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研究生:陳玉黛
研究生(外文):Chen Yu-Tai
論文名稱:肌無力症病患疾病感受、情緒、失能與生活品質之相關性探討
論文名稱(外文):The Relationships between Illness Perception, Mood, Disability and Quality of Life in Myasthenia Gravis Patients
指導教授:蔡秀鸞蔡秀鸞引用關係
指導教授(外文):Tsay Shiow-Luan
學位類別:碩士
校院名稱:國立台北護理學院
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:2002
畢業學年度:90
語文別:中文
論文頁數:74
中文關鍵詞:肌無力症疾病感受情緒失能生活品質
外文關鍵詞:Myasthenia GravisIllness PerceptionMoodDisabilityQuality of Life
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本研究目的旨在探討肌無力症病患的疾病感受、失能狀況、情緒與生活品質之相關性。研究以自我調整模式理論為背景,採橫斷式、探討性和相關性研究設計。研究對象採方便取樣的方式,選取台北市某醫院之肌無力症門診100名病患進行問卷調查。研究工具包括人口學特質與疾病相關資料表、疾病感受問卷調查表、醫院焦慮與憂鬱量表、失能狀況量表,以及生活品質量表等五部分。資料以SPSS10.0軟體建檔與分析。統計分析包括平均值、標準差、次數、相關係數,和逐步回歸分析。
研究結果顯示疾病症狀辨識與焦慮(r = -.45, p < .01)、憂鬱(r = -.32, p <. 01)、生理層面(r = .32, p <. 01)和心理層面生活品質( r = .46, p < .01)呈相關性;疾病原因與焦慮(r = .42, p < .01)、失能 ( r = .24, p < .05) 、生理層面(r = -.26, p < .01)和心理層面生活品質(r = -.38, p < .01)相關;疾病時間與焦慮(r = .29, p < .01)和生理層面生活品質(r = -.36, p < .01)相關;疾病影響與焦慮(r = .43, p < .01)、憂鬱(r = 25, p < .05)、失能( r = 26, p < .01)呈正相關、與生理層面(r = -.36, p < .01)、心理層面生活品質( r = -.50, p < .01)呈負相關;焦慮與憂鬱(r = .51, p < .01)、失能(r = .33, p < .01)呈正相關;憂鬱與失能(r = .465, p < .01)呈正相關、與生理層面(r = -.30, p < .01)、心理層面( r = -.60, p < .01)生活品質呈負相關;失能與生理層面(r = -.52, p < .01)、心理層面( r = -.23, p < .05)生活品質呈負相關。
逐步回歸分析結果顯示控制基本資料和疾病相關變項之後,疾病症狀辨識和憂鬱可有意義的解釋29.4%之失能狀況變異量;疾病時間與失能對於生理層面生理品質可以解釋39.4%的變異量;疾病症狀辨識、疾病原因、疾病影響、憂鬱與失能共可以解釋55.9%的心理層面生活品質變異量。研究結果期能提供臨床護理人員設計護理措施之參考,以其協助肌無力患者促進正向的疾病感受、減低負向的情緒反應和失能,和提昇生活品質。
關鍵詞:肌無力症、 疾病感受、情緒、失能、生活品質
Abstract
The purpose of this study is to test relationships between illness perceptions, mood, disability and quality of life in a group of patients with myasthenia gravis. The conceptual model for the study is primary derived from Leventhal’s self-regulation model. The study use a cross sectional, exploratory and correlational design. Data From 100 patients who visited the MG clinic at a medical center in Taipei were collected. Measures include Illness Perception Questionnaire, The Hospital Anxiety and Depression Scale, Incapacity Status Scale, Medical Outcome Study Short-Form General Health Survey MOS SF-36, and selected demographic and MG related variables. Data were analyzed by using the SPSS 10.0 statistical package. Statistical methods applied were mean, SD, frequency, Pearson’s correlations, and stepwise regression analyses.
