臺灣博碩士論文加值系統

對於肺癌患者而言，接受手術後患者經常有疼痛、疲憊、睡眠障礙、呼吸喘、活動無耐力及口乾等問題，而這些因癌症引起之相關症狀，將會對肺癌患者日常生活功能及生活品質造成不良影響。而步行運動介入措施近年來被運用於提升肺癌手術患者改善生活品質及相關生理指標，但目前國內尚無完整之文獻評價其臨床實務成效。本研究目的為運用系統性回顧暨統合分析探討步行運動介入肺癌術後患者身體活動力、肺功能及生活品質之成效。本研究以系統性回顧搜尋2006年11月31日至2016年11月31日止，發表於PubMed、EBSCO (MEDLINE、CINAHL、Academic Search complet-ASC)、PsycInfo、Cochrane Library Central Register of Controlled Trials (CENTRAL)及台灣期刊論文索引系統、台灣碩博士論文加值系統、華藝線上圖書館等資料庫進行檢索。使用關鍵字肺癌、手術、步行運動、身體活動力、肺功能及生活品質，選取符合篩選標準並排除重複文章，找出步行運動介入之隨機分派試驗研究及類實驗研究，進行文章的分析與整理。納入文獻經統合分析後發現，步行運動對於肺癌患者術後生活品質(EORTC-C30)呼吸困難構面有顯著差異(MD = -17.90, 95%CI [-30.84, -4.96], p < .05)，生活品質(SF-36)生理構面(MD 7.84, 95CI% [3.68, 12.00], p < .01)及心理構面(MD 8.17, 95CI% [13.11, 13.22 ], p < .01)，但對於肺癌患者術後體活動力及肺功能則無顯著差異。本文結果可提供步行運動介入改善肺癌術後患者患者身體活動力、肺功能及生活品質成效參考，有助於臨床護理人員以步行運動作為介入照護措施及未來研究方向及研究設計建議。

Lung cancer patients usually complain some health problems (e.g. pain, fatigue, sleep disorder, dyspnea, activity intolerance, dry mouth) after receiving the surgeries. Those health problems may have negative impact on quality of life and daily life function in patients with lung cancer. Walking exercise has been used to improve lung cancer patients’ quality of life and relevant physiological indices However, there was no systematic reviews to evaluate its practical clinic outcomes in Taiwan. To explore the effect of walking exercise on the outcomes of physiological indices in lung cancer patients who received surgery by using systematic reviews and meta-analysis method. To search published articles between Nov., 2006 and Nov., 2016 from PubMed, EBSCO( MEDLINE, CINAHL, Academic Search Complet – ASC ), PsycInfo, Joanna Briggs Institute EBP database, Cochrane Library Central Register of Controlled Trials, Index to Taiwan Periodical Literature System, National Digital Library of Theses and Dissertations in Taiwan, and Airiti Library by using the keywords,"Lung cancer", "surgery" and "walking exercise" to select the randomized control trail and quasi-experimental study design of walking exercise for further analysis, synthesis, and summarization. The results suggested that exercise compared with control has a positive impact on quality of life. Walking exercise resulted in improvement EORTC-C30 dyspnea domain (MD = -17.90, 95%CI [-30.84, -4.96], p < .05), Short-Form 36 physical domain (MD 7.84, 95CI%[3.68, 12.00], p < .01) and mental domain (MD 8.17, 95CI% [13.11, 13.22 ], p < .01). But there was no impact on exercise capacity and lung function. In conclusion, Walking exercise improves quality of life and physiological indices in lung cancer patients, which might help medical staffs to carry out as a caring intervention.

致 謝 ................................................................I
中文摘要 ............................................................. II
英文摘要 ............................................................. III
圖目錄................................................................VIII
表目錄.................................................................IX
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 ...................................................... 3
第三節 研究問題 ...................................................... 3
第四節 研究假設 ...................................................... 3
第五節 名詞定義........................................................4
第二章 文獻查證 ...................................................... 7
第一節 肺癌手術之相關概念 ............................................. 7
第二節 肺癌相關運動介入措施與成效 ...................................... 9
第三節 步行運動之內涵及相關研究 ....................................... 15
第四節 系統性文獻回顧暨統合分析相關文獻 ................................ 16
第三章 研究方法 ..................................................... 25
第一節 擬定待回顧問題 ................................................ 25
第二節 納入及排除條件 ................................................ 28
第三節 資料蒐集方法及檢索歷程 ......................................... 29
第四節 文獻篩選及分析 ................................................ 30
第五節 資料分析 ..................................................... 31
第六節 倫理考量 ..................................................... 32
第四章 結果 ......................................................... 33
第一節 研究樣本來源 .................................................. 33
第二節 納入文獻 ..................................................... 35
第三節 專家研究品質評量 .............................................. 42
第四節 誤差風險評估 .................................................. 45
第五節 身體活動力之成效 .............................................. 46
第六節 肺功能之成效 .................................................. 48
第七節 生活品質之成效 ................................................ 48
第八節 出版偏差 ..................................................... 51
第五章 討論 ........................................................ 55
第一節 身體活動力成效 ............................................... 55
第二節 肺功能 ...................................................... 57
第三節 生活品質 .................................................... 58
第六章 結論 ........................................................ 61
第一節 結論 ........................................................ 61
第二節 臨床衛教 ..................................................... 61
第三節 研究限制及建議 ............................................... 62
參考文獻
中文文獻..............................................................64
英文文獻..............................................................66
附錄
附件一、編碼表 ....................................................... 76
附件二、JBI Critical Appraisal Checklist for Randomized Controlled
Trials .............................................................. 89
附件三、JBI Critical Appraisal Checklist for Quasi-Experimental
Studies ............................................................. 91
附件四、研究倫理委員會免審證明 ......................................... 92

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