untitled

Size: px

Start display at page:

Download "untitled"

우 도
5 years ago
Views:

1 Journal of Korean Medicine Rehabilitation Vol. 25 No. 3, July 2015 pissn eissn Original Article 한의학계에서델파이방법을사용한연구에대한문헌고찰 ( 국내학술지를중심으로 ) 박창현 임형호가천대학교한의과대학한방재활의학과교실 The Review on the Studies Using Delphi Method in the Journals of Korean Medicine from 2006 to 2015 Chang-Hyun Park, K.M.D., Hyung-Ho Lim, K.M.D. Department of Oriental Rehabilitation Medicine, College of Korean Medicine, Gachon University 이논문은 2015 년도가천대학교교내연구비지원에의한결과임. RECEIVED June 18, 2015 REVISED July 6, 2015 ACCEPTED July 8, 2015 CORRESPONDING TO Hyung-Ho Lim, Department of Oriental Rehabilitation Medicine, College of Korean Medicine, Gachon University, Guwol 1-dong, Namdonggu, Incheon , Korea TEL (070) FAX (032) omdlimhh@naver.com Objectives The aim of this review is to analyse the study tendency in papers related with delphi method which are published in Korea from 2006 to Methods We searched the electronic database (NDSL, RISS, Korean traditional knowledge portal, OASIS) and checked relevant Korean journals from 2006 to research papers were found and they were analyzed according to the year of publishment, the titles of journals which have the papers, the time of repeated survey and purpose of technique application. Results 1. As we analyzed by years, 2.3 papers were published per year on average. 2. As we analyzed by jounals in which papers were published, 39% of total papers were published in The Journal of the Society of Korean Medicine Diagnostics, 30% were in Korean Journal of Oriental Physiology & Pathology, taking up 69% of total papers. 3. As we analyzed by the number of survey taken in each research, 11 papers surveyed 2 times, 7 papers surveyed 3 times, 1 paper suerveyed one time. 4. As we analyzed by the purpose of technique application, 91% of papers were aimed at the development of questions, 9% of papers were aimed at policy recommendation. Conclusions These results suggest that although many researches were trying to quantify the symptom of patient, to demonstrate on exact data and to accomplish the scientification of diagnosis, the number of paper is insufficient. Therefore, it seems that more researches must be taken afterward. (J Korean Med Rehab 2015;25(3):59-64) Copyright 2015 The Society of Korean Medicine Rehabilitation Key words Delphi method, Korean medicine, Review 서론»»» 델파이방법은예측하려는문제에관하여전문가들의견해를유도하고종합하여집단적판단으로정리하는일련의절차라고정의할수있다. 델파이방법은추정하려는문제에관한정확한정보가없을때는 두사람의의 견이한사람의의견보다정확하다. 는계량적객관의원리와 다수의판단이소수의판단보다정확하다. 는민주적의사결정의원리에논리적근거를두고있다 1). 내용이알려지지않거나일정한합의점에도달하지못한내용에대해다수의전문가의의견조사를통해합의된내용을얻는방법으로 2) 의료계에서는의료지침마련에널리쓰 59

