| 摘要: | 本研究旨在張口復健運動輔助張口器對改善接受放射治療之頭頸癌患者最大張口程度、預防發生牙關緊閉、提升生活品質及降低牙關緊閉症狀困擾程度之成效探討。研究以隨機實驗法、單盲設計，共納入34位符合條件之受試者，分為張口器加上張口復健運動組（實驗組）與張口復健運動（對照組）。受試者從放射治療前一週開始給予張口復健運動教學，介入措施為期12週，期間每週追蹤一次最大張口程度，之後於第16週、24週、36週追蹤及紀錄。研究工具包括基本屬性資料表、歐洲癌症研究與治療組織生活品質核心問卷核心版（The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, EORTC-QLQ-C30, EORTC-QLQ-C30）、歐洲癌症研究與治療組織生活品質頭頸癌版問卷（The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions, EORTC-QLQ-C30H&N35）、中文版哥德堡牙關緊閉問卷第二版（Chinese version of the Gothenburg rismus Questionnaire?2; GTQ2）及張口程度量尺。研究結果：介入後 36 週，實驗組與介入前最大張口程度相差2.29 毫米（SD = 4.15），對照組相差-1.53 毫米（SD = 6.36），達顯著差異（t = 2.08, p = 0.046），另外實驗組於介入措施後36週與前測之最大張口程度比較達顯著差異（t = 2.28, p = 0.04）。EORTC H&N35之張口困難面向改變量達顯著差異，實驗組得分降低15.7（SD = 26.7），對照組得分增加5.9（SD = 29.4）。GTQ2牙關緊閉症狀困擾量表，實驗組下頷問題面向改變量為-6.3 分（SD = 15.07），對照組為 5.1 分（SD = 12.1），達顯著差異（t = -2.43, p = 0.02）。本研究結果顯示接受放射治療之頭頸癌患者使用張口復健運動輔助張口器可改善最大張口程度，無法顯著預防牙關緊閉發生，可提升部分生活品質面向及降低部分牙關緊閉症狀困擾面向，提供臨床醫療人員對執行放射治療之頭頸癌患者臨床照護之參考。
The aim of this study was to evaluate the effect of structured exercise with the jaw-mobilizing device in improving the maximum mouth opening, preventing the occurrence of trismus, improving the quality of life and reducing the degree of trismus symptoms in patients with head and neck cancer undergoing radiotherapy. This was a prospective, single blind, randomized, controlled trial. 34 patients were randomly assigned to one of two groups with single blind : the jaw motion device group (experimental group) and the conventional exercise group (control group). Patients performed the exercise for 12 weeks and were followed up once a week during the course, and at 16, 24, 36 weeks after the treatment. Maximal mouth opening (MIO) was measured and the patients completed questionnaires on symptoms of trismus and health-related quality of life (The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30; EORTC-QLQ-C30, The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions; EORTC-QLQ C30H&N35, and the Gothenburg Trismus Questionnaire; GTQ2). 36 weeks after intervention, the mean change of MIO were 2.29 mm (SD = 4.15) and -1.53 mm (SD = 6.36), respectively and was with significant difference between groups (t = 2.08, p = 0.046). There was also a significant difference in change of MIO between the baseline and 36 weeks in the experimental group (t = 2.28, p = 0.04). There was a significant difference in change of score in “opening mouth”item of EORTC H&N35 between groups after intervention, while the score showed a decrease 15.7 (SD = 26.7) in the experimental group and an increase 5.9 (SD = 29.4) in the control group. There was also a significant difference in improvement of scale of GTQ2 between groups (t = -2.43, p = 0.02), which showed a decrease of 6.3 points (SD = 15.07) in the experimental group and an increase of 5.1 points (SD = 12.1) in the control group. The present study demonstrated that jaw motion devices could effectively increase the MIO in head and neck cancer patient who underwent radiotherapy, partially improve the health-related quality of life and relief the symptoms of trismus. These findings provide support to clinical medical teams during and after treatment of patients with head and neck cancer. |
