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研究生:吳姿葶
研究生(外文):Tzu-Ting Wu
論文名稱:行動健康介入對慢性阻塞性肺病患者身體活動、運動耐力及健康相關生活品質之成效探討:系統性文獻回顧暨統合分析
論文名稱(外文):Effect of mobile health interventions on physical activity, exercise capacity and health-related quality of life in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis
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:碩士
校院名稱:國立陽明大學
系所名稱:臨床護理研究所
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:2020
畢業學年度:108
語文別:中文
論文頁數:134
中文關鍵詞:慢性阻塞性肺病行動健康介入身體活動運動耐力健康相關生活品質系統性文獻回顧暨統合分析
外文關鍵詞:COPDmobile healthphysical activityexercise capacityhealth-related quality of lifesystematic reviewmeta-analysis
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背景: 慢性阻塞性肺病(chronic obstructive pulmonary disease, COPD)為全球第三大死亡原因,患者普遍有缺乏身體活動和運動耐力下降的現象,缺乏身體活動將使COPD患者疾病惡化加劇、死亡率提升及影響健康相關生活品質。現今國內外,使用行動健康介入提升COPD患者身體活動之研究逐漸普及。然而,各篇文獻探討行動健康介入的方案、介入週期及樣本數不同,導致各篇研究結果不一致。
目的: 使用系統性文獻回顧暨統合分析的方法,以身體活動為主要成效指標,次要成效指標為運動耐力及健康相關生活品質,探討行動健康介入對COPD患者之成效。
方法: 搜尋2020年7月前於PubMed、Cochrane Library、Embase、CINAHL、華藝中文電子期刊、台灣碩博士論文加值系統之資料庫,選入條件為(一)研究對象經醫師診斷為COPD且年紀≥ 18歲之男性或女性;(二)介入措施需符合行動健康定義之研究,且介入週期≥ 4週;(三)對照組為常規照護且不包含行動健康組成元素;(四)成效指標包括身體活動、運動耐力或健康相關生活品質;(五)屬於隨機對照試驗、前驅隨機對照試驗、系統性文獻回顧或統合分析之文獻;(六)成效指標數據以平均數、標準差、標準誤、p值或改變量呈現。使用Cochrane Library風險偏差工具第二版評讀文章品質,並以Comprehensive Meta-Analysis 2.0軟體進行統合分析,以標準化平均差異(standardized mean difference, SMD)及95%信賴區間(95% confidence interval, 95% CI)評估綜合效應。
結果:共納入8篇文獻(997位參與者),在身體活動方面,納入3篇文獻,統合分析結果並無顯著成效(SMD= 0.10, 95% CI [-0.19, 0.39] )。於運動耐力方面,文獻中採用不同評估方式,其中採六分鐘步行距離(six-minute walking test, 6MWT)納入4篇文獻; 增速性折返行走測試(incremental shuttle walk test, ISWT)納入3篇文獻; 耐力折返行走測試(endurance shuttle walk test, ESWT)納入2篇文獻,統合分析結果於6MWT未具顯著成效(SMD= 0.13, 95% CI [-0.05, 0.30] ),但在ISWT(SMD= 0.47, 95% CI [0.09, 0.85] )與ESWT(SMD= 1.12, 95% CI [0.66, 1.58] )呈現顯著成效。最後於健康相關生活品質方面,也採用不同評估方式,其中COPD評估試驗(COPD assessment tool, CAT)納入3篇文獻; 臨床COPD問卷(Clinical COPD Questionnaire, CCQ)納入2篇文獻,結果不論CAT (SMD= -0.07, 95% CI [-0.22, 0.09] )或CCQ (SMD= -0.30, 95% CI [-0.80, 0.20] )均未具顯著成效。至於次群組分析結果未能說明樣本數為影響成效指標的原因,以ISWT評估運動耐力且介入週期≥ 12週之研究具有較好的成效。
結論:行動健康介入能顯著提升COPD患者ISWT與ESWT,然而目前實證資料尚未能充分支持行動健康介入對COPD患者之身體活動、6MWT及採CAT與CCQ評估健康相關生活品質之效益。未來仍需要更多研究分析COPD患者之成效。
Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in worldwide. COPD patients usually lack of physical activity with decreased exercise capacity. Physical inactivity will speed exacerbation, increase mortality and impair health-related quality of life. Nowadays, using mobile health interventions to promote physical activity in patients with COPD is popular in research field. However, different studies yielded in inconsistent outcomes.
Objective: This study used systematic review and meta-analysis to evaluate the effect of mobile health interventions in patients with COPD. The primary outcome is physical activity and secondary outcomes are exercise capacity and health-related quality of life.
