- 學位論文
預防性上肢復健運動對乳癌婦女術後患肢功能及情緒成效探討
The Effect of a Preventive Upper Extremity Rehabilitation Program on Affected Arm Function and Emotional State in Women Underwent Mastectomy
摘要
肩關節活動障礙與上肢淋巴水腫是乳癌術後常見的合併症，常會影響患者獨立處理日常生活功能性活動的能力，進而降低生活品質。國外有許多實證研究成果說明乳癌患者術後執行上肢復健運動的成效，而目前國內類似的實證研究仍較缺乏，本研究目的即是探討預防性上肢復健運動方案對乳癌婦女術後患肢功能及情緒狀態的成效。研究採隨機、單盲的研究設計，自民國九十六年三月至九十六年六月，於北部某醫學中心納入六十名接受單側乳房切除術合併前哨淋巴結切片檢查或腋下淋巴結切除術的乳癌婦女，隨機分派至實驗組30名及控制組30名。實驗組於術後接受預防性上肢復健運動方案的指導，控制組則依常規接受一般術後衛教，兩組分別於術前、術後一天、術後十天、術後一至三個月測量肩關節活動度、臂圍、握力、日常活動功能、患肢不適症狀程度及焦慮、憂鬱程度。研究結果以卡方檢定（Chi-square test）、獨立t檢定（independent t-test）評估兩組之間在各個依變項是否有差異。研究結果顯示，（1）患肢功能方面，實驗組的肩關節活動恢復速度較控制組快，實驗組與控制組之肩內旋活動度在術後一個月，達統計上顯著意義（p<0.05）；兩組肩外旋活動度在術後三個月相差15.3度，達統計上顯著差異（p<0.01）。在日常活動功能方面，實驗組的日常活動功能從術後一個月開始持續進步且優於控制組。在術後三個月內，實驗組在「洗對側上背部」、「從背後扣胸罩」單項之執行能力較控制組佳，且達統計上顯著意義（p<0.05），其餘的依變項在兩組之間未達統計上顯著差異。（2）情緒狀態方面，實驗組的焦慮、憂鬱程度改善速度優於控制組，但兩組之間未達統計上顯著差異。整體而言，預防性上肢復健運動方案對乳癌婦女術後初期的患肢功能及情緒狀態具有正向的影響，值得臨床醫護人員參考，建議未來的研究應該可以更進一步探討乳癌婦女在手術與放射線治療的共同影響下，預防性上肢復健運動的介入對患肢功能及情緒狀態的持續性成效。
並列摘要
Impairment of shoulder range of motion and breast cancer-related lymphedema changes functional ability and may affect a patient’s overall quality of life. The purpose of this study was to evaluate the effect of a preventive upper extremity rehabilitation exercises program on affected arm function and emotional state in women underwent mastectomy. A longitudinal experimental design was employed. Women who were newly diagnosed with breast cancer and underwent mastectomy plus sentinel lymph node biopsy or axillary lymph node dissection were enrolled. Sixty subjects were randomly assigned to the experimental and control groups. Subjects in the experimental group received three face-to-face teaching sections on the upper extremity exercise. A booklet that carefully organized on preventive exercise with an eye toward adherence enforcement was also provided. Measures including shoulder range of motion, arm circumferences, hand grip force, perceived symptoms of affected limb, anxiety, and depression state were taken preoperatively and then postoperatively at day ten and one, two and three months. Demographics and disease/treatment related information was also collected. Descriptive, Chi-square test, and Independent t-test were performed by SPSS software package. The results showed that internal rotation and external rotation returned to preoperative levels more quickly in the experimental group than in the control group. Subjects in the experimental group had 14.2˚ more internal rotation at 1 month and 15.3˚ more external rotation at 3 months (p<0.01). The experimental group experienced a better recovery on functional status. Statistically significant differences were found for the following two items: “Washing your upper back on the ipsilateral side” (p<0.05) and “Fasten your bra at the back” (p<0.05). There were no differences in other outcomes between groups. The findings indicated that a preventive upper extremity rehabilitation program is beneficial in regaining shoulder range of motion and arm function for women underwent mastectomy. It will provide the basis for successful rehabilitation and reduction in upper extremity problems and health care use.
參考文獻
延伸閱讀
- 宋瑞祥、黃昭竣、楊凱傑、陳冠誠（2019）。復健治療運動對於乳癌術後之生活品質之探討－以上臂症狀與患側乳房症狀為例。台灣復健醫學雜誌，47(2)，117-124。https://doi.org/10.6315/TJPMR.201912_47(2).0005
- 林宜萱、白秀華（2020）。【論文摘要】乳癌術後病人施行居家衛教運動對於癌因性疲憊之改善探討。物理治療，45(2)，145-145。https://doi.org/10.6215/FJPT.202006.P14
- 黃詩祺、柯怡峰、賴甫誌、蔡佩珊、侯文萱（2014）。運用國際健康功能與身心障礙分類模式於乳癌個案之復建治療。榮總護理，31(1)，27-33。https://doi.org/10.6142/VGHN.31.1.27
- 向肇英（2000）。比較衛教與肌肉放鬆訓練處置乳癌婦女術後疼痛及焦慮改善之成效〔碩士論文，臺北醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0007-1704200714450647
- 鄭素月、楊莉娌、陳品玲、賴裕和（2000）。Implementation of Arm Exercise in Post-Mastectomy Breast Cancer Patients: Current Status and Related Factors。護理雜誌，47(1)，33-42。https://doi.org/10.6224/JN.47.1.33