臺灣博碩士論文加值系統

背景及目的：精神分裂症患者在抗精神病藥物治療後容易伴隨有肥胖或代謝異常的健康問題，增加身體活動是目前建議用於防治慢性病的重要方法之一。過去學者曾應用量表以評估慢性精神分裂症患者的身體活動，但是效度平均偏低且結果變異度較大，由於精神分裂症的臨床表徵特異性高，疾病特性是否會影響身體活動量的評估仍有待探討。因此，本研究目的為利用活動量表和加速規評估慢性精神分裂症患者的身體活動，了解患者平日的活動模式及身體活動量；進一步分析兩種評估結果的差異，探討疾病特性或是藥物等因素對身體活動量評估的影響。方法：本研究為橫斷式探索型研究設計，自某精神科醫院調查29位經治療及病情穩定的精神分裂症成年患者，34.48%為女性，年齡44.54 ± 6.63歲，平均身體質量指數24.18 ± 3.51 kg/m2，體重過重或肥胖者占44.83%。由病歷回顧受試者的基本資料及疾病特性(初次發病年齡、精神症狀、藥物使用)；利用簡短式智能評估(MMSE)及路徑描繪測試(TMT)進行智能及認知心智功能測試；選取國際身體活動量表-台灣短版問卷(IPAQ)及三軸加速規測量身體活動。受試者於加速規監測前先接受加速規活動總量閾值測試，利用線性回歸以心跳和加速規總量建立個別化回歸模型，再換算休息時心跳、60%及80%預估最大心跳百分比所對應之加速規總量作為加速規活動強度閾值。結果：本研究藥物控制穩定之精神分裂症患者，根據IPAQ短版調查一週中有連續十分鐘進行中等費力以上活動的受試者有13人(48.15%)，中等費力活動總時間的中位數(Q1 - Q3)為0 (0 - 135)分鐘/週，走路總時間為90 (20 - 210)分鐘/週，符合ACSM&;AHA活動建議量共8人(27.59%)。由加速規佩帶的結果分析，受試者每日各類活動總時間的中位數(Q1 - Q3)在高強度為0.83 (0.19 - 3.18)分鐘，中等強度為69.67 (23.08 - 108.75)分鐘，低強度活動為205.67 (97.29 - 261.13)分鐘，坐式活動為9.17 (8.05 - 11.01)小時，中等強度以上、低強度、坐式活動分別佔一天24小時的4.90%、14.28%、38.21%。整體而言，IPAQ活動量表和加速規結果的相關係數(Spearman’s ρ)，在中等費力活動為0.07 (p = 0.73)、在走路活動和低強度活動為0.32 (p = 0.09)、在坐式活動為0.29 (p = 0.12)。不同受試者的特性，在中等費力活動的相關係數有較明顯地差異，包括：女性高於男性(0.39 vs -0.05)、年齡＞45歲高於低齡者(0.36 vs -0.03)、體重正常高於過重或肥胖者(0.13 vs -0.05)、病程長(超過21.35年)高於病程短者(0.46 vs -0.18)、只有正向症狀高於只有負向症狀及合併正負向症狀者(0.61 vs -0.55 vs -0.09)、未使用拮抗錐體外路徑症候群藥物高於有使用者(0.64 vs -0.38)、認知心智功能較佳(TMT-A≦37秒)高於較差者(0.12 vs 0.01)。結論：本研究結果顯示慢性精神分裂症患者較少參與中等強度以上的身體活動，大多以走路作為休閒活動，但活動強度偏低；活動量表相較於加速規測量的結果為極低至低度的正相關。尤其當慢性精神分裂症患者有負向症狀、認知功能較差或抗精神病藥物副作用(肥胖、錐體外路徑症候群)，其在活動量表及加速規測量的相關程度都較低，顯示以IPAQ評估慢性精神分裂症患者的活動量會受到其疾病特徵的影響，建議宜結合主觀及客觀的評估為佳，另調整或發展適合的量表以能簡易而有效評估類此特性族群的身體活動量仍待再加強。