2 박창현 임형호 이고있는기법이며, 특히한의계에서는변증의표준화를위한변증설문지개발에주로사용된다. 변증설문지를개발하는것은한의진단의객관화를도모하는데중요한분야이다. 설문작업을거쳐서축적된자료는의료정보학분야의핵심적기초자료로활용되어근거중심의학의학문적바탕이되고, 임상통계의연구자료로사용될수있으며, 향후표준화된내용에따라증상이분류되고, 진단과치료가체계적으로이루어진다면주요질병, 증상등에있어서효율성을입증하는데중요한역할을할것으로기대된다 3,4). 이렇듯최근델파이기법을이용한연구들이지속적으로보고되고있으나, 연구에대한경향을고찰하는논문은없어기존연구에대해정리가필요한시점이다. 연구경향을살펴보는것은연구영역을확대하고, 새로운연구방법을구상할수있는기초안내자료로중요하다 5). 이에본연구는최근 10년간국내한의학관련학회지를통해보고된델파이방법을이용한연구를조사하여지금까지보고된논문의경향을파악하고향후, 델파이방법을이용함에있어서여러가지방향을제시할수있는기초자료가될수있고자한다. 대상및방법»»» 1. 연구대상연구대상은국내한의학관련학술지에등재된델파이에관한논문으로하였으며, 발표초록및학술대회초록, 신문기사등은제외하였다. 학술논문의검색은 NDSL ( RISS ( index.do), 전통지식포탈 ( OASIS ( 을사용하여검색하였으며, 검색어는 델파이 와 Delphi 를기본검색어로하여띄어쓰기등에의해빠지는논문이없도록교차검색을시행하였다. 델파이와관련없는논문, 게재년도가 10년초과된논문, 중복검색된논문을제외하여총 23편의논문을선정하였다. 2. 연구방법선정한 23편의논문을대상으로한의학분야에서의연구동향을고찰한기존연구분석방법을참고하여연도별분석및학회지별분석, 연구목적및내용등을대상으로분석을진행하였다 9,10). 결과»»» 1. 연도별분석최종선정된 23편의논문을연도별로분석한결과매년적게는 1편에서많게는 6편까지평균 2.3편의논문이게재되었으며 2009년 6편의논문이게재되었던년도를제외하면매년 1 3편의논문이게재되었다 (Fig. 1). 2. 학회지별분석등재된학회지를기준으로대한한의진단학회지가 9편으로 39% 로가장많았으며동의생리병리학회지가 7편으로 30%, 대한침구학회지가 2편으로 9%, 대한한의학회지및한방재활의학과학회지, 대한예방한의학회지, 대한한방내과학회지와동의신경정신과학회지가각 1편으로 4% 였다 (Table I). 3. 설문횟수별분석대상이된논문에서의설문횟수를분석한결과 23편 Fig. 1. Number of the these sorted by published year. 60 J Korean Med Rehab 2015;25(3):59-64

3 한의학계에서델파이방법을사용한연구에대한문헌고찰 ( 국내학술지를중심으로 ) Table I. The Number of the These Sorted by the Published Journals The published journals Number (%) The Journal of the Society of Korean Medicine 9 (39) Diagnostics Korean Journal Oriental Physiology & Pathology 7 (30) The Journal of Korean Acupuncture & Moxibustion 2 (9) Society Journal of Korean Medicine 1 (4) Journal of Korean Medicine Rehabilitation 1 (4) Korean Journal of Oriental Preventive Medical 1 (4) Society Korean Journal of Oriental Internal Medicine 1 (4) Journal of Oriental Neuropsychiatry 1 (4) 중총 11편의논문에서 2회의설문조사를시행하였으며, 3회의설문조사를시행한논문이 7편이었다. 설문조사횟수를언급하지않은논문은 4편이었다. 가장많은설문을시행한논문은최등 12) 의논문으로 4번의설문조사를실시하였다 (Fig. 2). 4. 연구목적별분석 델파이기법의활용목적에따라분류하였을때설문문항개발을목적으로한논문이 21편으로 91%, 정책제안을목적으로한논문이 2편으로 9% 였다. 설문문항개발을위한논문을다시분야별로나누어보면변증에따른증상분석 12편으로 52%, 한약적응증분석 5편으로 22%, 질환별증상분석 3편으로 13%, 맥상파의속성및구성요소분석 1편으로 4% 였다 (Table II). 5. 연구내용별분석 설문문항개발을위한연구가총 21편이었으며변증을기준으로한논문은총 12편으로熱, 氣虛ㆍ血虛ㆍ陰虛ㆍ陽虛, 中風辨證, 中風後憂鬱症의寒ㆍ熱ㆍ虛ㆍ實, 알코올성간염의寒ㆍ熱ㆍ濕ㆍ燥, 虛ㆍ實, 痰飮, 寒ㆍ熱, 十種腰痛辨證, 痺症, 瘀血, 眼診上虛ㆍ實辨證이었다. 한약적응증에대한논문은총 5편으로六味地黃湯, 歸脾湯, 平胃散, 補中益氣湯, 加味歸脾湯이었다. 질환별증상을기준으로한논문은총 3편으로膝痛, 알코올성간염, 頸項痛에대한설문이었다. 정책제안을목적으로한논 Fig. 2. The number of the these sorted by survey times. Table II. The Number of the These Sorted by the Contents of Study Purpose Of Technique Application Number (%) Developement Of Questionnaire 21 (91) Analysis Of Pattern Identification 12 (52) Analysis Of Herbal Medicine Indications 5 (22) Analysis Of Disease-Specific Symptoms 3 (13) Analysis Of Physical Attribute & Components in 1 (4) Pressure Pulse Waveform Policy Recommendation 2 (9) 문은총 2편으로한의학분야에서의연구개발인력의수급전망및정책제안을위한논문과통합의료정책우선순위설정을위한논문이었다. 고찰»»» 시대적인변화의흐름은한의학의과학화, 합리화의기조아래임상에서진단과치료및예후판정에정량적이고객관적인자료를요구하고있다. 따라서최근한의계에서는환자의증상을정량화하고객관적인정보를확보하여변증하기위한다양한연구들이시도되고있다 13). 특히현재의상태에대한일반화, 표준화된자료가부족한경우전문가적인직관을객관화하는예측의방법으로델파이기법이많이사용되어진다. 이는영향력있는몇몇사람의의견이아닌전체의의견을공정하게모으려개발된기법이며, 논리적이며객관적으로체계적인분석을수행하고, 수차례에걸쳐피드백시킴으로써, 다수의전문가들의의견을종합하고합의점을도출하는보다체계화, 객관화라는측면에유용한기법이다 14,15). 61