Correlational results indicated that the illness identity was related to anxiety (r = -.45, p < .01), depression (r = -.32, p <. 01), physical component(r = .32, p <. 01)and mental components ( r = .46, p < .01) of quality of life (QOL). Illness cause was related to anxiety (r = .42, p < .01), disability (r = .24, p < .05), physical component(r = -.26, p < .01)and mental component (r = -.38, p < .01) of QOL. Illness timeline was related to anxiety (r = .29, p < .01) and physical component of quality of life (r = -.36, p < .01). Whereas, illness consequence was related to anxiety(r = .43, p < .01), depression(r = 25, p < .05), disability( r = 26, p < .01), physical component(r = -.36, p < .01)and mental component( r = -.50, p < .01) of QOL.
Stepwise regression analyses showed that after controlling for demographic and disease related variables, 29.4% of the variance in disability can be significantly explained by illness identity and depression; 39.4% of the variance in physical component of quality of life can be explained by timeline and disability; a total of 55.9% of the variance in mental component of quality of life can be explained by illness identity, cause, timeline, consequence, depression and disability.
These findings could provide vital information for nurses who are taking care of MG patients.
Key Words: Myasthenia gravis, Illness perception, Mood, Disability
Quality of life
目錄 頁次
目錄………………………………………………………………………………… III
圖表目錄…………………………………………………………………………… IV
中文摘要…………………………………………………………………………… V
英文摘要…………………………………………………………………………… VI
第一章 緒論
第一節 研究動機與重要性……………………………………………… 1
第二節 研究目的………………………………………………………… 3
第三節 研究問題………………………………………………………… 3
第二章 文獻查證
第一節 肌無力症………………………………………………………… 4
第二節 疾病感受………………………………………………………… 6
第三節 情緒…………………………………………………………… 10
第四節 失能…………………………………………………………… 12
第五節 生活品質……………………………………………………… 14
第六節 研究架構……………………………………………………… 17
第七節 名詞界定……………………………………………………… 18
第八節 研究假設……………………………………………………… 18
第三章 研究方法
第一節 研究設計……………………………………………………… 20
第二節 研究對象與場所……………………………………………… 20
第三節 研究工具……………………………………………………… 20
第四節 工具信度檢定………………………………………………… 25
第五節 資料處理與分析……………………………………………… 26
第四章 研究結果
第一節 研究對象之基本特質與疾病特性…………………………… 27
第二節 疾病感受狀況………………………………………………… 31
第三節 焦慮與憂鬱狀況……………………………………………… 34
第四節 失能狀況……………………………………………………… 35
第五節 生活品質狀況………………………………………………… 35
第六節 疾病感受、焦慮、憂鬱、失能和生活品質之相關性……… 36
第七節 疾病感受、焦慮、憂鬱對失能之預測……………………… 37
第八節 疾病感受、焦慮、憂鬱、失能對生理層面生活品質之預測 39
第九節 疾病感受、焦慮、憂鬱、失能對心理層面生活品質之預測 39
第五章 討論
第一節 肌無力症病患之基本特性與疾病特性、疾病感受、焦慮、
憂鬱、失能狀況之現況……………………………………… 41
第二節 肌無力病患之疾病感受、焦慮、憂鬱、失能和生活品質之
相關性………………………………………………………… 45
第三節 肌無力症病患的疾病感受、焦慮、憂鬱對失能變異量之預
測……………………………………………………………… 47
