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| 題名: | 乳癌病人手術後三個月內患肩功能變化及相關因素之探討 |
| 作者: | 鄭素月 |
| 貢獻者: | 醫學科學研究所 |
| 日期: | 2010 |
| 上傳時間: | 2010-10-21 09:50:31 (UTC+8) |
| 摘要: | 乳癌為台灣女性癌症發生率的第二位，目前針對初期乳癌，多採取手術治療，過去研究指出乳癌病人手術後第三個月的患肩活動功能可預測一年後的生活品質，可見術後早期的患肩活動功能對乳癌病人生活品質改善的重要性，然患肩活動功能的相關研究，仍付之闕如。故本研究的目的為：一、探討乳癌病人手術後三個月內執行手臂運動行為的變化。二、探討乳癌病人手術後三個月內肩活動功能的變化。三、探討乳癌病人手術後三個月內執行手臂運動行為的相關因素。四、探討乳癌病人手術後三個月內肩活動功能的預測因素。
本研究採縱貫性研究設計，收案對象初次診斷為第I 至III 期乳癌，且首次接受乳房切除手術的乳癌病人，在病房及門診填寫問卷、測量肩關節外展範圍，四次收案時間分別為術前一天 ( T0)、手術後一個月 ( T1)、手術後二個月 ( T2)及手術後三個月 ( T3)。以結構式問卷及測量患肩外展收集四次資料，問卷包括手臂運動促進量表、症狀嚴重程度量表、憂鬱程度次量表及自我效能等量表。共收集71位個案資料，運用15.0版SPSS統計軟體，並以GEE模式分析手臂運動促進行為及患肩活動功能變化的預測因素。
研究結果發現：乳癌病人手術後三個月內，(一)手臂運動執行率在第一個月約有三成，第二個月、第三個月維持大約五成，第一個月執行比率少於第二及第三個月，此變化具有統計學意義，(二)在患肩活動功能變化方面，術後第二個月肩外展角度比術後第一個月大，術後第三個月又比術後第二個月大，但術後第三個月肩外展角度仍比術前差，(三)手臂運動執行變化的預測因素有癌症期數及手術前自我效能，即第三期以上患者及手術前高自我效能的乳癌病人，較能規則執行手臂運動，(四)患肩活動功能變化的預測分析發現若手臂運動利益感受越好、手術前維持良好生活品質的自我效能越好的乳癌病人，則患肩活動功能越好，而疲倦越嚴重的乳癌病人，患肩活動功能越差。
此結果可提供臨床更多有關病人復原訊息，手術後第三個月乳癌病人患肩的外展仍未完全復原，但僅五成病人執行規則性手臂運動，醫護人員可依據研究中發現的預測因素，發展合適的護理措施，協助增強手臂運動利益感受、情境支持感受，提昇手術前維持良好生活品質的自我效能，並減少疲倦，以增強乳癌病人手術後三個月內促進手臂運動行為及患肩活動功能，並進一步提昇乳癌病人的生活品質。
Aim. This paper is a longitudinal study to examine the changes of arm exercise and shoulder function and those related factors in breast cancer patients during the first three months after surgery.
Background. Surgery was the treatment for breast cancer. In the previous study revealed that breast cancer patients’ quality of life at third month after surgery was predicted by the shoulder function one month after surgery. Longitudinal following to examine changes in arm exercise and shoulder function and those possible causes have not been well studied.
Method. Newly diagnosed breast cancer patients were recruited. A total of 71 cases completed the 4 times data collection: pre-operation day, one and two, and three months after surgery. Data were collected using the Arm Exercise Promotion Scale, Symptom Severity Scale, Self-Efficacy Scale and Hospital Depression subscale. Generalized Estimating Equation was applied for data analysis.