4 박창현 임형호 델파이기법의특징은첫번째, 집단효과이다. 집단내의극단적오류가상호균형및수정을통해의견간의합의가도출될수있도록한다. 두번째, 익명성이다. 설문서의응답자는철저하게익명성이보장되므로외부적인영향력으로결론이왜곡되거나표현이제한되는예가매우적다. 세번째, 통제된피드백과다중반복이다. 개개의참여자들의정보의가능성은한번의개인적, 개방적순환보다여러번의순환에서보다집중적으로도출될수있다. 게다가다중반복은개개인의의견을수렴하는데효과적이다. 또한통제된피드백과정을반복하기때문에주제에대한계속적인관심과사고촉진, 종합된의견의전달은질문서에대한답을집계하는형식으로이루어지게된다. 따라서통계적으로의견을처리하여제시함으로써그룹내의의견차이정도를보여주고, 강한소수의견에대해서도내용을파악할수있도록해준다 6,7,8). 델파이를이용한연구들에대한본격적인고찰은시도한경우가없어최근 10년간국내한의학관련학회지를통해보고된델파이방법을이용한연구동향을관찰하였다. 제목과초록, 키워드중심으로검토하여델파이기법과직접적인관련이없는논문, 2005년이전의논문및중복검색된논문을제외한결과 23편의논문이선정되어본연구에사용되었다. 최종선정된논문을연도별로분석한결과연평균 2.3 개의논문이게재되고있었으며, 2009년 6편의논문이게재되었던년도를제외하면매년 1 3편의논문이게재되고있음을알수있었다. 학회지별로분석한결과논문의 69% 가대한한의진단학회지 (9편) 와동의생리병리학회지가 (7편) 에게재되었다. 그밖에대한침구학회지및대한한의학회지 (2편), 한방재활의학과학회지및대한예방한의학회지, 대한한방내과학회지 (1편) 으로한의학관련학회지가다수있는등좋은연구여건에도불구하고연구가많지않음을확인할수있었다. 설문을반복하여특정한주제에대해전문가집단의합의를도출하는방식으로진행되는델파이기법에서는 2 회이상의설문조사를통해응답간의편차가줄어들고의견이서로비슷해지는경향을보이는데, 이과정을통해전문가의견을수렴한다. 23편의논문중설문조사를시행한횟수를밝힌논문이 19편으로이중 2회의설문조사를시행한논문은 58%(11 편 ) 이었으며, 3회의설문조사를시행한논문이 37%(7 편 ), 4 번의설문조사를실시한논문이 5%(1 편 ) 순으로나타났다. 델파이기법의활용목적에따라분석한결과설문문항개발을목적으로한논문이 91% 로대부분을차지하고있었고정책제안을목적으로한논문이 9% 였다. 설문문항개발을위한논문 21편을다시분야별로나누어보면변증에따른증상분석 12편, 한약적응증분석 5편, 질환별증상분석 3편, 맥상파의속성및구성요소분석 1편의순이었다. 변증내용을세부적으로살펴보면瘀血 2), 寒熱 3), 虛實 16), 熱 17), 氣血陰陽虛 18), 痰飮 19) 20), 痺證등으로이는한의계에서델파이기법이변증의표준화를위한변증설문지개발에주로사용된다는것을보여준다. 또한많은수의연구에서단순히설문문항을개발하는데서그치지않고개발한설문지의신뢰도및타당도를평가하는등이에대한검증이이루어지고있음을알수있었다. 김등 21) 의연구에서델파이기법을통해만든설문문항의임상활용가능성을확인하기위하여환자에게설문조사를실시하여설문이실제수치적호전도를반영하는지여부를검증하였으며, 고등 22) 의연구에서는합의된설문을바탕으로임상증례를수집하여타당도및중요도등을연구하였다. 또한유등 16), 구등 23) 의연구에서도합의를통한설문의개발에서더진행하여신뢰도및타당도를연구한것을알수있었다. 한의계에서의델파이방법을이용한연구경향을살펴보았을때, 기법을사용한연구수가그리많지않은것이사실이고현재까지이루어진연구에서도대부분이델파이기법을사용하여전문가의합의를통해설문문항을개발하는연구로, 이는변증의측면에서든질환의측면에서든비교적다양하게이루어지고있다고볼수있지만상대적으로정책을제안하는등의설문개발을제외한분야의델파이연구는거의전무한것으로조사되었다. 김등 24) 의연구나안등 25) 의연구에서와같이최근의료계에서의델파이방법이특정질병군에대한진료지침을개발및개선하거나의료체계적측면에서의개발을목적으로사용되었음을볼때한의학계에서도이러한목적을갖고있는연구가추가적으로진행되어야할것으로사료된다. 최근변증의표준화, 한의진단의객관화라는주제에대한관심이높아지는상황에서이를이룰수있는도구로써사용될수있는델파이연구가한의학계에서어떻게적용되고있는지에대해국내논문들의동향을살펴보았 62 J Korean Med Rehab 2015;25(3):59-64

