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研究生:黃良慧
研究生(外文):Huang,Liang-Hui
論文名稱:心率變異之生物回饋合併復健運動促進慢性阻塞性肺病患者運動遵從度之探討
論文名稱(外文):Effects of Combined Heart Rate Variability Biofeedback Training with Rehabilitation Exercise on Improving Adherence of Regular Exercise in Patients withChronic Obstructive Pulmonary Disease
指導教授:陳玉如陳玉如引用關係
指導教授(外文):Chen,Yu-Ju
口試委員:彭萬誠李其融陳玉如
口試委員(外文):Perng, Wann-CherngLi, Chi-RongChen,Yu-Ju
口試日期:2014-12-05
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:125
中文關鍵詞:慢性阻塞性肺病心率變異生物回饋訓練復健運動遵從度
外文關鍵詞:COPDheart rate variability biofeedback trainingrehabilitation exerciseadherence of regular exercise
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摘要
背景:文獻皆已證實肺部復健運動訓練對慢行阻塞性肺病 (Chronic Obstructive Pulmonary Disease, COPD) 病人之成效。但因多數病人無法維持規律的運動習慣,而使其效益隨著時間消失。所以若要增加病人肺部復健的成效,應增加肺部復健運動的遵從度,使維持長期規律運動。心率變異生物回饋方法已被證實可以提升運動自我效能。但較少用於輔助COPD病人肺部復健運動之研究的探討。
目的:本研究主要在探究心率變異生物回饋配合肺部復健運動,對於促進COPD病人的生理、心理之健康,及增進病人之運動自我調節效能、規律運動遵從度與生活品質之成效。
方法:本研究採隨機對照試驗 (randomized control trial) 設計,於北部某一醫學中心胸腔內科門診進行個案招募。經個案同意後隨機分配至呼吸訓練組、肺部復健運動訓練組、生物回饋組,並予四週不同之介入措施。個案基本資料和一年內肺功能測量値均被記錄自個案病歷。所有個案於訓練前、後及三個月後,均接受心率變異測量及六分鐘行走測試。醫院焦慮憂鬱量表、健康相關生活品質量表、運動自我效能量表及Borg自覺呼吸困難量表,用以測量個案心理感受。個案規律運動遵從度於介入措施後三個月追蹤紀錄。所有研究結果以SPSS 19.0版統計軟體進行資料分析。
結果:本研究以隨機分配所招募個案,減去23%的流失率,分別有13人、11人、12人納入呼吸訓練組、肺部復健運動訓練組、及生物回饋組。最後個案總計36位COPD病人,其平均年齡為70.03±10.19歲,疾病嚴重度以第二級 (GOLDⅡ) 居最多數,佔66.67%。經四週訓練後,生物回饋組於憂鬱 (-1.92±2.68, p < .05)、SF 12-MCS (4.08±6.53, p < .05)、6MWT (40.03±59.00, p < .05) 及SDNN ln (0.34±0.25, p < .01)、rMSSD ln (0.20±0.24, p < .01)、LF ln (0.63±1.06, p < .01) 及TP ln (0.69±0.85, p < .05) 等,達顯著地改善幅度;而在肺部復健運動訓練組,則有Borg (-0.86±1.23, p < .05)、SF 12-PCS (5.59±6.23, p < .01)、LF ln (0.49±0.71, p < .05) 及TP ln (0.38±0.54, p < .01) 等改善幅度,達顯著差異。
追蹤訓練後三個月的個案狀況,生物回饋組的改善幅度,於SF 12-PCS (6.35±5.51, p < .01)、6MWT (42.16±56.94, p < .05) 及SDNN ln (0.32±0.19, p < .05)、LF ln (0.97±0.51, p < .05) 及TP ln (0.75±0.46, p < .01)等,達顯著差異;肺部復健運動訓練組,於Borg (-1.00±1.28, p < .05)、焦慮 (-2.09±2.12, p < .01)、憂鬱 (-2.91±2.55, p < .01)、SF 12-PCS (7.52±5.55, p < .01)、Ex-RSE (197.27±265.03, p < .05)、6MWT (32.39±28.56, p < .05)、LF ln (0.79±1.01, p < .05) 等改善幅度,均達顯著差異;而呼吸訓練組亦均無顯著差異。但三組間不同的介入措施則僅有運動遵從度 (p < .01) 與SF 12-PCS (p < .05) 於訓練後,達統計上之顯著差異。然而,呼吸訓練組的生理及心理的測量反應,無論於四週訓練或三個月後追蹤均無顯著差異。
結論:穩定期COPD病人,經肺部肺健運動訓練計畫後,在心、生理方面均可獲得改善成效。若進一步再加上心率變異生物回饋輔助訓練,則能改善心率變異度及促進病人有較長久且規律的運動。因此,心率變異生物回饋合併肺部復健運動訓練對於COPD病人之效益,將可建議臨床工作者。