Methods: The databases searched were PubMed, Cochrane Library, Embase, CINAHL, Airiti Library and National Digital Library of Theses and Dissertations in Taiwan up to July, 2020. Eligibility criteria: (1) participants ≥18 years, diagnosed with COPD; (2) interventions could be classified as mobile health and intervention duration≥ 4 weeks; (3) comparison were usual care and not included mobile health component; (4) outcome measurements included physical activity, exercise capacity or health-related quality of life; (5) study design were randomized controlled trials, randomized controlled pilot trials, systematic review or meta-analysis and; (6) outcome measurements were presented as mean, standard deviation, standard error, p-value or change scores. Cochrane Library risk of bias 2.0 tool measured methodological quality. All statistical analyses were perform using Comprehensive Meta-Analysis 2.0. Standardized mean differences (SMD) with 95% confidence intervals (95% CI) were calculated pooled effect.
Results: Eight studies (997 patients) were included. Three studies were included in physical activity, and the result of meta-analysis were no significant effect (SMD= 0.10, 95%CI [-0.19, 0.39]). Exercise capacity was measured by six-minute walking test (6MWT), incremental shuttle walk test (ISWT) or endurance shuttle walk test (ESWT). Four studies were included in 6MWT, three studies were included in ISWT, and two studies were included in ESWT. No difference between groups was found for 6MWT (SMD= 0.13, 95%CI [-0.05, 0.30] ), however, ISWT (SMD= 0.47, 95% CI [0.09, 0.85] ) and ESWT (SMD= 1.12, 95% CI [0.66, 1.58]) were a significant effect favoring mobile health. Health-related quality of life was measured by COPD assessment tool (CAT) or Clinical COPD Questionnaire (CCQ). Three studies were included in CAT and two studies were included in CCQ. No difference between groups was found for CAT (SMD= -0.07, 95% CI [-0.22, 0.09] ) or CCQ (SMD= -0.30, 95% CI [-0.80, 0.20] ). Sample size was not a factor affecting outcome measurement, and intervention duration ≥12 weeks was effective for ISWT.
Conclusion: According to our study, the mobile health interventions significantly increased ISWT and ESWT in patients with COPD, but didn’t significantly improve physical activity, 6MWT, CAT, and CCQ. More research is needed in the future to analyze the effectiveness of COPD patients.
緒論…………………………………………………………………....….....1
第一節 研究動機及重要性………………………………………………………..1
第二節 研究目的…………………………………………………………………..6
第二章 文獻查證……………………………………………………………..……...7
第一節 慢性阻塞性肺病之症狀照護需求及治療………………………………..7
第二節 行動健康介入……………………………………………………………12
第三節 行動健康介入於COPD患者身體活動之應用………………………...17
第四節 行動健康介入於COPD患者運動耐力之應用………………...............21
第五節 行動健康介入於COPD患者健康相關生活品質之應用……………...26
第六節 名詞解釋…………………………………………………………………31
第三章 研究方法……………………………………………………………....…...33
第一節 資料的搜尋與篩選………………………………………………………33
第二節 研究品質評估……………………………………………………………35
第三節 資料分析方式與解讀……………………………………………………36
第四節 統合分析…………………………………………………………………37
第四章 研究結果…………………………………………………..……………….39
第一節 納入文獻之基本屬性……………………………………………………41
第二節 研究品質…………………………………………………………………48
第三節 行動健康組成內涵………………………………………………………51
第四節 統合分析結果……………………………………………………………53
第五章 討論……………………………………………………………………...…66
第一節 納入文獻基本屬性………………………………………………………66
第二節 文獻品質…………………………………………………………………67
第三節 行動健康介入對COPD患者身體活動之成效…………………….......68
第四節 行動健康介入對COPD患者運動耐力之成效…………………….......71
第五節 行動健康介入對COPD患者健康相關生活品質之成效………….......75
第六章 結論、建議與限制………………………………………....…………...…78
第一節 研究結論與建議…………………………………………………………78
第二節 研究限制…………………………………………………………………80
參考文獻…………………………………………………………………….………..81
附錄一、PROSPERO註冊……………………………………………….………...108
附錄二、RoB 2.0評讀工具………………………………………………………..109
圖目錄
圖1 文獻搜尋流程………………………………………………………….……….40
圖2 納入文獻之風險偏差…………………………………………………..………50
圖3 納入文獻品質評估……………………………………………………….…….50
圖4 身體活動-每日步數……………………………………………………............57
圖5 運動耐力-6MWT……………………………………………………................57
圖6 運動耐力-ISWT…………………………………………………………….….58
圖7 運動耐力-ESWT………………………………………………………….……58
圖8 健康相關生活品質-CAT………………………………………………….…...59
圖9 健康相關生活品質-CCQ………………………………………………….…..59
圖10 樣本數之次群組分析-6MWT…………………………………………….….60
圖11 樣本數之次群組分析- ISWT…………………………………….…………..61
圖12 介入週期之次群組分析-身體活動……………………………………….….62
圖13 介入週期之次群組分析-6MWT……………………………………….…….63
圖14 介入週期之次群組分析- ISWT……………………………………….……..64
圖15 介入週期之次群組分析- CAT………………………………………….……65


表目錄
表1 搜尋關鍵字詞表…………………………………………………………….….34
表2 文章特性一覽表…………………………………………………………….….43
表3 行動健康組成內涵………………………………………………………….….52
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