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研究生:陳晶晶
研究生(外文):Ching Ching
論文名稱:乳癌手術婦女執行手臂復健運動現況及障礙之探討
論文名稱(外文):Exploration of Barriers of Shoulder Rehabilitation Exercise in Post-mastectomy Women
指導教授:陳清惠陳清惠引用關係
指導教授(外文):Ching-Huey Chen
學位類別:碩士
校院名稱:國立成功大學
系所名稱:護理學系碩博士班
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:2009
畢業學年度:97
語文別:中文
論文頁數:85
中文關鍵詞:改良型乳房根除手術障礙手臂復健運動乳癌
外文關鍵詞:breast cancermodified radical mastectomyshoulder rehabilitation exercisebarrier
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改良型乳房根除手術是治療乳癌最常見的手術方式。本研究目的,為了解改良型乳房根除術後婦女,出院後居家執行手臂復健運動的現況及障礙因素,及對術後肩關節角度及手臂活動功能之影響。本研究為橫斷式、描述性相關性研究。於南部某醫學中心,改良型乳房根除手術後2至7個月之婦女為對象,共收案91位。研究工具包含:病人基本資料問卷、乳癌手術後執行手臂復健運動障礙量表、手臂復健運動執行現況調查表、乳房術後活動功能問卷表。資料以SPSS進行統計分析。
結果顯示手臂復健運動執行現況,無論是每週的運動量或持續的週次,普遍低於臨床標準執行復健運動之要求,尤其針對較困難的轉繩、拉繩及拉肘運動,完全未執行者近50%。轉繩運動、拉肘運動運動量與肩關節前屈、外展、外轉角度恢復有顯著正相關,轉繩運動及拉肘運動運動,可作為個案居家手臂復健運動必須執行的項目。執行手臂復健運動障礙因素中,以生理障礙因素排序最高,其次是心理因素,生理因素中的緊繃感(49.5%)及疼痛(41.8%)佔比率最高,且疼痛指數愈高,拉肘運動運動量愈低。超過50%以上手術超過4個月的個案,手臂前屈及外展角度不正常;且術後4個月以上者,在手臂前屈、外展、及外轉角度不正常比率卻比術後2至4個月者為高,推測可能與術後>4個月仍持續復健運動比率減少有關。建議醫護人員在病人術後至六個月內,每隔一段固定時間,應主動提醒及確認病人執行手臂復健運動的狀況,尤其針對與手臂功能恢復密切相關的轉繩運動、拉肘運動、拉繩運動,以展現確實的復健成效。
Modified radical mastectomy (MRM) is the most common surgery of breast cancer treatment. The purposes of this study were to explore the practice and the barriers of shoulder rehabilitation exercise and the recovery of shoulder function in post-mastectomy women and their related factors. This was a cross-sectional and correlational study. Ninety one subjects who received MRM after 2 to 7 months were recruited from a medical center in southern Taiwan. Shoulder rehabilitation exercise questionnaire, shoulder rehabilitation exercise barriers scale, shoulder functional scale and demographic questionnaire were used to collect data. SPSS/PC software version 15.0 was applied to analyze data.
The results showed that the conducting of shoulder rehabilitation exercise were under clinical standards. Especially for the shoulder rotation stretching, elbow stretching and rope rolling exercises, more than 50% of subjects reported not performing. The amount of shoulder rotation stretching and rope rolling exercise were significantly correlated with the angles of shoulder flexion, abduction, and external rotation. These two exercises may be the most important exercises to prevent the disorder of shoulder function after MRM. Physical barriers and psychological barriers were the most reported rehabilitation exercise barriers among subjects. In physical barriers, tightness (49.5%) and pain (41.8%) were the most frequent obstacles. Higher in pain perception scores was correlated with lower exercise volume of shoulder rotation stretching exercise. For those subjects who received MRM over 4 months, still more than 50% of them showed abnormal in shoulder flexion and abduction. Moreover, the percentage of abnormal subjects in shoulder flexion, abduction, and external rotation were higher in subjects had MRM over 4 months than those within 2 to 4 months. Based on the study findings, the possible reason was the majority of subjects stop performing exercise after 3 months. To receive the best effects of the rehabilitation exercise, healthcare providers should keep instructing and reminding post-mastectomy women to perform shoulder rehabilitation exercise regularly, especially for the shoulder rotation stretching and rope rolling exercise which were highly correlated with the recovery of the shoulder function.
目 錄
第一章 緒論…………………………………………………………1
第一節 研究動機及重要性………………………………………1
第二節 研究目的…………………………………………………2
第二章 文獻查證……………………………………………………3
第一節 乳癌手術之介紹…………………………………………3
第二節 乳癌切除術後對患側手臂功能的影響…………………5
第三節 乳癌術後手臂復健運動之目的及方法…………………9
第四節 乳癌術後手臂復健運動之成效…………………………12
第五節 乳癌術後手臂復健運動相關研究及障礙之探討………15
第六節 文獻總結…………………………………………………17
第三章 研究架構與研究問題………………………………………18
第一節 研究架構…………………………………………………18
第二節 名詞界定…………………………………………………19
第三節 研究問題…………………………………………………21
第四章 研究方法與過程……………………………………………22
第一節 研究設計…………………………………………………22
第二節 研究場所與對象…………………………………………22
第三節 研究工具及信效度………………………………………23
第四節 研究過程…………………………………………………27
第五節 資料分析與處理…………………………………………28
第六節 倫理考量…………………………………………………29
第五章 研究結果……………………………………………………30
第一節 人口學特性資料、疾病特性資料………………………30
第二節 執行手臂復健運動之現況………………………………34
第三節 手術後執行手臂復健運動之障礙………………………38
第四節 肩關節角度恢復之分析…………………………………41
第五節 手臂活動功能恢復之分析………………………………43
第六節 基本資料、手臂復健運動現況、手臂復健運動障礙、肩
關節角度、手臂活動功能之相關分析…………………………45
第六章 討論…………………………………………………………53
第一節 人口學特性資料…………………………………………53
第二節 執行手臂復健運動之現況………………………………54
第三節 手術後執行手臂復健運動之障礙………………………56
第四節 肩關節角度及手臂活動功能恢復………………………58
第七章 結論與建議…………………………………………………60
第一節 結論………………………………………………………60
第二節 臨床運用與建議…………………………………………62
第三節 研究限制及未來相關研究之建議………………………63
參考文獻……………………………………………………………66
中文部份…………………………………………………………66
英文部份…………………………………………………………67
中文文獻
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英文文獻
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