Background: Literature has proven the effectiveness of pulmonary rehabilitation training on Chronic Obstructive Pulmonary Disease (COPD) patients. However, since most patients are unable to maintain regular exercise habits, the benefits disappear with time. In order to enhance the effectiveness of pulmonary rehabilitation for patients, the adherence of regular exercise should be strengthened. The heart rate variability (HRV) biofeedback and breathing training method has been proven to improve exercise self-efficacy. However, HRV biofeedback used for facilitating regular pulmonary rehabilitation exercise in patients with COPD remain scarce.
Purpose: This study is conducted to explore the effectiveness of heart rate variability biofeedback combined with pulmonary rehabilitation exercise on physiological and psychological wellbeing, and also to enhance the adherence of regular exercise, exercise self-efficacy and improve the quality of life in patients with COPD.
Methods: The randomized control trial design was adopted in this study. Subjects were recruited from the outpatient clinic of pulmonary medicine of a medical center in Northern Taiwan. After obtaining patient consent, the subjects were randomly assigned to the breathing training group, pulmonary rehabilitation exercise training group, or biofeedback training group for four weeks different interventions respectively. All subjects received HRV measures and the 6-minute walk test before and after 4-week training, and also after 3-month follow-up. The demographics and a recent pulmonary function test were recorded from subjects’ medical charts. In addition, the hospital anxiety and depression scale, health related life quality scale, exercise self-regulatory efficacy scale, and Borg scale of perceived dyspnea were use to measure the subjects’ psychological responses. Moreover, the adherence of regular exercise was recorded at 3-month follow up. All data were analyzed by using the statistical software SPSS 19.0.
Result: After randomly assignment with drop out 23 % of total recruited subjects, there were 13, 11, 12 subjects in breathing training group, pulmonary rehabilitation training group, and biofeedback group respectively. The average age of the 36 COPD patients was 70.03±10.19 years old. The majority of subjects’ disease severity was GOLD II, accounting for 66.67%. The results indicated that the biofeedback group had significantly improvement in subjects’ depression (-1.92±2.68, p < .05), SF 12-MCS (4.08±6.53, p < .05), 6MWT (40.03±59.00, p < .05), SDNN ln (0.34±0.25, p < .01), rMSSD ln(0.20±0.24, p < .01), LF ln (0.63±1.06, p < .01), TP ln (0.69±0.85, p < .05) after 4 weeks training. In the pulmonary rehabilitation training group, 4 weeks training significantly improved subjects’ Borg (-0.86±1.23, p < .05),
SF 12-PCS (5.59±6.23, p < .01), LF ln (0.49±0.71, p < .05), and TP ln (0.38±0.54, p < .01). After the 3-month follow-up, subjects’ SF 12-PCS (6.35±5.51, p < .01), 6MWT (42.16±56.94, p < .05), SDNN ln(0.32±0.19, p < .05), LF ln (0.97±0.51, p < .05), and TP ln (0.75±0.46, p < .01) were significantly improved in the biofeedback group. Meanwhile, subjects’ Borg (-1.00±1.28, p < .05), anxiety (-2.09±2.12, p < .01), depression (-2.91±2.55, p < .01), SF 12-PCS (7.52±5.55, p < .01), Ex-RSE (197.27±265.03, p < .05), 6MWT (32.39±28.56, p < .05) LF ln (0.79±1.01, p < .05) had a significant improvement in the pulmonary rehabilitation training group. However, the breathing training group showed no significant difference on psychological or physiological wellbeing at 4 weeks training or 3-month follow-up. Under the different interventions in these three groups, only the adherence of regular exercise (p < .01) and SF 12-PCS (p < .05) reached significant statistical differences after the 3-month follow-up.
Conclusion: We found that the pulmonary rehabilitation exercise training was found can improve psychological and physiological wellbeing in patients with stable COPD. Further, combined the biofeedback with pulmonary rehabilitation exercise training could improve the heart rate variability wasd, and drive patients to keep long-term and regular exercise, which could suggest to clinical practice.

摘要 I
Abstract IV
第一章 緒論 1
第一節 研究背景、動機與重要性 1
第二節 研究目的 4
第三節 研究假設 5
第二章 文獻查證 6
第一節 慢性阻塞性肺病與肺部復健運動之相關概念 6
第二節 運動遵從度與運動自我效能對COPD病人之影響 16
第三節 心率變異生物回饋與運動遵從度的相關性 20
第三章 概念架構 27
第一節 研究架構 27
第二節名詞解釋及操作型定義 29
第四章 研究方法及過程 32
第一節 研究設計 32
第二節 研究對象及研究場所 33
第三節 研究工具 34
第四節 研究倫理考量 42
第五節 資料收集過程 43
第六節 資料處理及分析 47
第五章 研究結果 49
第一節 基本資料之分布情形 52
第二節 心理、生理變項前測之分布情形 58
第三節 心理、生理變項之介入後效果 64
第四節心理與生理之相關性 76
第六章 研究討論 79
第一節 前測之心、生理指標之探討 79
第二節 心率變異生物回饋輔助肺部復健運動訓練對遵從度及心、生理成效之探討 82
第七章 結論與建議 92
第一節 結論 92
第二節 建議 93
第三節 研究限制 95
英文參考資料 97
中文參考資料 124



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