5 한의학계에서델파이방법을사용한연구에대한문헌고찰 ( 국내학술지를중심으로 ) 으며, 이를바탕으로델파이연구의설계및진행에도움을제공할수있을것으로사료된다. 결론»»» 최근 10년간델파이기법을사용한한의학계에서의연구의경향을분석한결과다음과같은결론을얻었다. 1. 연도별분석결과매년평균 2.3개의논문이게재되었다. 2. 학회지별분석결과대한한의진단학회지에 39%, 동의생리병리학회지에 30% 로전체논문의 69% 가게재되었으며대한침구학회지에 9%, 대한한의학회지및한방재활의학과학회지, 대한예방한의학회지, 대한한방내과학회지, 동의신경정신과학회지에각 4% 순이었다. 3. 각연구에서의설문시행횟수를기준으로분석하였을때 2회의설문조사를시행한논문 11편, 3회의설문조사를시행한논문이 7편, 4번의설문조사를실시한논문 1편으로나타났다. 4. 활용목적에따라분석한결과설문문항개발을목적으로한논문이 91% 로대부분을차지하고있었고정책제안을목적으로한논문이 9% 였다. 설문문항개발을위한논문을다시분야별로나누어보면변증에따른증상분석 12편으로 52%, 한약적응증분석 5편으로 22%, 질환별증상분석 3편 (13%) 의순으로나타났다. 이상과같은결론으로보아한의학계에서환자의증상을정량화하고객관적인정보를확보하여변증하고진단의과학화를이루기위해델파이기법을사용한연구가시도되고있으나그수가많이부족하고또한설문개발을제외한분야의델파이연구는거의이루어지지않았음을알수있었으며, 따라서추후여러방향에서의델파이연구가필요할것으로보인다. References»»» 1. Delphi method. Lee GS. Gyeonggi : Kyoyookkwahaksa. 2006:7-27, Yang DH, Park YJ, Park YB, Lee SC. Development of Questionnaires for Blood Stasis Pattern. The Journal of the Society of Korean Medicine Diagnostics. 2006;10(1): Kim SK, Park YB. Development of Questionnaire for Cold-Heat Patternization. The Journal of the Society of Korean Medicine Diagnostics. 2004;7(1): Kim SK, Nam TH, Park YB. Validity of Questionnaires for Cold-Heat Patternization(I). The Journal of the Society of Korean Medicine Diagnostics. 2002;6(2): Yea SJ, Jang HC, Kim JH, Kim C, Kim SK, Song MY. Design of Models for the Korean Traditional Medicine Research Trend Analysis System. Journal of Korea Contents Association. 2009;9(12): Ahn MY, Song YK, Ko SG, Lim HH. Development of Questionnaire for Pattern Identification of Chronic Low Back Pain by Delphi Method. Journal of Korean Medicine Rehabilitation. 2013;23(4): Gibson JM. Using the Delphi technique to identify the content and context of nurses' continuing professional development needs. J Clin Nurs. 1998;7: Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criterial for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Inetern Med. 2003;163: Jung H, Park SJ, Lee HE, Kim Binnara, Lee EJ, Oh MS, Heo DS. Review on the Study of Sibjeondaebo-tang (Shiquan dabutang) Published in Korea from 2000 to Journal of Korean Medicine Rehabilitation. 2014; 24(1): Lee SJ. Research Trends on the Effect of Sagunzatang and Samultang. J of Daejeon Oriental Medicine. 2011; 20(1): Park SJ, Kang KR, Kim SA, Hwang SM, Chae H. Systematic Review on the Study of Sasang Typology Published in Korea from 2000 to Korean J. Oriental Physiology & Pathology. 2011;25(4): Choi SH, Rhim HM, Oh JG, Rhim JY, Kang HW, Kim YS, Hang CH, Lee I, Moon SK, Yun HJ, Sung KK, Lee SK. Standard Pattern Identifications for Post Stroke Depression by Delphi Method. Korean J. Oriental Physiology & Pathology. 2012;26(3): Bae NS, Park YJ, Oh HS, Park YB. Preceding Studies for Questionnaires on Han-Yol Patternization. The Journal of the Society of Korean Medicine Diagnostics. 2005;9(1): Hasson F., Keeney S., McKenna H. Research guidelines for Delphi survey technique. Journal of Advanced Nursing. 2000;32(4): Danielle Cabral, Jeffery N. Katz, Michael E. Weinblatt, Gladys Ting, Jerry Avorn, Daniel H. Solomon. Develpment and Assessment of Indicators of Rheumatoid Arthritis Severity: Results of a Delphi Panel. Arthritis & 63

