- 學位論文
影響心臟衰竭病患身體活動量因素之探討:前瞻性研究
The Factors Affecting Physical Activity in Heart Failure Patients: A Prospective Study
摘要
適度的身體活動量不僅可使心臟衰竭患者的症狀獲得控制，亦可以預防患者再入院。若能了解影響心臟衰竭病患出院後身體活動量的影響因素，將有助於臨床護理人員在進行出院準備服務的參考。 本研究目的為探討(1)心臟衰竭病患出院後一個月的身體活動量；(2)心臟衰竭病患之個人屬性、疾病特性、出院前一週內的症狀困擾、出院當日的身體活動自我效能及身體活動知識與出院後一個月身體活動量的關係；(3)心臟衰竭病患出院後一個月身體活動量的重要解釋因子。研究採前瞻性、相關性研究設計(prospective and correlational study)，以立意取樣調查南部某家醫學中心及區域醫院的心臟血管病房內，選取符合條件之心臟衰竭病患為研究對象，共收集111位病患。由研究者翻閱病歷收集病患資料記錄，包括個人屬性、疾病特性，並以問卷調查，包括簡式症狀評估量表、身體活動自我效能量表、身體活動知識量表及心臟衰竭活動量表。量表經信度及效度檢定，包括內部一致性信度、再測信度、表面效度及內容效度。所得資料以SPSS 12.0套裝軟體，以百分比、平均值、標準差、t檢定、單因子變異數分析、皮爾森積差相關及逐步複迴歸進行分析。 本研究結果發現心臟衰竭個案(1)出院後一個月的每日總身體活動量為8175.85kJ.24h-1，其中清醒時的身體活動量為2853.84kJ.24h-1，3 METs以下 的身體活動量為1562.90kJ.24h-1，而3-5METs之間的身體活動量為588.96kJ.24h-1，5METs以上的身體活動量為115.74kJ.24h-1，活動量偏低；(2)年齡越大、教育程度越低，出院後一個月的總身體活動量越差；身體質量指數較高者，出院後一個月的總身體活動量較佳；(3)在3-5METs之間的身體活動量，女性高於男性(t = -2.54, p = .02)；在5METs以上的身體活動量，無配偶高於有配偶(t = 2.12, p = .04)、NYHA一級及二級的患者高於NYHA三級的患者(t = 2.12, p = .04)；(4)症狀困擾的標準化得分為22.50分，呈低等程度，症狀困擾越高，執行5METs以上身體活動量越差(r = - .21, p = .05)；(5)研究對象總身體活動自我效能標準化得分為69.50分，呈中上程度，活動自我效能越高，執行總身體活動量(r = .50, p < .01)、3-5METs(r = .39, p < .01)、5METs以上(r = .26, p < .01)及清醒時(r = .55, p < .01)的身體活動量越佳；(6)身體活動知識標準化得分為63.20分，呈現中上程度，身體活動知識越高，執行總身體活動量(r = .20, p = .05)、清醒(r = .20, p = .05)及休息時(r = .21, p = .05)的身體活動量越佳；(7)身體質量指數、年齡、工具性生活活動自我效能及教育程度，共解釋出院後一個月每日總身體活動量72.4%之總變異數，其中身體質量指數為最重要的解釋因子。本研究結果有助於醫療專業人員了解心臟衰竭病患出院後一個月身體活動量及其影響因素，並提供醫療專業人員提高心臟衰竭患者出院後身體活動量設計的參考。
並列摘要
Adequate physical activity level can not only control symptoms but also prevent readmission of heart failure patients. Therefore, it is necessary to explore the factors affecting physical activity after discharge, which could effectively assist clinical nursing staff in preparing discharge planning for heart failure patients. The purposes of this study were (1) to explore the physical activity level one month after discharge; (2) to explore the relationship of demographic characteristics, disease characteristics, symptom distress during one week before discharge, physical activity self-efficacy and activity knowledge at discharge to physical activity level one month after discharge; (3) to identify the important explanatory factors for physical activity level one month after discharge in heart failure patients. The study adopted a prospective and correlational research design. Purposive sampling was used to recruit 111 patients with heart failure from departments of cardiology at a medical center and a regional hospital in southern Taiwan. The researcher recorded patients’ both demographic and disease characteristics by reviewing medical records and also collected data by using questionnaires including brief symptoms rating scale, physical activity self-efficacy scale, physical activity knowledge scale, and daily activity questionnaire in heart failure. Internal consistency, test-retest reliability, content validity, and surface validity were used to examine the reliability and validity of all scales. By using SPSS 12.0, data were analyzed with percentage, mean, standard deviation, t-test, one way ANOVA, Pearson product-moment correlation coefficients, and stepwise multiple regression. Results showed that (1) total daily energy expenditure (DEE) one month after discharge was 8175.85kJ.24h-1, and among which physical activity energy expenditure during the waking period (PAEE) was 2853.84kJ.24h-1, physical activity strictly below 3 METs (PAlow) was 1562.90kJ.24h-1, physical activity from 3 to 5 METs (PAhigh) was 588.96kJ.24h-1, and physical activity strictly above 5 METs (PAintensive) was 115.74kJ.24h-1, indicating a low activity level; (2) the older and lower education level the patients were and had, the worse total DEE one month after discharge they had; the higher body mass index (BMI) they had, the better total DEE one month after discharge they had; (3) in PAhigh, females were statistically significantly higher than males (t = -2.54，p < .02); in PAintensive, patients without spouse were statistically significantly higher than ones with spouse (t = 2.12，p < .04), and NYHA Class I and II patients were statistically significantly higher than Class III ones (t = 2.12，p < .04); (4) the standardized score in symptom distress was 19.36, indicating a low level; the greater symptom distress the patients had, the worse PAintensive they performed (r = -.21, p = .05); (5) the standardized score in total physical activity self-efficacy was 69.50, indicating a medium high level; the greater activity self-efficacy they had, the better total DEE (r = .50, p < .01), PAhigh (r = .39, p < .01), PAintensive (r = .26, p < .01) and PAEE (r = .55, p < .01) they performed; (6) the standardized score in physical activity knowledge was 63.20, indicating a medium high level; the greater physical activity knowledge they had, the better total DEE (r = .20, p = .05), PAEE (r = .20, p = .05) and resting energy expenditure (REE) (r = .21, p = .05) they performed; (7) BMI, age, instrumental activities of daily living self-efficacy, and education level explained 72.4% of the variation, and among which BMI was the most important explanatory factor. The study results could help clinical nursing staff understand both the status quo of physical activity level and the factors affecting physical activity in heart failure patients one month after discharge and could be a good reference for them in discharge planning preparation regarding physical activity design in heart failure patients.