第四節 肌無力症病患的疾病感受、焦慮、憂鬱和失能對生理層面
生活品質變異量之預測……………………………………… 48
第五節 肌無力症病患的疾病感受、焦慮、憂鬱和失能對心理層面
生活品質變異量之預測……………………………………… 48
第六章 結論
第一節 結論…………………………………………………………… 50
第二節 建議…………………………………………………………… 52
第三節 限制…………………………………………………………… 53
參考資料
中文部分………………………………………………………………… 54
英文部分………………………………………………………………… 55
附錄一 疾病感受問卷量表授權書………………………………………… 62
附錄二 肌無力症病患參與研究同意書…………………………………… 64
附錄三 病患基本資料與疾病特性問卷調查表…………………………… 65
附錄四 疾病感受問卷表…………………………………………………… 67
附錄五 醫院焦慮與憂鬱量表……………………………………………… 69
附錄六 失能狀況量表……………………………………………………… 71
附錄七 生活品質量表……………………………………………………… 72
圖表目錄
圖一 概念架構…………………………………………………………… 17
表3-1 疾病感受、情緒、失能與生活品質量表之信度………………… 26
表4-1 研究對象人口學基本特質………………………………………… 29
表4-2 研究對象疾病特性………………………………………………… 30
表4-3 肌無力症病患對疾病症狀辨識的看法…………………………… 31
表4-4 肌無力症病患對疾病原因的看法………………………………… 32
表4-5 肌無力症病患對疾病期間的看法………………………………… 32
表4-6 肌無力症病患對疾病影響的看法………………………………… 33
表4-7 肌無力症病患對疾病可治癒或控制的看法……………………… 33
表4-8 肌無力症病患之焦慮與憂鬱狀況………………………………… 34
表4-9 肌無力症病患之失能狀況………………………………………… 35
表4-10 肌無力症病患之生活品質狀況…………………………………… 36
表4-11 肌無力症病患疾病感受、焦慮、憂鬱、失能、生理層面與心理
層面生活品質之相關分析………………………………………… 37
表4-12 逐步迴歸分析:疾病感受、焦慮、憂鬱對失能的預測………… 38
表4-13 逐步迴歸分析:疾病感受、焦慮、憂鬱、失能對生理層面生活
品質的預測………………………………………………………… 38
表4-14 逐步迴歸分析:疾病感受、焦慮、憂鬱、失能對心理層面生活
品質的預測………………………………………………………… 39
參考資料
中文部分
SF-36台灣版 (2002)‧http://sf36.cgu.edu.tw/main.htm。
邱浩彰 (2002)‧新光醫院之肌無力症臨床觀察‧於邱浩彰、葉建宏編著,認識肌無力症,23-28。
邱浩彰、葉建宏 (2001)‧重症肌無力危象的加護照顧‧中華民國重症醫學雜誌,3(2),174-182。
許淑敏 (2001)‧主要照顧者對居家護理服務的需求與滿意度及其相關因素‧未發表碩士論文‧高雄:高雄醫學大學。
莊凱迪、王署君、林正修、傅中玲 (1999)‧中文版醫院焦慮與憂鬱量表在頭痛病人中之應用‧中華醫學雜誌,62(11),749-755。
張明聰 (2002)‧類固醇介紹‧於邱浩彰、葉建宏編著,認識肌無力症,52-56。
英文部分
Addington-Hall, J. & Kalra, L. (2001). Who should measure quality of life. British Medical Journal, 322(7299), 1417-1420.
Amato, M.P., Ponziani, G., Siracusa, G., & Sorbi, S. (2001). Cognitive Dysfunction in Early-Onset Multiple Sclerosis: A Reappraisal After 10 years. Archives of Neurology, 58(10), 1602-1606.
Augustus, L. (2000). Crisis: Myasthenia Gravis. American Journal of Nursing, 100 (1, part 1 of 2), 24AA-24HH.
Brazier, J.E., Harper, R., Jones, N.M., O’Cathain A., Thomas, K.J., Usherwood T., & Westlake, L. (1992). Validating the SF-36 health survey questionnaire: new outcome measure for primary care. British Medical Journal, 305, 160-164.
Brown, C., Dunbar-Jacob, J., Palenchar, D.R., Kelleher, K. J., Bruehlman, R.D., Sereika, S., & Thase, M.E. (2001). Primary care patients’ personal illness models for depression: a preliminary investigation. Family practice, 18(3), 314-320.
Cameron, L., Leventhal, E.A., & Leventhal, H. (1995). Seeking Medical Care in Response to Symptom and Life Stress. Psychosomatic Medicine, 57(1), 37-47.
