乳癌術後病人執行上肢復健運動是否能改善肩頸抬舉角度之成效探討Discussion of the Effect of Upper Limp Rehabilitation Exercise on the Improvement of Breast Cancer Patient’s Shoulder joint Range

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2019-04-30 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

江秋怡* 楊喬茵 王美文

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

一般外科醫學 General Surgery

科別

  • 腸胃護理 Gastroenterology Nursing
  • 傷口照護/造口/失禁照護護理 Wound Care / Ostomy / Continence Care Nursing

中文關鍵詞

乳癌術後、復健運動、肩關節角度

英文關鍵詞

breast cancer surgery rehabilitation exercise shoulder joint Range

機構名稱

長庚醫療財團法人高雄長庚紀念醫院

申請單位

護理部

中文摘要

形成臨床提問:
近年來國人飲食習慣改變及環境生態變遷、乳癌的發生率一直逐年增加,但也因為乳癌可以經由早期診斷早期治療有良好治癒率、更多研究開始探討乳癌病人如何維持長久的治療成效,而當乳癌病人行手術切除腫瘤組織後、最常見為患肢肩關節抬舉角度受限、導致病人日常基本活動出現問題而影響生活品質,如果只是輕微肩關節抬舉角度受限可以藉由簡單上肢復健運動來恢復功能、嚴重肩關節功能受限就需要藉由一系列縝密的復健課程、耗費更長時間來改善,因此、如何改善乳癌術後病人肩關節抬舉角度極為重要。 回顧藉由執行上肢復健運動來改善乳癌病人肩關節抬舉角度、作為應用在乳癌病人術後提升肩關節抬舉角度相關臨床應用之參考。
文獻搜尋的方法與分析:
本文依據實證設定 PICO之關鍵字、以系統性文獻回顧法搜尋所有國內外發表與乳癌術後肩關節抬舉角度、以及乳癌復健運動相關文章,所搜尋資料庫包含有華藝線上圖書館、Cochrane Library、PubMed、CINAHL(EBSCO)、Clinicalkey Nursing 等,並運用布林邏輯「OR」、「AND」,限制女性、中英文、人類進行搜索,搜尋結果於Cochrane Library有2篇、PubMed資料庫有19篇、CINAHL有篇、Clinicalkey Nursinguu有16篇、華藝線上圖書館搜尋結果5篇,篩選後選擇最符合主題二篇SR文章、並使用CASP為工具進行嚴格評讀,內容主要以三大面向VIP:V(Validity/Reliability)效度/信度、I(Importance/Impact)重要性,以及P(Practice/Applicability)為臨床適用性。
文獻的品質評讀:
將以PICO問題類型選擇合適的文獻且評析為治療型問題,此二篇systemic review研究文章將其嚴格評讀後,依照Oxford CEBM 2011 Levels of Evidence 分級均為Level 1,二篇文章研究對象皆為罹患乳癌病人、介入措施均為上肢復健運動、評讀結果在統計學上均有顯著性差異(P=0.02;P<0.001),顯示乳癌術後病人早期執行患肢肩關節復健運動,的確是有助於病人肩關節抬舉角度且也可以減少患肢疼痛度,文章也將乳癌病人術後早期介入復健運動、是否因此增加患部引流管量分組比較結果並無差異,二篇評讀結果一致性相同,以GRADE評分系統證據品質,評析證據品質分級為「高」、建議強度分級為「強」。
結論與建議:
綜合二篇文獻介入探討、再依照GRADE建議強度分級顯示乳癌術後病人早期執行上肢復健運動有益於肩關節抬舉角度、故屬於強烈建議。應將乳癌術後病人執行上肢復健運動落實執行且標準化,藉由證據結果提出臨床推行政策、以執行上肢復建運動於乳癌術後病人上來改善肩關節抬舉角度之成效。

英文摘要

Ask an answerable question (PICO):
In recent years, due to changes in the diet and our environment,breast cancer occurrence has being increasing. With early diagnosis and treatment, the recovery rate of breast cancer patient is quite high;with such, more researches started to explore how can breast cancer patients maintain long-term surgical effectiveness. After the surgical removal of tumor tissue in the breast cancer patients, the limited mobility of affected limb has become the most common problems affecting patients’ quality of life。 If a patient’s shoulder lift range is only slightly affected, it can be rehabilitated with simple upper limb exercises;however, with severe case of limited shoulder lift, it requires a series of well-planned rehabilitation classes and significant amount of time to achieve recovery. Therefore, how to improve the angle range of cancer patient’s shoulder lift post -surgery has become extremely important. This is to review the upper limb rehabilitation exercises, as a reference to the clinical application for shoulder lift angle range improvement of post-surgery breast cancer patient.
The Method and Analysis of Literature Review:
ln this paper, based on the PICO keywords, a systematic literature review method is used to research all domestic and international publications related to breast cancer postoperative shoulder lift angle range and breast cancer rehabilitation exercise. The searched database included Huayi Online Library and Cochrane. Library, PubMed, CINAHL (EBSCO), Clinicalkey Nursing and others with the Boolean logic "OR" and "AND" with filters as “women”, “Chinese”, “English”, and “humans”. The search showed result of 2 records from the Cochrane Library, 19 records from the PubMed database, 0record from the CINAHL16 ,records from Clinicalkey Nursinguu, and 5 records from Huayi online library respectively. After screening, the two most relevant SR articles were selected and assessed with CASP tool for rigorous review. Their content were mainly assessed from three aspects,in short VIP, V is for validity or reliability, I is for importance or impact, and P for practice or clinical applicability.
Critical Appraisal:
Based on PICO question type,the suitable literature were selected and assessed as treatment-type question. The two articles have been undergone rigorous systematic review before been ranked as Level 1 according to the Oxford CEBN 2011 Levels of Evidence standard; The two articles were the studies of postoperative patients with breast cancer after the intervention of upper limb rehabilitation exercises; the results varied significantly (P=0.02; P<0.001) showing early implementation of shoulder joint rehabilitation exercise being helpful in improving patient's shoulder joint lifting range and pain reduction of the affected limb. The articles also refer to the early intervention of rehabilitation exercise of breast cancer patients on whether it increases the amount of drainage tubes used in the affected part. The results shows no difference from both comparing groups. There is consistency in the results of the two reviews; according to the GRADE scoring system, and the quality of evidence was graded as “high” with recommendation rating as “strong”.
Conclusions and Recommendations:
After the comprehensive review of the two literature assessed with the GRADE system, it strongly recommends early implementation of upper limb rehabilitation exercise for the postoperative breast cancer patients for it is beneficial to improve the shoulder joint lifting range. The upper limb rehabilitation exercise, supported by the clinical evidence, should be standardized as policy for clinical implementation with the aim of improving the shoulder lift range of postoperative breast cancer patients.