乳腺癌術后患者功能康復訓練效果的系統評價_《中國循證醫學雜志》

作者：

 胡雁 , 顧沛 , 張曉菊

復旦大學JBI循證護理合作中心（上海 200433）;

關鍵詞：

乳腺癌術后功能康復生活質量

DOI：

10.7507/1672-2531.20090012

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　評價功能康復訓練對改善乳腺癌術后患者患側肢體功能和生活質量的效果。
方法　計算機檢索Cochrane Database of Systematic Reviews（2007年第2期）、JBI Database of Systematic Reviews、MEDLINE（1966～2008）、EMbase（1989～2007）、CINAHL（Cumulative Index to Nursing and Allied Health literature）、CBMdisc（1978～2008）、CNKI（1994～2008）中關于康復訓練對改善乳腺癌術后患者肢體功能和生活質量的隨機對照試驗，同時篩檢納入文獻的參考文獻。由3名研究者對文獻質量進行嚴格評價和資料提取，對符合質量標準的RCT進行Meta分析。
結果　共納入19個RCT。9 個RCT的結果顯示，肢體功能康復訓練對改善患者術后的關節活動度有顯著作用。4項研究結果表明全身康復運動訓練對改善患者的心肺功能、提高身體耐力方面有顯著作用，6 項研究結果顯示乳腺癌術后系統的康復運動對提高其健康相關生活質量有顯著效果，6項研究結果表明康復訓練對緩解治療期間的疲乏癥狀有顯著意義。在康復訓練的時機上選擇上，術后早期開始康復訓練是積極而安全的措施。
結論　乳腺癌術后患者開展肢體漸進式康復訓練和全身康復運動可有效改善患者的患肢功能，提高生活質量，對緩解化療和放療患者疲乏癥狀有一定的效果。

引用本文： 胡雁,顧沛,張曉菊. 乳腺癌術后患者功能康復訓練效果的系統評價. 中國循證醫學雜志, 2009, 09(1): 41-54. doi: 10.7507/1672-2531.20090012 復制