Caress, A.L, Luker, K.A., & Owens, R.G. (2000). A descriptive study of meaning of illness in chronic renal disease. Journal of Advanced Nursing, 33(6), 716-727.
Cooper, A., Lloyd,G., Weinman, J.& Jackson, G. (1999). Why patients do not attend cardiac rehabilitation: role of intentions and illness beliefs. Heart, 82, 234-236.
Cunning, S. (2000). When The Dx is myasthenia gravis. RN, National Magazine of Nurses, 63(4), 28-31.
Ditto, P.H. (1999). Perceptions of Health and Illness: Current Research and Application. Psychological Medicine, 29(6), 1467-1472.
Farguhar, M. (1995). Definition of quality of life: a taxonomy. Journal of Advanced Nursing,22,502-508.
Ferrans, C.E., & Power, M.J. (1985). Quality of life index: Development and psychometric properties. Advances in Nursing Service, 1,15-24.
Fruhwald S, Loffler-Stastaka H, Eher R, Saletu B, Baumhackl U (2001). Relationship between symptoms of depression and anxiety and the quality of life in multiple sclerosis. Wien Klin Wochenschr,113(9), 333-338.
Goodall, C.J. (1995). Is disability any business of nurse education? Nurse Education today, 15, 323-327.
Goodinson, S.M., & Singleton, J. (1989).Quality of life: a critical review of current concepts, measures and their clinical implications. International Journal of Nursing Studies, 26, 327-341.
Granger, C.V., Cotter, A.C., Hamilton, B.B., Fiedler, R.D., Hens, M.M. (1990). Functional Assessment Scales: a Study of Persons with Multiple Sclerosis. Archives of Physical Medical & Rehabilitation, 71, 870-873.
Graham, P., Stevenson, J. & Flynn, D. ( 1997).A new measure of Health-related quality of life for children: preliminary findings. Psychology and Health, 12, 655-665.
Grohar-Murray, M.E., Becker, A., Reilly,S., & Ricci, M. (1998). Self-Care Action to Manage Fatigue Among Myasthenia Gravis. Journal of Neuroscience Nursing, 30(3), 191-199.
Guyon, T., Wakkach, A., Poea, S., Mouly, V., Klingel-Schmitt, I., Levasseur, P., Beeson, D., Asher, O., Tzartos, S., & Berrih-Aknin, S. (1998). Regulation of Acetylcholine Receptor Gene Expression in Human Myasthenia Gravis Muscle: Evidences for a Compensatory Mechanism Triggered by Receptor Loss. The Journal of Clinical Investigation, 102(1), 249-263.
Hart, L., Freel, F. &Milde, F. (1990). Fatigue. Nursing Clinical of Northern America, 25(4),967-976.
Higginson, I., & Carr, A. (2001). Using quality of life measures in the clinical setting. British Medical Journal, 322(7297), 1297-1300.
Hobart, J.C., Lamping, D.L., & Thompson, A.J. (1996). Evaluation neurological outcome measures: the bare essential. Journal of Neurology, Neurosurgery & Psychiatry, 60(2), 127-130.
Janardhan, V. & Bakshi, R. (2000). Quality of Life and Its Relationship to Barin Lesions and Atrophy on Magnetic Resonance Images in 60 Patients With Multiple Sclerosis. Archives of Neurology, 57(10), 1485-1491.
Jayne, R.L. & Rankin, S.H. (2001). Application of Leventhal’s Self-Regulation Model to Chinese Immigrants With Type 2 Diabetes. Journal of Nursing Scholarship, 33(1), 53-59.
Jonsson, A., Dock, J., & Ravnborg, M.H. (1996). Quality of life as a measure of rehabilitation outcome in patients with multiple sclerosis. Acta Neurologia Scandinavica, 93, 229-235.
Koplas P.A., Gans, H.B., Wisely, M.P., Kuchibhatla, M., Cutson, T.M., Gold, D.T., Taylor, C.T., & Schenkman, M. Quality of life and Parkinson’s Disease. Journal of A Biological Science Medical Science, 54(4), 197-202.
