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研究生:吳美玲
研究生(外文):Mei-Ling Wu
論文名稱:運動諮商對全身性紅斑狼瘡婦女身體活動量、疲憊、睡眠品質和生活品質之成效探討
論文名稱(外文):The Effects of Exercise Counseling on Physical Activity, Fatigue, Quality of Sleep, and Quality of Life in Women with Systemic Lupus Erythematosus
指導教授:蔡仁貞蔡仁貞引用關係
指導教授(外文):Jen-Chen Tsai
學位類別:博士
校院名稱:國立陽明大學
系所名稱:護理學系
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:2017
畢業學年度:105
語文別:中文
論文頁數:168
中文關鍵詞:全身性紅斑狼瘡運動諮商身體活動疲憊睡眠品質生活品質
外文關鍵詞:Systemic lupus erythematosusexercise counselingphysical activityfatiguequality of sleepquality of life
相關次數:
  • 被引用被引用:3
  • 點閱點閱:414
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  • 下載下載:36
  • 收藏至我的研究室書目清單書目收藏:2
背景:全身性紅斑狼瘡是一種好發於年輕女性,且會侵犯全身器官的慢性自體免疫疾病,屬於全民健保重大傷病之一。病人普遍有身體活動量不足和運動能力不佳的現象,超過九成以上病人至少有一種影響生活品質的不適症狀,尤其是疲憊和睡眠障礙。結構式運動訓練證實能增加全身性紅斑狼瘡病人的心肺功能和改善疲憊嚴重度,但低遵從度讓運動計畫在病人的日常生活中難以推行。相反的,生活型態改變的運動計畫融入於日常生活中更容易執行。因此,本研究的主要目的在探討運動諮商結合計步器自我監測對全身性紅斑狼瘡婦女身體活動量提升的成效,次要目的是探討身體活動量改變與疲憊、睡眠品質和生活品質的關係。
方法:本研究分成二階段,第一階段為描述相關性研究,進行Agoss計步器效度檢定,於2014年12月至2015年2月以方便取樣法於某醫學中心風濕免疫科門診進行研究。共30位全身性紅斑狼瘡成年女性完成同時配戴計步器與ActiGraph GT3X+一週,驗證計步器與ActiGraph GT3X+的同時效度。第二階段屬於正式研究,研究採縱貫性、重複測試隨機對照試驗設計法,於2015年3月至2016年8月以方便取樣法於某醫學中心風濕免疫科門診招募76名全身性紅斑狼瘡成年女性,實驗組與控制組各38名進行為期共13週的研究,實驗組接受3次個人化運動諮商及3次電話追蹤併用計步器作為監測與回饋的工具;控制組維持原有的生活習慣。資料收集時間為前測、介入後第8週和介入後第12週。測量項目包括每日總步行數、疲憊嚴重度量表(FSS)、中文匹茲堡睡眠品質量表(CPSQI)及生活品質問卷(SF-36)。資料以SPSS 20.0軟體進行分析。獨立t檢定和卡方檢定檢驗二組人口特徵的同質性,Pearson r檢驗Agoss計步器和ActiGraph GT3X+在步數之相關性,並以平均絕對差異(MAPE)和Bland-Altman plots驗證二者的同時效度。廣義估計方程式(GEE)分析運動諮商介入對全身性紅斑狼瘡婦女身體活動量、疲憊、睡眠品質和生活品質的成效,以Pearson r 檢驗身體活動量改變和疲憊、睡眠品質和生活品質之相關性,並以拔鞋法(bootstrapping method)驗證身體活動量的中介作用。
結果: 第一階段研究結果顯示Agoss計步器與ActiGraph GT3X+在每日步數的相關係數為.97 (p < .001),平均絕對差異(MAPE)為9.98±6.71%,Bland-Altman plots顯示平均每日差異為399±613步;二個裝置在中等強度運動(MVPA)的相關係數為.71(p<.001)。第二階段運動諮商介入後,以GEE分析實驗組與時間交互作用於介入後第8週及第12週較對照組在步數上有顯著差異(B=1028.17, p<.05;B=1023.70, p<.01);睡眠品質在第8週和第12週也有顯著差異(B=-1.08, p<.01; B=-1.24, p<.01);對疲憊顯示無改善效果。在生活品質方面,活力狀況在第8和第12週均顯著增加(B=7.20, p<.05;B=9.15, p<.01);心理健康在第8週有顯著增加,但第12週則無顯著差異(B =4.34, p<.05;B =3.54, p>.05),生活品質其他6個構面無顯著差異。隨運動諮商後每日步數的增加,實驗組個案的活力顯著增加(r=0.49, p<.01);心理健康亦呈顯著正相關(r=0.50, p<.01)。同時身體活動量對活力狀況和心理健康具有中介效果。
結論與建議:本研究證實運動諮商併用計步器能有效增加全身性紅斑狼瘡婦女的身體活動量,增進睡眠品質和增進活力,隨身體活動量的增加,個人會覺得自己愈有活力,愈快樂。因此,建議提供在門診追蹤的全身性紅斑狼瘡病人至少12週運動諮商並追縱長期效果,未來也可追蹤生理指標的改變。
Background: Systemic lupus erythematosus (SLE) is a complicated autoimmune disorder. It mainly occurs in young women. SLE is registered as a catastrophic disease by the National Health Insurance (NHI) in Taiwan. Low physical activity and exercise intolence had been reported in SLE populations. More than ninety percent of SLE populations have been suffered from at least one unpleasant symptom, especially fatigue and sleep disorder. Evidences showed that structured exercise training has positive effects on SLE patients’ cardiopulmonary function and levels of fatigue. However, low adherance rate limited the exercise program implementation. On the contrary, lifestyle change with exercise program is easier to stick into daily life. The purposes of this study were to investigate effects of exercise counseling on physical activity, fatigue, quality of sleep, and quality of life in women with SLE.
