E. B.-N., & Stappers, P. J. (2008). Co-creation and the new landscapes of design. Co-design, 4(1), 5-18.
Segal, N. A. (2012). Bracing and orthoses: a review of efficacy and mechanical effects for tibiofemoral osteoarthritis. PM&R, 4(5), S89-S96.
Shany, T., Redmond, S. J., Narayanan, M. R., & Lovell, N. H. (2012). Sensors-based wearable systems for monitoring of human movement and falls. Sensors Journal, IEEE, 12(3), 658-670.
Sharma, L., Dunlop, D. D., Song, J., & Hayes, K. W. (2003). Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Annals of internal medicine, 138(8), 613-619.
Sharma, L., Hurwitz, D. E., Thonar, E., Sum, J. A., Lenz, M. E., & Dunlop, D. D. (1998). Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Age, 4, 13.
Sharma, L., Song, J., Felson, D. T., Shamiyeh, E., & Dunlop, D. D. (2001). The role of knee alignment in disease progression and functional decline in knee osteoarthritis. Jama, 286(2), 188-195.
Shelburne, K. B., Torry, M. R., & Pandy, M. G. (2006). Contributions of muscles, ligaments, and the ground‐reaction force to tibiofemoral joint loading during normal gait. Journal of Orthopaedic Research, 24(10), 1983-1990.
Shull, P. B., Shultz, R., Silder, A., Dragoo, J. L., Besier, T. F., Cutkosky, M. R., & Delp, S. L. (2013). Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis. Journal of biomechanics, 46(1), 122-128.
Slemenda, C., Brandt, K. D., Heilman, D. K., Mazzuca, S., Braunstein, E. M., Katz, B. P., & Wolinsky, F. D. (1997). Quadriceps weakness and osteoarthritis of the knee. Annals of internal medicine, 127(2), 97-104.
Stamenović, D., Kojić, M., Stojanović, B., & Hunter, D. (2009). Pneumatic osteoarthritis knee brace. Journal of biomechanical engineering, 131(4), 045001.
Stratford, P. W., Kennedy, D. M., & Woodhouse, L. J. (2006). Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee. Physical therapy, 86(11), 1489-1496.
Terwee, C. B., van der Slikke, R. M., van Lummel, R. C., Benink, R. J., Meijers, W. G., & de Vet, H. C. (2006). Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients. Journal of clinical epidemiology, 59(7), 724-731.
Thomas, E., Peat, G., Harris, L., Wilkie, R., & Croft, P. R. (2004). The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain, 110(1), 361-368.
Thorp, L. E., Sumner, D. R., Wimmer, M. A., & Block, J. A. (2007). Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis. Arthritis care & research, 57(7), 1254-1260.
Tsagarakis, N. G., & Caldwell, D. G. (2003). Development and control of a ‘soft-actuated’exoskeleton for use in physiotherapy and training. Autonomous Robots, 15(1), 21-33.
Tsai, Y.-F. (2007). Gender differences in pain and depressive tendency among Chinese elders with knee osteoarthritis. Pain, 130(1), 188-194.
Van der Esch, M., Heijmans, M., & Dekker, J. (2003). Factors contributing to possession and use of walking aids among persons with rheumatoid arthritis and osteoarthritis. Arthritis care & research, 49(6), 838-842.
Walsh, C. J., Endo, K., & Herr, H. (2007). A quasi-passive leg exoskeleton for load-carrying augmentation. International Journal of Humanoid Robotics, 4(03), 487-506.
Walter, J. P., D'Lima, D. D., Colwell, C. W., & Fregly, B. J. (2010). Decreased knee adduction moment does not guarantee decreased medial contact force during gait. Journal of Orthopaedic Research, 28(10), 1348-1354.
Wilder, F., Hall, B., & Barrett, J. (2003). Osteoarthritis pain and weather. Rheumatology, 42(8), 955-958.
Zhao, D., Banks, S. A., Mitchell, K. H., D'Lima, D. D., Colwell, C. W., & Fregly, B. J. (2007). Correlation between the knee adduction torque and medial contact force for a variety of gait patterns. Journal of Orthopaedic Research, 25(6), 789-797.