Background: Schizophrenic patients with antipsychotic treatment have been found to have the side-effect of obesity and/or metabolic abnormalities. Physical activity was recommended as an intervention on patients with schizophrenia to reduce the risk of chronic comorbidity. Previous studies have used self-reported questionnaire in assessing physical activity of patients with schizophrenia, and found the low validity and great variability. Whether the psychotic characteristics influence the accuracy of physical activity assessing remains unknown. Purposes: This study aimed to assess the daily physical activity using self-reported questionnaire and accelerator, and to investigate the influencing factors on correlation between both measurements. Methods: We recruited 29 adult schizophrenic patients (34.48% female, age 44.54 ± 6.63 years, BMI 24.18 ± 3.51 kg/m2 and 44.83% overweight or obese) from the rehabilitation ward of a psychiatric hospital of Taipei. Basic data and psychotic characteristics (age of onset, psychotic symptoms and medication) were recorded by chart review. Mini-mental state examination (MMSE) and trail making test (TMT) were selected to evaluate cognitive and psychomotor function. The daily activity was assessed by International Physical Activity Questionnaire (IPAQ) and by 2-weekdays tri-axis accelerator record. To define the activity intensity of accelerator recordings, participants also completed the vector magnitude threshold test. The threshold was established using linear regression model with heart rate and vector magnitude of different walking speed. Statistics: Descriptive statistic was used to investigate the data distribution of physical activity. Subjects were stratified with psychotic characteristics, and then Spearman rank correlation was used to analyses the correlation between IPAQ and accelerator. The significant level was set at 0.05. Results: 13 (48.15%) subjects engaged in moderate activity for more than 10 minutes in a week from IPAQ, and the median (Q1 - Q3) time was 0 (0 - 135) minute/week. The time in walking from IPAQ was 90 (20 - 210) minutes/week. Only 8 (27.59%) subjects met the current recommendation of physical activity for general population. Daily activities derived from accelerator were 0.83 (0.19 - 3.18) minutes/day in vigorous activity, 69.67 (23.08 - 108.75) minutes/day in moderate activity, and 205.67 (97.29 - 261.13) minutes/day in light activity. The sedentary time was 9.17 (8.05 - 11.01) hours/day. The correlation coefficient of activity time between IPAQ-reported and accelerator-derived was 0.07 (p = 0.73) in moderate activity, 0.32 (p = 0.09) in walking/light activity, and 0.29 (p = 0.12) in sitting/sedentary. When stratifying subjects with different characteristics, the greater inconsistent correlation coefficients were found in time of moderate activity between IPAQ-reported and accelerator-derived. The influenced factors included gender (Spearman’s ρ: female 0.39 vs male -0.05 ), age (ρ: ＞45 years 0.36 vs younger -0.03), weight (ρ: normal 0.13 vs overweight/obese -0.05), duration of diagnoses (ρ: ＞21.35 years 0.46 vs shorter -0.18), psychotic symptoms (ρ: only positive 0.61 vs negative -0.55 vs combined -0.09), psychomotor function (ρ: TMT-A≦37 sec 0.12 vs longer 0.01) and anti-EPS prescription (ρ: not prescribed 0.64 vs prescribed -0.38). Conclusions: Patients with schizophrenia spent less time on physical activity and tended to live a sedentary lifestyle. The most common physical activity is low intensity walking exercise. This survey found the correlation of daily activity time was low to fair degree between self-reported questionnaire and accelerator and the degree of correlation became lower in patients with negative symptoms, poor psychomotor function and side-effect of antipsychotics (obese or EPS). Our findings evidenced the physical activity measurement was affected by psychotic characteristics. Using both subjective and objective tools was suggested to accurately evaluate physical activity in applications. Otherwise, a modified version or disease-specific questionnaire to assess physical activity may be needed in patients with schizophrenia.

目錄
目錄 i
表目錄 iii
圖目錄 iv
誌謝 v
摘要 vi
Abstract viii
第一章、緒論 1
第一節、研究背景與動機 1
第二節、研究目的 4
第三節、研究假設 4
第四節、研究重要性 5
第二章、文獻回顧 6
第一節、精神分裂症影響的不只是心理健康 6
第二節、身體活動不足對健康是一種威脅 10
第三節、正確地評估身體活動 13
第四節、精神分裂症患者的身體活動 15
第五節、文獻回顧之綜合探討 17
第三章、研究方法 19
第一節、研究對象 19
第二節、研究流程 19
第三節、研究測量及工具 20
第四節、資料處理與統計分析 26
第四章、研究結果 29
第一節、受試者基本特性 29
第二節、活動量表調查結果 30
第三節、加速規活動閾值結果 31
第四節、活動加速規監測結果 31
第五節、受試者基本特性對活動量表和加速規相關性的影響 32
第六節、受試者疾病特性對活動量表和加速規相關性的影響 33
第五章、討論 36
第一節、慢性精神分裂症患者的身體活動量 36
第二節、基本特性對身體活動評估的影響 38
第三節、精神疾病對身體活動評估的影響 39
第四節、界定身體活動量強度之不同方法的可能影響 42
第五節、研究限制及未來研究建議 44
第六節、臨床建議 45
第六章、結論 46
參考文獻 47
附錄一、人體試驗委員會計劃執行許可書 64
附錄二、活動日誌 65
表目錄
表一、受試者基本資料及特性 56
表二、國際身體活動量表-台灣短版測量結果 57
表三、活動加速規測量結果 58
表四、活動加速規和活動量表的相關性 59
表五、不同疾病特性之間活動加速規和活動量表的相關性 60
圖目錄
圖一、不同步行速度之加速規總量表現 27
圖二、研究流程 61
圖三、加速規總量閾值之個別化回歸模型 62
圖四、加速規監測結果及活動強度分析 63

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