Method: This study was divided into two phases. Phase 1 was a crossectional correlation study. The main purpose was to validate Agoss pedometer. Study was conducted at a medical center rheumatology outpatient clinic from December 2014 to February 2015. Thirty women outpatients with SLE wore a pedometer and an ActiGraph GT3X+ simultaneously for 7 days consecutively. Phase 2 was a randomized controlled trial. Study was conducted from March 2015 to August 2016. Seventy-six SLE women were randomly assigned to the intervention or control groups. The participants in the intervention group received a pedometer as the monitor device and 3 times exercise counseling and 3 times telephone follow up in 13-week. The participants in the control group maintained usual care. Data were collected at baseline, week 8 and week 12. The outcome measures included daily steps, fatigue severity scale (FSS), Chines Pittsburgh sleep quality index (CPSQI) and quality of life short form-36 (SF-36). Data were analyzed by SPSS20.0 software. The independent t-test and Chi-square test were used to test homogeneity of demographic characteristic between experimental and control groups. Pearson correlation, mean absolute percentage errors (MAPE), and Bland-Altman plots were used to test concurrent validity of Agoss pedometer and ActiGraph. Generalized estimating equation (GEE) was used to examine the effects of exercise counseling on fatigue, quality of sleep and quality of life. Bootstrapping method tested the mediation effect of physical activity.
Results: Phase 1 study shown steps record by Agoss pedometer and ActiGraph were highly correlated (r= .97, p < .001). MAPE was 9.98 ± 6.71%. Bland-Altman plots showed that the daily difference was 399±613 steps. The results of Phase 2 study showed that daily steps (B=1028.17, p<.05;B=1023.70, p<.01), quality of sleep (B=-1.08, p<.01; B=-1.24, p<.01) and vitality (B=7.20, p<.05;B=9.15, p<.01) were significantly improved in change over time between groups in each testing time point (week 8, and week 12) compared to the baseline. Mental health was significantly improved in change over-time between groups in week 8, but not in week 12 (B =4.34, p<.05;B =3.54, p>.05). No statistically significant difference was found in fatigue and quality of life except vitality and mental health between the two groups. Physical activity was a mediator in the experimental group in vitality and mental health, but not in quality of sleep. Moreover, positive correlation between physical activity changes and vitality (r=0.49, p<.01) and mental health (r=0.50, p<.01) changes was observed.
Conculsion: The results supported that exercise counseling combining pedometor monitoring could improve physical activity, sleep quality, vitality and mental health among women with SLE. As physical activity increase, SLE women feel more energetic and happier. Thus, clinical staffs should provide routine exercise counseling to SLE patients in the outpatient center. Future studies might examine longitudinal effects and physical changes.
誌謝……………………………………………………………………………i
中文摘要……………………………………………………………………...ii
Abstract……………………………………………………………………..iv
目錄………………………………………………………………………….vi
圖目錄………………………………………………………………………..ix
表目錄……………………………………………………………………......xi
第一章 緒論………………………………………………………….......1