Results. There were significant changes in arm exercise and shoulder function across 3 months after surgery, the shoulder function was improved with time, but not recover in the third month after surgery; the prevalence rate of arm exercise practice was 30 % at the first month and maintained around 50 % at the 2nd and 3rd months. Stage and self-efficacy perceived by patients in preoperative can predict the changes of arm exercise practice. Patients who practiced arm exercise had more advanced cancer stage and higher self-efficacy perceived by patients in preoperative. Benefit perception of arm exercise, arm exercise practice, self-efficacy perceived by patients in preoperative and fatigue can predict the changes of shoulder function. Patients with higher benefit perception of arm exercise, regularly practiced arm exercise, perceived higher self-efficacy in preoperative interview, and with lower fatigue could have more positive changes of shoulder function significantly.
Conclusion. The physical and psychological factors, and preoperative self-efficacy on managing cancer are important factors predicting patients’ arm exercise and shoulder function changes. Clinical interventions based on these results should be developed and further to examine its effects in order to improve breast cancer patients’ arm exercise and shoulder function, then improve breast cancer patients’ quality of life. |
| 關聯: | 102頁 |
| 描述: | 目 錄 頁數
致謝 I
中文摘要 II
英文摘要 IV
目錄 VI
圖表目次 IX
第壹章 緒論 1
第一節 研究動機與重要性 3
第二節 研究目的 5
第貳章 文獻查證 6
第一節 健康促進行為的理論基礎 6
第二節 乳癌病人手術後的手臂不適 10
第三節 癌症病人的運動行為 16
第四節 乳癌病人手術後手臂運動行為的相關研究 21
第五節 乳癌病人手術後肩活動功能的相關研究 27
第參章 研究架構與名詞界定 29
第一節 研究架構 29
第二節 研究假設 31
第三節 名詞界定 32
第肆章 研究設計 33
第一節 研究對象及研究場所 33
第二節 研究工具 34
第三節 資料收集步驟 40
第四節 樣本數估計 42
第五節 資料處理及分析 43
第伍章 研究結果 44
第一節 乳癌病人的人口學特質及醫療情況 44
第二節 乳癌病人手術後手臂運動執行、肩活動功能、手臂運動
促進感受及相關變項之變化 46
第三節 乳癌病人手術後手臂運動執行變化的預測因素 53
第四節 乳癌病人手術後三個月內肩活動功能變化的預測因素 59
第陸章 討論 66
第一節 乳癌病人手術後手臂運動執行、肩活動功能、手臂運動
促進及相關變項之變化 66
第二節 乳癌病人手術後手臂運動執行變化的預測因素 68
第三節 乳癌病人手術後三個月內肩活動功能變化的預測因素 71
第柒章 結論與建議 74
第一節 結論 74
第二節 研究限制 77
第三節 護理應用 78
參考資料 80
附錄一 研究同意書 94
附錄二 研究問卷 95
附錄三 收案醫院臨床試驗委員會審查通過證明書 100
附錄四 收案醫院人體試驗審查委員會同意臨床研究證明書 101
附錄五 已發表之相關著述 102
圖 表 目 次 頁頁 數
圖一 手臂運動促進肩活動功能的研究架構 30
圖二 乳癌病人肩活動功能的變化情形 50
圖三 乳癌病人症狀嚴重程度的變化情形 50
圖四 乳癌病人手臂運動促進感受的變化情形 52
表一 乳癌病人手臂運動執行、肩活動功能、手臂運動促進感
受、症狀嚴重程度、憂鬱及自我效能四次不同時間點之研
究測量一覽表 41
表二 資料統計及分析方法 43
表三 乳癌病人的人口學及醫療資料 45
表四 乳癌病人的肩活動功能與相關變項變化情形 49
表五 乳癌病人手臂運動促進感受的變化情形 52
表六 乳癌病人手術後第一個月規則性手臂運動執行的相關因素
分析 55
表七 乳癌病人手術後第二個月規則性手臂運動執行的相關因素
分析 55
表八 乳癌病人手術後第三個月規則性手臂運動執行的相關因素
分析 56
表九 乳癌病人手術後三個月內手臂運動執行變化的預測因子:
GEE分析 58
表十 乳癌病人的人口學及醫療變項、手術後執行手臂運動與肩
活動功能之相關性 61
表十一 乳癌病人手術後手臂運動促進感受與肩活動功能之相關性 63
表十二 乳癌病人手術後三個月內肩活動功能變化的預測因子:
GEE分析 65
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