2011-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/655864摘要：疲倦是癌症病患在治療期或存活期，最常面臨的症狀困擾；高達90%的癌症病患在治療期間經歷疲倦且疲倦在治療結束後，仍維持數個月至數年之久。雖然目前已證實運動可以減輕疲倦，但是對於運動在於不同疾病階段之成效，則未有定論且疲倦之改善成果與運動劑量之相關性並未被建立。再者，疲倦之測量仍僅有主觀之問卷測量，缺乏客觀之測量指標(例如肌力)。因此，此四年期計畫之研究目的： (1)探討治療期及存活期結直腸癌病患的上下肢肌力與疲倦之相關性及分析肌力成為身體疲倦之生理監測指標的可能性。(2) 比較8週、12週個人化居家走路運動於治療期及存活期結直腸癌病患，對於上下肢肌力與改善疲倦之成效及三個月後之運動維持現況。(3)發展適合台灣治療期及存活期結直腸癌病患之居家運動臨床建議指引。第一階段(1-15個月)採橫斷式研究設計，針對接受治療中及治療結束五年內之結直腸癌病患進行問卷訪談及6分鐘走路測試、手部握力及下肢肌力(膝伸直及髖屈曲)之測量，以瞭解結直腸癌病患之運動習慣、疲倦、心肺適能、及上下肢肌力現況，同時分析6分鐘走路測試前後之疲倦及肌力之改變，以探討疲倦之改變與上下肢肌力的相關性。問卷使用自擬之基本屬性及運動習慣、癌症疲倦量表、症狀困擾量表、及醫院焦慮與憂鬱量表評估病患之運動習慣、疲倦、症狀困擾、焦慮及憂鬱。使用描述性統計、student t test, Pearson’s 相關性分析、及廣義線性推估模式，以瞭解疲倦、心肺適能、及肌力之相關性及比較治療期與存活期是否有差異，並分析疲倦之重要預測因子。預估第一階段完成治療期與存活期各84位，共計168位。第二階段(16-48個月)採隨機臨床試驗，於台北市某一醫學中心大腸直腸外科及腫瘤科病房及門診，選取接受輔助性化學治療(治療期)及完成治療三月以上但三年以內(存活期)之研究對象，隨機分配至對照組或實驗組。對照組接受常規照護，而實驗組則給予12週之中等強度走路運動計畫。將以癌症疲倦量表、症狀困擾量表、醫院焦慮與憂鬱量表、評估病患之疲倦、症狀困擾、焦慮及憂鬱，同時進行6分鐘走路測試、手部握力及下肢肌力之測量。測量時間共計四次，分別於介入前、進入研究第9、13、25週進行問卷及體能測量以瞭解執行8週、12週走路運動之立即效果及維持三個月之效果。資料將以描述性統計、獨立t檢定、以及廣義估計模式 (generalized estimating equations; GEE)進行分析，以瞭解結直腸癌治療期與存活期病患在執行8週、12週走路運動之疲倦、心肺適能、及肌力之改變，並分析走路運動之成效。此階段實驗組與對照組各 43人，治療期與存活期各需86位，考量流失率30%，預計各時期共需徵求112位病患，共計224位。預期結果: 預期本研究結果可瞭解結直腸癌病患之肌力與疲倦之相關性以及測試發展肌力成為疲倦的生理監測指標之可能性，同時發展適合台灣結直腸癌病患於治療期及存活期之走路運動建議指引，並作為未來臨床照護之參考。<br> Abstract: Around 90% of cancer patients experienced fatigue and it lasted for few months or years after completing treatment. Although evidences showed that exercise is the best strategy to alleviate fatigue, there is no consistent conclusion for the effect of exercise on improving fatigue during cancer trajectory and without evidences for dose-response relationships between exercise and fatigue. Only subjective measures of fatigue and without any objective measurement indicator (i.e., muscle strength) is available. Therefore, the aims of this four-year study are to (1) explore the relationships between fatigue and muscle strength (i.e., upper limbs and lower legs), (2) comparison with the effects of 8-week, 12-week moderate intensity of walking program on muscle strength and fatigue, and (3) develop a clinical guidelines of home-based walking program for patients with colorectal cancer receiving active treatment and survivors in Taiwan.In the first phase (the 1-15th month), a cross-sectional correlation design will be used to recruit patients with colorectal cancer receiving active treatment and completed treatment within 5years. A set of structured questionnaire with Cancer Fatigue Scale, the Symptom Distress Scale, and the Hospital Anxiety and Depression Scale will be used to assess patients’ fatigue, symptom distress, anxiety, and depression. Cardiorespiratory fitness and muscular strength (grip strength, knee extension and hip flexion) will be examined using 6-minute walking test, hand dynamometer, and hand-held dynamometer. Data will be analyzed by descriptive, Pearson’s Correlation, student t test and generalized estimating equations to examine the relationship among fatigue, muscle strength, and cardiorespiratory fitness and further explore the significant factors for fatigue. At least 84 subjects for each group and totally 168 subjects will be interviewed in the first phase.In the second phase (the 16-48th month), randomized control trial will be used to recruit eligible subjects from outpatients on a medical center in Taipei. The eligible subjects will be patients with colorectal cancer receiving adjuvant chemotherapy or those completed treatment over 3 months but within 3 years. They will be randomized into a control or experimental group. The patients in the control group will maintain their daily activity and those in the experimental group will receive 12-week moderate intensity walking program. Four time points of data collection will be on the day before intervention and during the 9, 13, 25 weeks entering into the program in order to explore the effect of walking program at midpoint, immediate, and short term of three months. A set of structured questionnaire and physical testing used in the first phase will also be used in this phase. Data will be analyzed by descriptive, student t test and generalized estimating equations to examine the effect of walking program on fatigue, muscle strength, and cardiorespiratory fitness. Forty-three subjects will be recruited in each group and 86 subjects will be needed in different disease status. Totally, 224 subjects will be approached in terms of including a 30% dropout rate in the second phase.We expect this study to explore the relationship between muscle strength and fatigue in patients with colorectal cancer and develop the clinical walking program guideline for patients with colorectal cancer both in active treatment and survivor stage. The results may provide information for clinicians to tailor interventions in clinical settings.結直腸癌肌力疲倦Colorectal CancerMuscle strengthFatigue