第一節 研究背景………………………………………………........1
第二節 研究問題重要性及動機……………………………………3
第三節 研究目的………...…………………………………………6
第四節 研究問題與假設……………………………………………6
第五節 名詞定義……………………………………………………7
第二章 文獻查證…………………………………………………….....10
第一節 全身性紅斑狼瘡與症狀困擾……………………………10
第二節 全身性紅斑狼瘡病人的生活品質……….……….............24
第三節 運動的成效與機轉………………………………………..27
第四節 全身性紅斑狼瘡病人運動的相關文獻…………………37
第五節 運動諮商…………………………………………………..40
第六節 研究概念架構……………………………………………..45
第三章 研究方法……………………………………………………….47
第一節 研究設計…………………………………………………..47
第二節 研究對象及場所…………………………………………..49
第三節 運動諮商內容與品質……………………………………..50
第四節 研究工具…………………………………………………..51
第五節 研究步驟…………………………………………………..56
第六節 資料處理與分析…………………………………………..60
第七節 倫理考量…………………………………………………..63
第四章 研究結果……………………………………………………….64
第一節 健康存摺計步器效度驗證…………...………..………….64
第二節 全身性紅斑狼瘡婦女身體活動量、疲憊、睡眠品質和生活
品質的分布狀況…………………………………………..66
第三節 運動諮商介入對全身性紅斑狼瘡婦女身體活動量、疲憊、睡眠品質和生活品質的成效……………………………81
第四節 身體活動量改變與疲憊、睡眠品質和生活品質的關係..99
第五章 討論與建議…………………………………………………...104
第一節 全身性紅斑狼瘡婦女的身體活動量……………………104
第二節 運動諮商對全身性紅斑狼瘡婦女身體活動量、疲憊、睡眠品質和生活品質的改善成效………………………….107
第六章 結論與限制…………………………………………………...116
第一節 結論..……………………………………………………..116
第二節 研究限制…………………………………………………117
第三節 建議………………………………………………………117
參考文獻
一、 中文部份………………………………………………………..120
二、 英文部份………………………………………………………..123
附件
附件一 運動諮商手冊……………………………………………148
附件二 基本屬性量表……………………………………………151
附件三 運動行為階段問卷…………………………………….152
附件四 體能活動適應力問卷……………………………………153
附件五 全身性紅斑狼瘡疾病活動度指數(SLEDAI-2K)………154
附件六 疲憊嚴重程度量表………………………………………155
附件七 匹茲堡睡眠品質量表……………………………………156
附件八 匹茲堡睡眠品質量表評分表……………………………157
附件九 SF-36生活品質量表……………………………………..158
附件十 人體試驗倫理審查同意書……………….……………161
附件十一 問卷使用同意書…………………………………………164 


圖目錄
圖2-6-1 運動諮商對全身性紅斑狼瘡婦女身體活動量、疲憊、睡眠品質和生活品質成效研究概念架構……………………………………...46
圖3-1-1研究設計…………………………………………………………....48
圖3-1-2 運動諮商對全身性紅斑狼瘡婦女身體活動量、疲憊、睡眠品質和生活品質之成效研究架構………………………………………...48
圖3-5-1 第一階段研究流程………………………………………………...57
圖3-5-2 第二階段研究流程………………………………………………...59
圖3-5-3 中介作用圖………………………………………………………...62
圖4-1-1 Agoss計步器和ActiGraph GT3X+測得平均每日步數差異……..66
圖4-2-1 CONSORT研究流程圖……………………………………………67
圖4-3-1 實驗組與對照組於三時間點之平均每日步數變化比較………...83
圖4-3-2 實驗組與對照組於三時間點之疲憊嚴重度變化比較…………...84
圖4-3-3 實驗組與對照組於三時間點之睡眠品質變化比較……………...86
圖4-3-4 實驗組與對照組於三時間點之生理功能變化比較……………...95
圖4-3-5 實驗組與對照組於三時間點之因身體健康角色限制變化比較...95
圖4-3-6 實驗組與對照組於三時間點之身體疼痛變化比較……………...96
圖4-3-7 實驗組與對照組於三時間點之一般健康狀況變化比較……96
圖4-3-8 實驗組與對照組於三時間點之活力狀況變化比較………..97
圖4-3-9實驗組與對照組於三時間點之社會功能變化比較…………..97
圖4-3-10實驗組與對照組於三時間點之因情緒問題導致角色限制變化比
較…………………………………………………………………...98
圖4-3-11實驗組與對照組於三時間點之心理健康變化比較…………….98
圖4-4-1 身體活動量對睡眠品質的中介效果…………………………….102
圖4-4-2 身體活動量對活力狀況的中介效果…………………………….102
圖4-4-3 身體活動量對心理健康的中介效果…………………………….103




表目錄
表2-1-1 運動介入對全身性紅斑狼瘡婦女疲憊的成效…………………..18
表3-5-1 研究工作內容……………………………………………………...59
表3-6-1 研究使用統計方法一覽表………………………………………...63
表4-1-1 健康存摺計步器效度驗證人口學特性…………………………...64
表4-2-1 實驗組與控制組人口學特性與檢定……………………………...69
表4-2-2運動諮商前實驗組與控制組的身體活動量符合建議量分佈狀況72
表4-2-3 運動諮商前實驗組與控制組的身體活動量、疲憊、睡眠品質和生
活品質與檢定……………………………………………………...72
表4-2-4 研究對象人口學特性與身體活動量、疲憊、睡眠品質的關係..75
表4-2-5 研究對象人口學特性與生活品質各構面的關係………………...79
表4-3-1 全身性紅斑狼瘡病友在身體活量之敘述性統計………………...82
表4-3-2 平均每日步數於前測、第8週、第12週之GEE模式分析……….82
表4-3-3 全身性紅斑狼瘡病友在疲憊之敘述性統計……………………...84
表4-3-4 疲憊嚴重度於前測、第8週、第12週之GEE模式分析………….84
表4-3-5 全身性紅斑狼瘡病友在睡眠品質之敘述性統計……..………….86
表4-3-6 睡眠品質於前測、第8週、第12週之GEE模式分析…………….86
表4-3-7 全身性紅斑狼瘡病友在生活品質各構面敘述性統計…………...92
表4-3-8 生活品質於前測、第8週、第12週之GEE模式分析…………….93
表4-4-1 身體活動量改變與疲憊、睡眠品質和生活品質改變的相關性...99
表4-4-2 身體活動量的中介效果分析…………………………………….102
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