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標題: | 運動訓練介入對化學治療引起的周邊神經病變的療效:系統評價、統合分析和臨床試驗計畫書 Efficacy of Exercise Training Intervention on Chemotherapy-Induced Peripheral Neuropathy. A Systematic Review, Meta-Analysis, and A Clinical Trial Protocol |
作者: | 陳品如 Pin-Ru Chen |
指導教授: | 邵幼雲 Yu-Yun Shao |
關鍵字: | 化學治療,化學治療引起的周邊神經病變,運動訓練,神經痛,生活品質, chemotherapy,chemotherapy-induced peripheral neuropathy,exercise training,quality of life,neuropathic pain, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 研究背景
化學治療引起的周圍神經病變(chemotherapy-induced peripheral neuropathy, CIPN)是化學治療的常見副作用之一,發病率高達60%。目前有研究嘗試以非藥物方式改善CIPN,其中運動是常見的方法。運動可促進神經細胞生長和修復,提高神經傳導速度和協調能力,改善CIPN的症狀和功能障礙。然而,現有研究不足以證實運動可預防或改善CIPN。因此,本研究以統合分析評估運動對CIPN引起的周邊神經痛及生活品質的效益。 研究方法 本研究利用系統性文獻回顧和統合分析,以化學治療引起周邊神經病變、各種運動訓練、周邊神經痛或腫瘤之生活品質為關鍵詞,在PubMed和Embase電子資料庫中搜集至2022年12月31日的文獻,比較常規照護與運動介入對化學治療引起周邊神經病變改善之效果,並分析疼痛和生活品質分數。 研究結果 本研究共納入八篇隨機分派的研究進行統合分析,結果顯示,化學治療引起的周邊神經病變疼痛,可透過運動介入顯著降低疼痛分數(standardized mean difference [SMD] = −0.3038, 95% confidence interval [CI] −0.5595, −0.0481, Z = −2.33, p = 0.0199) 與改善生活品質之功能層面 (SMD = 0.6740 , 95% CI 0.1874, 1.1606, Z = 2.71, p = 0.0066)。 結論 本研究結果顯示,運動介入能降低化學治療引起的周邊神經疼痛分數以及改善生活品質之功能層面。由於樣本數有限且資料不足,無法針對不同藥物提供個別化的運動指導。對於特定化學治療藥物引起的周邊神經病變,仍需要進一步的研究探討。 未來方向 藉由前述的研究結果,我們設計了一項臨床試驗來研究運動介入是否有助於改善bortezomib引起的周邊神經病變。該化學治療藥物可能對神經細胞和神經纖維產生不良影響,從而引發CIPN的發生。目前對於bortezomib引發CIPN的藥物或運動介入的資訊相對較少,需要提供更具體和個別化的運動指導和疼痛管理策略。這項臨床試驗的研究目的在解決知識差距並改善CIPN疼痛的治療。 關鍵字 化學治療、化學治療引起的周邊神經病變、運動訓練、神經痛、生活品質 Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, with an incidence rate of up to 60%. Current research is exploring non-pharmacological interventions to improve CIPN, and exercise is a commonly used approach Exercise promotes nerve cell growth and repair, enhances nerve conduction velocity, and improves coordination, thus benefiting CIPN symptoms and functional impairments. However, the existing evidence is insufficient to confirm the preventive or therapeutic effects of exercise on CIPN. Therefore, the objective of this study is to conduct a meta-analysis to evaluate the effects of exercise on peripheral neuropathic pain and quality of life in individuals with CIPN. Methods This study conducted a systematic review and meta-analysis to evaluate the effects of exercise interventions on CIPN, pain, and quality of life in cancer patients. A comprehensive search was conducted in PubMed and Embase databases up to December 31, 2022, using relevant keywords. The study compared standard of care with exercise interventions and analyzed pain and quality of life scores as outcomes. Results This study included a total of eight randomized controlled trials for meta-analysis. The results showed that exercise intervention significantly reduced pain scores (standardized mean difference [SMD] = −0.3038, 95% confidence intervals [CI] −0.5595, −0.0481, Z = −2.33, p = 0.0199) and improved functional aspects of quality of life (SMD = 0.6740, 95% CI 0.1874, 1.1606, Z = 2.71, p = 0.0066). Conclusion The results of this study demonstrated that exercise intervention can reduce peripheral neuropathic pain scores induced by chemotherapy. However, it should be noted that the sample size was limited and the data were insufficient to provide individualized exercise guidance for different medications. Further research is still needed to investigate the effects of exercise intervention specifically for peripheral neuropathy induced by specific chemotherapy drugs. Future Directions According to previous results, we designed a clinical trial for studying exercise interventions to ameliorate bortezomib-induced peripheral neuropathy. Limited information exists on interventions for bortezomib-induced peripheral neuropathy, including pharmacological and exercise approaches. More specific and individualized exercise guidance and pain management strategies are needed. This clinical trial proposal aims to address knowledge gaps and improve the management of CIPN pain. Key words: chemotherapy; chemotherapy-induced peripheral neuropathy; exercise training; quality of life; neuropathic pain. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/89204 |
DOI: | 10.6342/NTU202301761 |
全文授權: | 同意授權(限校園內公開) |
顯示於系所單位: | 臨床醫學研究所 |
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