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2.	張總清, 李廣燦, 葉召. 乳腺癌當前流行趨勢分析. 中國腫瘤, 2000, 9(10): 454-455.
3.	吳亞群, 薛新波. 乳腺腫瘤. 武漢: 湖北科學技術出版社, 2002, 118-120.
4.	Hladiuk M, Huchcroft S, Temple W, et al. Arm function after axillary dissection for breast cancer. Journal of Surgical Oncology, 1992, 50: 47-52.
5.	Shapiro SL, Lopez AM, Schwartz GE, et al. Quality of life and breast cancer: Relationship to psychosocial variables. Journal of Clinical Psychology, 2001, 57(4): 501-519.
6.	Shimozuma K, Ganz PA, Petersen L, et al. Quality of life in the first year after breast cancer surgery: rehabilitation needs and patterns of recovery. Breast Cancer Research and Treatment, 1999, 56: 45-57.
7.	Bendz I, Olsen MF. Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection - a randomsed controlled trial. The Breast, 2002, 11: 241-248.
8.	Matthews CE, Wilcox S, Hanby CL, et al. Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Support Care Cancer, 2007, 15: 203-211.
9.	Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology, 2007, 28(28): 4396-4404.
10.	Kirshbaum MN. A review of the benefits of whole body exercise during and after treatment for breast cancer. Journal of Clinical Nursing, 2006, 16: 104-121.
11.	Pinto BM, Floyd A. Methodologic issues in exercise intervention research in oncology (review). Seminars in Oncology Nursing, 2007, 23(4): 297-304.
12.	Knols R, Aaronson NK, Uebelhart D, et al. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology, 2005, 23(16): 3830-3842.
13.	Higgins JPT, Green S. Cochrance Handbook for Systematic Reviews of Interventions 4.2.6. 2006: The Cochrane Collaboration.
14.	Beurskens CHg, vanUden CJT, Strobbe LJA, et al. The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer: a randomzed controlled study. BMC Cancer, 2007, 7: 166.
15.	Box RC, Reul-Hirche HM, Bullock-Saxton JE, et al. Shoulder movement after breast cancer surgery: results of a randomised controlled study of postoperative physiotherapy. Breast Cancer Research and Treatment, 2002, 75: 35-50.
16.	Box RC, Reul-Hirche HM, Bullock-Saxton JE, et al. Physiotherapy after breast cancer surgery: results of a randomised controlled study to minimise lymphoedema. Breast Cancer Research and Treatment, 2002b, 75: 51-64.
17.	Campbell A, Mutrie N, White F, et al. A pilot study of a supervised group exercise programme as a rehabiltation treatment for women with breast cancer receiving adjuvant treatment. European Journal of Oncology Nursing, 2005, 9: 56-63.
18.	Cho OH, Yoo YS, Kim NC. Efficacy of comprehensive group rehabilitation for women with early breast cancer in South Korea. Nursing and Health Science, 2006, 8: 140-146.
19.	Courneya KS, Mackey JR, Bell GJ, et al. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology, 2003, 21(9): 1660-1668.
20.	Daley AJ, Crank H, Saxton JM, et al. Randomized trial of exercise therapy in women treated for breast cancer. Journal of Clinical Oncology, 2007, 25(13): 1713-1721.
21.	Lauridsen MC, PChristlansen, Hessov L. The effect of physiotheray on shoulder function in patients surgically treated for breast cancer: a randomized study. Acta Oncologica, 2005, 44: 449-457.
22.	Milne HM, Wallman KE, Gordon S, et al. Effect of a combined aerobic and resistance exercise program in breast cancer survivors; a randomized conrolled trial. Breast Cancer Research and Treatment, 2008, 108(2): 279-288.
23.	Mock V, Pickett M, Ropka ME, et al. Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Practice, 2001, 9(3): 119-127.
24.	Mock V, Frangakis C, Davidson NE, et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psycho-Oncology, 2005, 14: 464-477.
25.	Mutrie N, Campbell AM, Whyte F, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ, 2007, Doi:10.1136/bmj.39094.648553.AE: 1-7.
26.	Pinto BM, Frierson GM, Rabin C, et al. Home-based physical activity intervention for breast cancer patients. Journal of Clinical Oncology, 2005, 23(15): 3577-3587.
27.	Sandel SL, Judge J, Landry N, et al. Dance and movement program improves quality of life measures in breast cancer survivors. Cancer Nursing, 2005. 28(4): 301-309.
28.	Segal R, Evans W, Johnson D, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. Journal of Clinical Oncology, 2001, 19(3): 657-665.
29.	徐文紅, 楊碎勝, 張曉華, 等. 以有氧運動為基礎的術側上肢針對性醫療體操對乳腺癌術后上肢功能康復的臨床效果. 中國康復醫學雜志, 2004, 19(7): 529-531.
30.	王炳高, 袁新顏, 王啟堂, 等. 乳腺癌術后康復訓練對患者上臂水及肩關節活動的影響. 中國臨床康復, 2005, 9(30): 16-19.
31.	張曉菊, 胡雁, 黃嘉玲, 等. 漸進式康復護理對乳腺癌術后肩關節活動度及生命質量的影響. 復旦學報(醫學版), 2008, 35(1): 128-132.
32.	Courneya KS, Friedenreich CM, Sela RA, et al, The group psychotherapy and home-based physical exercise (Group-Hope) trail in cancer survivors: physical fitness and quality of life outcomes. Psycho-Oncology, 2003b. 12: 357-374.
33.	McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. Journal of Clinical Oncology, 2003, 21(3): 463-466.

