居家運動對於心臟衰竭病人憂鬱、焦慮、心肺功能和生活品質之成效：隨機臨床試驗之系統性文獻回顧與統合分析

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题名:	居家運動對於心臟衰竭病人憂鬱、焦慮、心肺功能和生活品質之成效：隨機臨床試驗之系統性文獻回顧與統合分析 Effects of Home-Based Exercise on Depression, Anxiety, Functional Capacity and Quality of Life in Patients with Heart Failure: A Systematic Review and Meta-Analysis of Randomized Control Trials
作者:	王怡晴 WANG, YI-CHING
贡献者:	護理學系碩士在職專班蔡佩珊
关键词:	心肺功能指標;心臟衰竭;生活品質;居家運動;統合分析;焦慮;憂鬱 Anxiety;Depression;Functional Capacity;Heart failure;Home-based exercise;Meta-analysis;Quality of Life
日期:	2024-01-04
上传时间:	2025-01-06
摘要:	研究背景：心臟衰竭是全球發病率及死亡率相當高的心臟疾病，常見症狀為疲憊、呼吸急促、周邊組織水腫，以及運動耐受力降低等生理症狀。除了生理症狀，心臟衰竭病人常伴隨憂鬱症狀，罹患憂鬱的比率約為一般族群的2－3倍。結構性的運動訓練計畫，可有效改善病人心肺功能、健康狀態、憂鬱狀況，以及生活品質等，然而，針對居家運動對於心臟衰竭病人憂鬱之成效尚無明確定論。研究目的：以系統性文獻回顧與統合分析，探討居家運動對於心臟衰竭病人憂鬱、焦慮、心肺功能和生活品質等成效指標之成效。研究方法：本研究為系統性文獻回顧與統合分析，透過7個中英文資料庫蒐集文獻至2023年6月。研究對象為年滿18歲的心臟衰竭病人，居家運動為介入措施，對照組為常規治療或其他介入措施，主要成效指標為憂鬱，次要指標為焦慮、心肺功能（尖峰攝氧量、六分鐘步行距離）及生活品質，納入文獻之研究設計類型為隨機對照試驗。採用考科蘭偏差風險評讀工具（Cochrane Risk of bias tool, Rob 2.0），並使用Comprehensive Meta-Analysis Software統計軟體，進行統合分析，以隨機效應模式計算效果量，連續變項指標結果採用Hedges’ g及95％信賴區間（Confidence interval , CI），估計實驗組與控制組兩組，在介入措施前後改變量的差異性，並以Cochrane Q及I2值檢測研究間異質性，調節變項分析探討異質性來源，以敏感度分析檢測研究結果的穩健性，並以漏斗圖、Egger’s test以及Trim and fill檢測出版偏差，最後使用GRADE證據等級系統評比本研究之證據級別。研究結果：共納入16篇隨機臨床試驗。居家運動於改善心臟衰竭病人憂鬱的效果量為：-0.317（95% CI: -0.479－-0.156, p < .001），改善焦慮的效果量為：-0.217（95% CI: -0.414－-0.020, p＝0.031），改善尖峰攝氧量效果量為：0.458（95% CI: 0.166－0.750, p＝0.002）、六分鐘步行距離效果量為：0.610（95% CI: 0.257－0.964, p＝0.001），改善生活品質效果量為：-0.734（95% CI: -1.134－-0.333, p < .001）。因尖峰攝氧量、六分鐘步行距離及生活品質成效存有中度至高度異質性，故進行調節變項分析，結果顯示運動類型、左心室射出率、運動強度、完成率、療程總分鐘數及對照組的不同影響居家運動對於心肺功能指標和生活品質的成效。敏感度分析發現，無論移除任何一篇文章，居家運動對憂鬱、尖峰攝氧量、六分鐘步行距離和生活品質的成效，皆有統計學上的顯著意義。Egger’s test回歸分析檢定，發現尖峰攝氧量、六分鐘步行距離及生活品質變項，皆存有出版偏差。針對憂鬱及焦慮GRADE證據等級評定為中度，尖峰攝氧量、六分鐘步行距離和生活品質GRADE證據等級評定為非常低度。結論：居家運動訓練可能中度的改善心臟衰竭病人的憂鬱及焦慮。 Background: Heart failure is a cardiac disease with a high global incidence and mortality rate. Common physical symptoms include fatigue, shortness of breath, peripheral edema, and reduced exercise tolerance. Heart failure patients often experience symptoms of depression with a prevalence rate that is 2 to 3 times higher than that of the general population. Structured exercise training programs have been shown to effectively improve functional capacity, health status, depression symptoms, and quality of life in different patient populations. To date, however, there is no meta-analysis providing a definitive conclusion on the effect of home-based exercise on depression in patients with heart failure. Objective: To examine the effects of home-based exercise on depression, anxiety, functional capacity, and quality of life in patients with heart failure through conducting a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: Seven Chinese and English databases were searched from inception until June 2023. Studies that 1) included heart failure patients aged 18 years and older; 2) assessed home-based exercise as the intervention; 3) included any type of comparator (any other interventions or usual care); 4) assessed depression, anxiety, functional capacity, and quality of life as outcome; and 5) used a RCT design were included. The primary outcome was depression and secondary outcome included anxiety, functional capacity, and quality of life. The Cochrane Risk of Bias Tool (Rob 2.0) was used to study quality. Data were analyzed using Comprehensive Meta-Analysis Software version 4.0. The random-effects model was used to calculate effect sizes, presented as Hedges’ g and 95% confidence intervals (CI) for continuous variable outcomes, indicating the pretest-to-posttest difference between the intervention and control groups. Heterogeneity was examined by Cochrane Q and I2 statistics. Moderator analysis was conducted to explore sources of heterogeneity. Further, Sensitivity analysis was performed by excluding one study at a time to determine the robustness of the studies. Publication bias was evaluated using a funnel plot, Egger's test, and Trim and Fill method. Finally, The Grading of Recommendations Assessment, Development, and Evaluation system was used to evaluate the evidence quality of this study. Result: A total of 16 RCTs were included in this study for meta-analysis. The effect size of home-based exercise for improving depression in heart failure patients was -0.317 (95% CI: -0.479－-0.156, p < .001). The effect size for improving anxiety was -0.217 (95% CI: -0.414－-0.020, p = 0.031). The effect size for improving peak oxygen consumption and six-minute walk distance was 0.458 (95% CI: 0.166－0.750, p = 0.002) and 0.610 (95% CI: 0.257－0.964, p = 0.001), respectively. The effect size for improving quality of life was -0.734 (95% CI: -1.134－-0.333, p < .001). The moderator analyses revealed that left ventricular ejection fraction, exercise intensity, treatment completion rate, training dosage in minutes, the type of exercise and type of control group could explain the sources of heterogeneity in the effects of home-based exercise on functional capacity and quality of life. Sensitivity analysis demonstrated that the overall effect size for depression, peak oxygen consumption, six-minute walk distance, and quality of life remained significant. Egger’s regression suggested that publication bias existed for peak oxygen consumption, six-minute walk distance, and quality of life. The quality of evidence was moderate for depression and anxiety, and very low certainty for peak oxygen consumption, six-minute walk distance, and quality of life. Conclusion: Home-based exercise may have moderate effects for improving depression and anxiety in patients with heart failure.
描述:	碩士指導教授：蔡佩珊口試委員：蔡佩珊口試委員：鄭綺口試委員：謝敏雄
附注:	論文公開日期：2024-01-22
数据类型:	thesis
显示于类别:	[護理學系] 博碩士論文

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