2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/648136摘要：本三年研究計劃研究目的為：(1) 以橫斷式研究探討口腔癌病人接受頸部廓清術後肩部失能的特質、衝擊 (第一年)；(2) 以縱貫式研究探討口腔癌病人接受頸部廓清術後24 個月肩部功能失調及其相關因素變化型態 (病人在第一年開始參與本研究，並追蹤24 個月；本階段收案為第一年~第三年)；(3) 發展運動方案，並測試本方式對口腔癌病人接受頸部廓清術後肩部功能失調及生活品質的成效 (本階段收案為第二~三年)。本研究第一年研究目的為：(1) 針對口腔癌病人接受頸部廓清術五年內的病人為研究對象，採方便取樣於北部二所醫學中心之頭頸部癌症腫瘤科門診，評估病人的雙側肩部活動範圍，並以“肩部疼痛功能失調指標(SPADI)”、“生活品質精簡版(SF-12)”、“華盛頓生活品質量表(UWQOL)” 及“基本資料表”為測量工具，本階段預估樣本數為300 位病人。(2) 使用研究目的一的測量工具，探討口腔癌病人接受頸部廓清術五年內肩部功能及其相關因素24 個月的變化型態，本階段測量時間點共有七次：基準點(手術前，T1)、手術後二週(T2)、手術後四週(T3)、手術後3 月(T4)、手術後6 月(T5)、手術後9 月(T6)、手術後12 月(T7)、手術後24 月(T8)，本階段預估樣本數為140 位病人。本研究第二~三年研究目的為：(1) 發展並測試肩頸運動方案 (shoulder and neckexercise program, SNEP) 對口腔癌病人接受腫瘤切除與頸部廓清術後的成效。採隨機控制臨床試驗研究設計，發展並測試12 週的肩頸運動方案，病人於手術前收案隨機分派致實驗組與控制組，控制組接受一般常規性照護，實驗組因考量傷口癒合時間，未接受重建手術病人於手術後第2 週開始接受運動處置，有接受重建手術病人於手術後第4 週開始接受運動處置，本階段測量時間點共有七次：基準點為手術前(T1)、接受運動處置前(T2)、接受運動處置第8 週(T3)、接受運動處置第12 週(T4)、接受運動處置結束後第6 月(T5)、接受運動處置結束後第9 月(T6)、接受運動處置結束後第12 月(T7)，測量結果同第一年的變項，研究資料將以廣義估計方程式(GEE)分析，本階段預估樣本數為192位病人。本研究結果將可提供臨床護理人與醫療專業人員更加瞭解口腔癌病人頸部廓清術手術後的肩部功能失調之問題及處置。<br> Abstract: The purposes of this three-year project are to (1) cross-sectionally explore thecharacteristics and impacts of shoulder dysfunction among oral cavity cancer patients havingneck dissection (collect data in the first year); (2) longitudinally explore the changes ofshoulder function and its related factors for 24 months in newly diagnosed eligible subjectsreceiving neck dissection (patients will be admitted during the first year and follow them for24 months; data will be collected across the three years); and (3) develop and examine anexercise program of its effects on shoulder dysfunction and patients’ quality of life amongnewly diagnosed oral cavity cancer patients with neck dissection surgery (recruited subjectsand follow during the second and third years).In the first year, for research purpose (1), oral cavity cancer patients who have receivedsurgery with neck dissection within 5 years will be recruited as consecutive manner in twohead and neck oncology outpatients in 2 medical centers in Taiwan. Eligible subjects will beassessed of the levels of Range of Motion in their shoulder area in both sides, Shoulder Painand Disability Index (SPADI), Short-Form 12 (SF-12), University of Washington - Quality ofLife (UWQOL), and Background Information Assessment. A total of 300 subjects are plannedto be recruited. For research purpose (2), same set of measures will be applied to collect thechanges of shoulder dysfunction and its related experiences of newly diagnosed oral cancerpatients with current neck dissection surgery for continuous 24 months. Data will be collected8 times: Baseline (before surgery, T1), 2 weeks after surgery (T2), 4 weeks after surgery (T3),3 month after surgery (T4), 6 month after surgery (T5), 9 month after surgery (T6), 12 monthsafter surgery (T7), and 24 months (T8). A total of 140 eligible subjects are planned to berecruited.In the second and third year, the shoulder and neck exercise program (SNEP) will bedeveloped and tested of its effects on newly diagnosed oral cavity cancer patients receivingtumor excision and neck dissection. A randomized controlled clinical trial will be developedto test the 12-week SNEP. Eligible subjects will be recruited before surgery and randomizedinto 2 groups -- control as usual group and experimental group (receiving SNEP). For patientswith SNEP, concerning the wound healing time, the 12-week intervention will be conductedfrom 2 weeks for whom do not receive free flap reconstruction, and from 4 weeks for whomreceive free flap reconstruction. Data and outcomes will be assessed in baseline beforesurgery (T1), before first exercise section (T2), 8 weeks (T3), the time completing 12-weekSNEP (T4), end of 6th, 9th, and 12 months (T5, T6, T7). Outcomes will be assessed asprevious mentioned measures in the first year. The GEE will be used to analyze the data. Atotal of 192 subjects will be expected to be recruited.This study can provide data to help nurses and health professional better understandingproblems and intervention related to neck dissection related shoulder dysfunction.口腔癌肩部功能失調運動憂鬱生活品質頸部廓清術Oral cavity cancershoulder dysfunctionExerciseDepressionQuality of lifeNeck dissection