Koutantji, M., Pearce, S., Harrold, E., Lane, S., Watts, R., Scott, D.G.I. (2000). The Relationship between Coping Strategies, Illness Perceptions and Psychological Adjustment in Patients with Primary Systemic Vasculitis. Clinical and Experimental Immunology, Supplement, 120(Supplement 1), 74.
Kurtzke, J.F. (1981). Initial proposal for a uniform minimal record of disability. Acta Neurologica Scandinavica, 64(suppl. 87), 48-51.
Kurtzke, J.F. (1981). A proposal for a uniform minimal record of disability in multiple sclerosis. Acta Neurologica Scandinavica, 64(suppl 87), 110-129.
Kurtzke, J.F. (1984). Disability Rating Scales in Multiple Sclerosis. Annals New York Academy of Sciences, 436, 347-360,
Lankhorst, G.J., Jelles, F., Smits, R.C., Polman, C.H., kuik, D.J., Pfennings, L.E., Cohen, L., van der Ploeg, H.M., Ketelaer, P. & Vleugels, L. (1996). Quality of life in Multiple Sclerosis: the disability and impact profile (DIP). Neurology, 243(6), 469-474.
LeMaistre, J.A. (2002). Coping with the Chronic Illness. In LeMaistre, J.A. After The Diagnosis, Available htpp:// www.alpineguild.com/Coping With Chronic Illness. Htm.
Leventhal, H., Nerenz, D.R. & Steele, D.J. (1984). Illness representations and coping with health threats. In Handbook of Psychology and Health: Social Psychological Aspects of Health, vol. IV (Baum, A., Taylor, S.E., & Singer, J.E. Eds), Erlbaum, Hillsdale, N.J.
Lukkarinen, H. (1997). Assessment of quality of life with the Nottingham Health Profile among patients with coronary heart disease. Journal of Advanced Nursing, 26(1), 73-84.
Mayou, R.A., Gill, D., Thompson, D.R., Day, A., Hicks, N., Volmink, J., & Neil, A. (2000). Depression and Anxiety As Predictors of Outcome After Myocardial Infarction. Psychosomatic Medicine, 62(2), 212-219.
Meyers, A.R., Gage, H., & Hendricks, A. (2000). Health-Related quality of Life in Neurology. Archives of Neurology, 57(8), 1224-1227.
Miller, D.M., Rudick, R.A., Cutter, G., Baier, M., Fisher, J.S. (2000). Clinical Significance of the Multiple Sclerosis Functional Composite: Relationship to Patient-Reported Quality of Life. Archives of Neurology, 57(9), 1319-1324.
Moss-Morris, R., Petrie, K.J., & Weiman, J., (1996). Functioning in chronic fatigue syndrome: do illness perceptions play a regulatory role? British Journal of Health Psychology, 1, 15-25.
Murphy, N., Confavreux, C., Haas, J., Konig, N., Roullet, E., Sailer, M., Young, C., & Merot, J-L. (1998). Quality of life in multiple sclerosis in France, Germany, and united kindom. Journal of Neurology, Neurosurgery, and Psychiatry, 65(4), 460-466.
Myasthenia Gravis Association (2002). Psychological Aspects of Myasthenia.
Myasthenia Gravis Association (2002). How to Fight MG Fatigue.
Palace, J., Vincent, A., & Beeson, D. (2001). Myasthenia gravis: diagnostic and management dilemmas. Current Opinion in Neurology, 2001, (14), 583-589.
Paul, R.H., Cohen, R.D., Goldstein, J.M.& Gilchrist, J.M. (2000a). Fatigue and Its Impact on Patients With Myasthenia Gravis. Muscle and Nerve, 2000(September), 1402-1405.
Paul, R.H., Cohen, R.D., Goldstein, J.M.& Gilchrist, J.M. (2000b). Severity of Mood, Self-Evaluation, and Vegetative Symptoms of Depression in Myasthenia Gravis. The Journal of Neuropsychiatry and clinical Neurosciences, 2000(12), 499-501.
