乳癌術後病人手臂運動執行現況之探討

Implementation of Arm Exercise in Post-Mastectomy Breast Cancer Patients: Current Status and Related Factors

本研究目的在（1）瞭解乳癌病人手術後患臂不適情形及執行手臂運動的現況，與（2）探討影響病人持續執行手臂運動的因素。本研究採橫斷式相關設計法，以研究者自擬的結構式問卷，分析手臂運動的執行狀況，及人口學因素、放射線治療、患臂不適和學習資源對手臂運動持續時問的影響。研究問卷以郵寄方式寄給174名乳癌團體會員，共回收121份，回收率為70%，其中有效問卷為111份，資料以SPSS統計軟體做資料分析。結果發現：（1）一半以上乳癌病人在手術後曾經歷患臂不適，其嚴重程度依序為肩關節活動受限、手臂酸、腫脹、無力、麻及疼痛等不適；（2）多數病人的手臂運動是由護理人員教導（60%），執行手臂運動的時機為想到就做（51%），並無規律性，且以每次做10分鐘居多（53%），六成以上（61%）執行未達半年；（3）以對數迴歸分析，手臂酸、手臂疼痛及電視陪伴是促進病人持續執行手臂運動達半年以上的預測因素。本研究結果建議醫護人員在指導手臂運動時，應考量及協助處理病人可能遭遇的困擾，及強調持續執行的概念，並長期追蹤，以提高手臂運動執行的有效性。

Systematic and continuous arm exercise is important to breast cancer patients receiving mastectomy. However, very limited studies examine the continuity of implementing arm exercise in this population. The purposes of this study were to (1) survey the discomfort and the current status of implementing post-mastectomy arm exercise; and (2) examine the half-year maintenance of post-mastectomy arm exercise and its related factors. A cross-sectional correlational design was applied to the study. A set of questionnaires were designed by the researchers to measure the characteristics of the subjects, the discomfort, experience and current status of implementing arm exercise and the maintenance of post-mastectomy arm exercise for 6 months. The questionnaires were mailed to members of a breast cancer support foundation. There were 111 valid responsive questionnaires. The results showed that (1) more than 50% of the subjects experienced a limited activity level in the shoulder joint, and weakness, soreness and pain in the affected arm; (2) nurses were the major sources to subjects in learning arm exercise (60%); most of the subjects implemented the arm exercise without a regular schedule (49%); most of subjects only spent 10 minutes doing exercise per time, and more than 60% of the subjects did not maintain the exercise to 6 months; and (3) the soreness and pain of the affected arm and watching TV while exercising were the predicting factors of 6-month arm exercise maintenance analyzed by logistic regression. The results suggested that nurses should focus more on post-mastectomy arm exercise, and also develop a systematic long-tem follow-up program in teaching and supporting breast cancer patients doing arm exercise to decrease the discomfort and increase the function of the affected arm.