6 박창현 임형호 Rheumaism. 2005;53(1): Ryu HH, Lee HJ, Jang ES, Lee SW, Lee GS, Kim JY. Study on Deficiency-Excess Pattern Questionnaire Development Possibility. Korean J. Oriental Physiology & Pathology. 2009;23(3): Bae NS, Yang DH, Park YJ, Park YB, Lee SC, Oh HS. Development of Questionnaires for yol Patternization. The Journal of the Society of Korean Medicine Diagnostics. 2006;10(1): Woo HJ, Kim SH, Choi MY, Kim YC, Lee JH. Development of Questionnaires for Differentiation of qì-xū, xuè-xū, yang-xū., yīn-xū analysis. Korean J. Oriental Internal Medicine. 2008;29(4): Park JS, Yang DH, Kim MY, Lee SC, Park YJ. Development of Questionnaire for Damum Patternization. The Journal of the Society of Korean Medicine Diagnostics. 2006;10(1): Ahn JH, Lee SH, Park YJ, Park YB. Developing Questionnaire of BiJeung which is similar to Arthralgia and Paresthesia Syndrome. Journal of Korean Medicine. 2013;34(3): Kim JE, Park SE, Lee SY, Son HY, Hong SH, Kang CW, Kim BK, Chi GY. Study about Validity of Measuring Instrument for Symptoms Improvement on the Alcoholic Hepatitis Patients. Korean J. Oriental Physiology & Pathology. 2010;24(2): Go HY, Kang BG, Kim BY, Kang KW, Go MM, Park SW, Cha MH, Kang BJ, Bang OS, Yu BC, Choi SM. Application Study of Symptoms Weight For Standard of Korean Medicine Pattern Identification In Stroke. Korean J. Oriental Physiology & Pathology. 2007;21(4): Koo BS, Lee SJ, Han CH, Kim HJ, Park SH. The Basic Study for Building the Depression Prescription Guideline of GamiguibiTang-The Evaluation of Reliability and Validity of the Depression Pattern-Identification Questionnaire-. Journal of Oriental Neuropsychiatry. 2009;20(4): Kim SG, Jung HG, Lee HL, Jang JY, Lee H, Kim CG, Shin WG, Shin ES, Lee YC. Guidelines for the Diagnosis and Treatment of Helicobacter pylori Infection in Korea, 2013 Revised Edition. The Korean Journal of Gastroenterology. 2013;62(1): Ahn GO, Shin SD, Song KJ, Park JO, Lee JS, Seo GJ. Delphi Study to Develop Consensus for the Quality Improvement of Prehospital Care. Journal of The Korean Society of Emergency Medicine. 2007;18(2): J Korean Med Rehab 2015;25(3):59-64

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical