陳佳慧 博士臺灣大學:護理學研究所田家嘉Tian, Jia-JiaJia-JiaTian2010-05-052018-07-072010-05-052018-07-072008U0001-2201200814221200http://ntur.lib.ntu.edu.tw//handle/246246/180306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。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.致謝 I文摘要 IIbstract III 錄 V目錄 VII目錄 VIII一章 緒論 1一節 研究動機與重要性 1二節 研究目的 3三節 研究問題與假設 4四節 名詞界定 5二章 文獻查證 7一節 乳癌手術治療的介紹 7二節 手術治療對乳癌病患身體方面的影響 9三節 手術治療對乳癌病患心理方面的影響 12四節 乳癌術後的上肢復健運動計畫 14三章 研究方法 18一節 研究設計 18二節 研究對象及場所 20三節 研究工具 21四節 資料收集流程 26五節 介入措施 28六節 資料處理與分析 29七節 研究倫理考量 30四章 研究結果 31一節 研究對象之基本屬性 31二節 預防性上肢復健運動方案對患肢功能之成效 35三節 預防性上肢復健運動方案對情緒狀態之成效 47五章 討論 50一節 患肢功能的改善效果 50二節 情緒狀態的改善效果 54三節 預防性上肢復健運動方案的執行 56六章 結論與建議 59一節 研究限制與建議 59二節 結論 61考文獻 64文部份 64文部分 65錄 72錄一、臺大醫院研究倫理委員會審查公文 72錄二、受試者說明及同意書 73錄三、情境焦慮量表中文版授權使用同意書 78錄四、流行病學中心憂鬱量表中文版授權使用同意書 79錄五、基本屬性問卷 80錄六、手臂功能評估表 81錄七、手部日常生活功能評估表 82錄八、情境焦慮量表中文版 83錄九、流行病學中心憂鬱量表中文版 84錄十、乳癌術後淋巴水腫相關症狀量表 85錄十一、預防性上肢復健運動衛教手冊 86application/pdf3761228 bytesapplication/pdfen-US上肢復健運動肩關節活動障礙上肢淋巴水腫乳癌情緒狀態Upper extremity rehabilitation exercisesImpairment of shoulder range of motionBreast cancer-related lymphedemaBreast cancerEmotional state[SDGs]SDG3http://ntur.lib.ntu.edu.tw/bitstream/246246/180306/1/ntu-97-R94426001-1.pdf