Paul, R.H., Nash, J.M., Cohen, R.A., Gilchrist, J.M.& Goldstein, J.M. (2001). Quality of life and well-being of patients with Myasthenia Gravis. Muscle & Nerve, 2001(4), 512-515.
Phillip II, L.H., & Torner, J.C. (1996). Epidemiologic evidence for a changing natural history of Myasthenia Gravis. Neurology, 47, 1233-1238.
Prince, M.I. & Jones, D.E.J. (2001). Measuring fatigue in medical unwell and distresses patients. Current Opinion in Psychiatry, 14(6), 585-590.
Poulas, K., Tsibri, E., Papanastasiou, D., Tsouloufis, T., Marinou, M., Tsantili, P., Papapetropoulas, T., Tzartos, S.J. (2000). Equal male and female incidence of myasthenia gravis. Neurology, 2000, 54, 1202-1203.
Schrag, A., Jahanshahi, M. & Quinn, N.P. (2001). What contributes to depression in Parkinson’s disease ? Psychological Medicine, 31(1), 65-73.
Scharloo, M., Kaptein, A.A., Weinman, J., Bergman, W., Vermeer, B.J., & Rooijman, H.G.M. (2000). Patients’ illness perceptions and coping as predictors of functional status in psoriasis: a 1-year follow up. British Journal of Dermatology, 142, 899-907.
Scullion, P.A. (1999). Challenging discrimination against disable patients. Nursing Standard, 13(18), 37-40.
Smith, G.B., & Bezon, J. (1997). Case Management Guideline: Major Depression in Adults and Older Adults. Nursing Case Management, 2(6), 246-256.
Steirs, W. & Tait, R.C. (2000). Psychological, Social, And Behavioral Assessment Tools. In Rondinelli, R.D., & Katz, R.T. (Eds.) Disability Evaluation (pp.95-117). Philadelphia: Saunder.
Stuifbergen, A.K., & Rogers, S. (1997). Health Promotion: An Essential Component of Rehabilitation for Peersons with Chronic Disabling Condition. Advances in Nursing Science, 19(4), 1-20.
Stuifbergen, A.K., Seraphine, A., & Roberts, G. (2000). An Exploratory Model of Health Promotion and Quality of Life in Chronic Disabling Condition. Nursing Research, 49(3), 122-129.
Van der Schaaf, I.C., Brilstra, E.H., Rinkel, G.J.E., Bossuyt, P.M.,& van G.J. (2002). Quality of Life, Anxiety, and Depression in patients With an Intracranial Aneurysm or Arteriovenous Malformation. Stroke, 33(2), 440-443.
Ware, J.E., & Sherbourne, C.D. (1992). The MOS 36-Item Short-Form Health Survey (SF-36). Medical Care, 30(6), 473-483.
Watkins, K.W., Connell, C.M., Fitzgeralt, J.T., Klem, L., Hickey,T., & Ingersoll-Dayton, B. (2000). Effect of Adults’ Self-Regulation of Diabetes on Quality-of-Life Outcomes. Diabetes care, 23(10), 1511-1515.
Wichowski, H.C., Kubsch, S.M. (1997). The relationship of self-perception of illness and compliance with health care regimens. Journal of Advanced of Nursing, 25(3), 548-553.
Weinman, J., Petrie, K.J., Moss-Morris, R., & Horne, R. (1996). The Illness Perception Questionnaire: A new method for assessing the cognitive representations of illness. Psychology and Health, 11, 114-129.
WHO (1993). International Classification of Impairments, Disabilities, Handicaps: A Manual of Classification Relating to the Consequences of Disease, Geneva, Switzerland.
Wolinsky, F.D. & Timothy, E.S. (1996). A Measurement Model of the Medical Outcomes Study 36-Item Short-Form Health Survey in a Clinical Sample of Disvantage, Older, Black, and White Men and Women. Medical Care, 34, 537-548.
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta psychiatry scand, 67, 361-370.
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