頭頸部癌症為台灣常見的癌症之ㄧ,手術為該種癌症主要之治療方式,然而,病人在接受頭頸部腫瘤切除時,經常合併頸部淋巴廓清手術 (neck dissection ),術後可能導致肩部功能受損,為評估病人該方面之功能,需要有合於臨床使用且具研究嚴謹度之工具,因此,本研究的目的為測試中文版「美國肩肘外科醫師會標準肩評估量表」(ASES)、「康氏肩功能表」(CMS)及「肩痛及無力指數」(SPADI)三個肩功能量表之信、效度的檢驗和比較,同時探討國內頭頸癌病人在接受「頸部淋巴廓清術」後,肩功能的現況與生活品質及情緒之間的相關性。本研究為橫斷式研究設計(cross-sectional design),以立意取樣(purposive sampling),並使用結構式問卷「華盛頓大學生活品質量表」(UW-QoL)、「中文版SF-12健康調查表」(SF-12)及「醫院焦慮及憂鬱量表」(HADS)進行資料收集,於98年3月到6月在北部某醫學中心耳鼻喉腫瘤外科門診收案,共計收案110位病人。研究結果顯示,「ASES」、「CMS」及「SPADI」三個量表之內在一致性信度Cronbach’s alpha皆達0.69~0.86;而「ASES」、「CMS」和「SPADI」與目前廣泛被使用的UW-QoL、SF-12及HADS各量表間呈現顯著相關,顯示三個肩功能量表具良好的同時效度。此外,研究結果顯示術後頭頸癌病人的肩功能因其年齡、體重、身體活動功能(KPS)、手術方式及有接受放射線治療而有顯著差異,且肩功能受限程度與病人的生活品質呈顯著正相關。本研究檢測的三個肩功能量表其測量所需的時間皆不長,約為3~10分鐘,但其中「康氏肩功能表」(CMS)量表題目簡單扼要,並有主、客觀測量,在肩關節活動角度和肌力測量方面,皆可提供更充分的訊息,建議日後可以加測量表之「再測信度」(test-retest reliability)以更確定其穩定性。本研究結果可增進臨床醫護人員對頭頸癌術後病人的認識,並提供日後醫學研究的依據。
Head and neck cancer is one of the major health care problems in Taiwan. Surgery is the major treatment in curing theses types of cancers. Patients receiving surgery usually also receive neck dissection for preventing further metastasis. However, it potentially might cause shoulder dysfunction. Therefore, we need to have valid instrument to assess patients’ shoulder dysfunction. The purpose of this study was to examine and compare three shoulder-specific measures Chinese version of their psychometrics and feasibility used in head and neck cancer patients. An instrument validation study with cross-sectional data collection was conducted in a medical center in Northern Tawian. There were 110 eligible subjects were recruited. The three measures included:(1) American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form(ASES)﹐(2) the Constant Murley Score(CMS)﹐and (3) Shoulder Pain and Disability Index(SPADI).The results showed that the three measures all had good content validity. These three measures also had acceptable internal consistency reliability(Cronbach’s alpha ranged from0.69 to 0.86). Concurrent and Convergent validity were demonstrated﹒The effect of post surgical status on shoulder function was correlated to patient’s age﹐body weight﹐Karnofsky Performance Status (KPS)﹐types of surgery and radiotherapy. There is positive relationship between shoulder function and quality of life﹒Among the ASES﹐the CMS﹐and the SPADI were easily to be used, the CMS was most useful to detect shoulder complaints since that includes subjective and objective scoring of shoulder condition﹒We suggest to do test-retest reliability of CMS to confirm that stability﹒