1. Parkin DM, Bray F, Perlay J, et al. Global cancer statistics, 2002. CA: A Cancer Journal for Clinicians, 2005, 55: 74-108.
2. 張總清, 李廣燦, 葉召. 乳腺癌當前流行趨勢分析. 中國腫瘤, 2000, 9(10): 454-455.
3. 吳亞群, 薛新波. 乳腺腫瘤. 武漢: 湖北科學技術出版社, 2002, 118-120.
4. Hladiuk M, Huchcroft S, Temple W, et al. Arm function after axillary dissection for breast cancer. Journal of Surgical Oncology, 1992, 50: 47-52.
5. Shapiro SL, Lopez AM, Schwartz GE, et al. Quality of life and breast cancer: Relationship to psychosocial variables. Journal of Clinical Psychology, 2001, 57(4): 501-519.
6. Shimozuma K, Ganz PA, Petersen L, et al. Quality of life in the first year after breast cancer surgery: rehabilitation needs and patterns of recovery. Breast Cancer Research and Treatment, 1999, 56: 45-57.
7. Bendz I, Olsen MF. Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection - a randomsed controlled trial. The Breast, 2002, 11: 241-248.
8. Matthews CE, Wilcox S, Hanby CL, et al. Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Support Care Cancer, 2007, 15: 203-211.
9. Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology, 2007, 28(28): 4396-4404.
10. Kirshbaum MN. A review of the benefits of whole body exercise during and after treatment for breast cancer. Journal of Clinical Nursing, 2006, 16: 104-121.
11. Pinto BM, Floyd A. Methodologic issues in exercise intervention research in oncology (review). Seminars in Oncology Nursing, 2007, 23(4): 297-304.
12. Knols R, Aaronson NK, Uebelhart D, et al. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology, 2005, 23(16): 3830-3842.
13. Higgins JPT, Green S. Cochrance Handbook for Systematic Reviews of Interventions 4.2.6. 2006: The Cochrane Collaboration.
14. Beurskens CHg, vanUden CJT, Strobbe LJA, et al. The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer: a randomzed controlled study. BMC Cancer, 2007, 7: 166.
15. Box RC, Reul-Hirche HM, Bullock-Saxton JE, et al. Shoulder movement after breast cancer surgery: results of a randomised controlled study of postoperative physiotherapy. Breast Cancer Research and Treatment, 2002, 75: 35-50.
16. Box RC, Reul-Hirche HM, Bullock-Saxton JE, et al. Physiotherapy after breast cancer surgery: results of a randomised controlled study to minimise lymphoedema. Breast Cancer Research and Treatment, 2002b, 75: 51-64.
17. Campbell A, Mutrie N, White F, et al. A pilot study of a supervised group exercise programme as a rehabiltation treatment for women with breast cancer receiving adjuvant treatment. European Journal of Oncology Nursing, 2005, 9: 56-63.
18. Cho OH, Yoo YS, Kim NC. Efficacy of comprehensive group rehabilitation for women with early breast cancer in South Korea. Nursing and Health Science, 2006, 8: 140-146.
19. Courneya KS, Mackey JR, Bell GJ, et al. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology, 2003, 21(9): 1660-1668.
20. Daley AJ, Crank H, Saxton JM, et al. Randomized trial of exercise therapy in women treated for breast cancer. Journal of Clinical Oncology, 2007, 25(13): 1713-1721.
21. Lauridsen MC, PChristlansen, Hessov L. The effect of physiotheray on shoulder function in patients surgically treated for breast cancer: a randomized study. Acta Oncologica, 2005, 44: 449-457.
22. Milne HM, Wallman KE, Gordon S, et al. Effect of a combined aerobic and resistance exercise program in breast cancer survivors; a randomized conrolled trial. Breast Cancer Research and Treatment, 2008, 108(2): 279-288.
23. Mock V, Pickett M, Ropka ME, et al. Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Practice, 2001, 9(3): 119-127.
24. Mock V, Frangakis C, Davidson NE, et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psycho-Oncology, 2005, 14: 464-477.
25. Mutrie N, Campbell AM, Whyte F, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ, 2007, Doi:10.1136/bmj.39094.648553.AE: 1-7.
26. Pinto BM, Frierson GM, Rabin C, et al. Home-based physical activity intervention for breast cancer patients. Journal of Clinical Oncology, 2005, 23(15): 3577-3587.
27. Sandel SL, Judge J, Landry N, et al. Dance and movement program improves quality of life measures in breast cancer survivors. Cancer Nursing, 2005. 28(4): 301-309.
28. Segal R, Evans W, Johnson D, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. Journal of Clinical Oncology, 2001, 19(3): 657-665.
29. 徐文紅, 楊碎勝, 張曉華, 等. 以有氧運動為基礎的術側上肢針對性醫療體操對乳腺癌術后上肢功能康復的臨床效果. 中國康復醫學雜志, 2004, 19(7): 529-531.
30. 王炳高, 袁新顏, 王啟堂, 等. 乳腺癌術后康復訓練對患者上臂水及肩關節活動的影響. 中國臨床康復, 2005, 9(30): 16-19.
31. 張曉菊, 胡雁, 黃嘉玲, 等. 漸進式康復護理對乳腺癌術后肩關節活動度及生命質量的影響. 復旦學報(醫學版), 2008, 35(1): 128-132.
32. Courneya KS, Friedenreich CM, Sela RA, et al, The group psychotherapy and home-based physical exercise (Group-Hope) trail in cancer survivors: physical fitness and quality of life outcomes. Psycho-Oncology, 2003b. 12: 357-374.
33. McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. Journal of Clinical Oncology, 2003, 21(3): 463-466.

《中國循證醫學雜志》

乳腺癌術后患者功能康復訓練效果的系統評價

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《中國循證醫學雜志》

乳腺癌術后患者功能康復訓練效果的系統評價

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