Paklitaksel alan meme kanserli kadınlarda Rahatsız Edici Semptomlar Teorisi'ne dayalı yapılan yürüyüş egzersizinin periferal nöropati ve artralji-miyalji üzerine etkisi: Randomize kontrollü pilot uygulama
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Tarih
2024
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Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kemoterapiye bağlı ortaya çıkan periferal nöropati ve artralji-miyalji, hastanın günlük yaşama aktif katılımını engelleyerek tedavinin değişmesine ya da sonlanmasına neden olabilmektedir. Bu nedenle araştırma, paklitaksel alan meme kanserli kadınlarda Rahatsız Edici Semptomlar Teorisi'ne dayalı yapılan yürüyüş egzersizinin periferal nöropati ve artralji-miyalji üzerine etkisini belirlemek amacıyla yapılmıştır. Araştırma, bir şehir hastanesinin tıbbi onkoloji polikliniğinin ayaktan tedavi ünitesinde Temmuz 2022-Temmuz 2023 tarihleri arasında gerçekleştirilmiştir. Prospektif, tek kör, paralel grup randomize kontrollü tasarım ile yapılmıştır. Örnekleme, blok randomizasyonla 41 müdahale, 41 kontrol grubuna olmak üzere toplam 82 hasta dahil edilmiştir. Müdahale grubuna TOUS teorisine göre fiziksel aktivitenin yararları konusunda bilgilendirmeler yapılmış, pedometreler verilmiş, haftada en az 3 gün ortalama 30 dakika pedometre ile yürüyerek adım sayılarını kaydetmeleri istenmiştir. Başlangıç, 4. hafta ve 8. haftalarda motivasyonel görüşmeler yapılmış ve yürüyüş durumları takip edilmiştir. Müdahale ve kontrol grubuna başlangıçta, 4. haftada, 8. haftada ve 12. haftada ölçekler uygulanmış ve yürüme izlem çizelgesi bu haftalarda teslim alınmıştır. Ayrıca 12 hafta boyunca yürüyüşle ilgili yüz yüze görüşmeler sağlanmıştır. Kontrol grubu ise hastanede yapılan standart eğitimi almıştır. Veri toplama aracı olarak, Bilgi Formu, Kemoterapiye Bağlı Periferal Nöropati Değerlendirme Aracı ve McGill Ağrı ölçeği kısa formu kullanılmıştır. Araştırmanın yürütülebilmesi için etik kurul izni, kurum izni ve protokol kaydı (Clinical Trial No: NCT0544820) alınmıştır. Verilerin analizinde sayı, yüzde, ortalama, standart sapma, medyan, minimum, maksimum ve kategorik değişkenkler için Pearson kikare/Fisher exact test, gruplar arası karşılaştırmada bağımsız gruplarda t testi, tekrarlı ölçümlerde ANOVA, grup-zaman etkileşimini değerlendirmek için karışık düzen ANOVA kullanılmıştır. Anlamlılık düzeyi p<0,05 olarak kabul edilmiştir. Araştırmaya katılan hastaların yaş ortalaması müdahale grubunda 50,78±8,39 yıl, kontrol grubunda 52,59±9,55 yıl bulunmuştur. Hastaların sosyodemografik ve hastalık özellikleri bakımından benzer bir dağılıma sahip olduğu belirlenmiştir (p>0,05). Müdahale grubunda, 12 haftalık yürüyüş egzersizi sonrası kontrol grubuna göre CIPNAT puan ortalamaları alt boyutlarının 4. hafta, 8. hafta ve 12. hafta puanına göre azaldığı tespit edilmiştir (p<0,05). Uygulama sonrası müdahale grubunda, kontrol grubuna göre McGill Ağrı puan ortalamaları ve alt boyutlarının 4. hafta, 8. hafta ve 12. hafta puanına göre azaldığı tespit edilmiştir (p<0,05). CIPNAT ve McGill Ağrı puan ortalamaları 4. hafta, 8. hafta ve 12. haftalarda kontrol grubunda müdahale grubuna göre daha hızlı arttığı belirlenmiştir (p<0,05). Müdahale ve kontrol gruplarında zamana göre puan değişimleri müdahale grubu lehine olup, CIPNAT grup x zaman etkileşimi için etki büyüklüğü η2=0,278, McGill Ağrı grup x zaman etkileşimi için etki büyüklüğü η2=0,147 olarak bulunmuştur. Araştırmada Rahatsız Edici Semptomlar Teorisi'ne göre yapılan yürüyüş egzersizinin meme kanseri olan hastalarda periferal nöropati ve artralji-miyaljiyi azaltmada etkili olduğu belirlenmiştir. Yürüyüş egzersizi her ortamda uygulanabilir olduğu için hastalar motive edilmeli; etkisi başka kanser türü, kemoterapi ilaçları ve semptomlarda da değerlendirilmesi önerilmektedir.
Chemotherapy-induced peripheral neuropathy and arthralgia-myalgia can hinder the patient's actively participation in daily life, leading to a modification or termination of treatment. Therefore, this study was conducted to determine the effect of walking exercise based on the Theory of Disturbing Symptoms on peripheral neuropathy and arthralgia-myalgia in women with breast cancer receiving paclitaxel. The study took place at the outpatient treatment unit of a city hospital's medical oncology clinic between July 2022 and July 2023. It was conducted with a prospective, single-blind, parallel group randomized controlled design. A total of 82 patients were included in the sample through block randomization, with 41 in the intervention group and 41 in the control group. The intervention group received information about the benefits of physical activity according to the TOUS theory, were provided pedometers, and were asked to record their step counts by walking with the pedometer for an average of 30 minutes at least 3 days per week. Initianlly, motivational interviews were conducted at the week 4 and week 8 and gait status was monitored. Scales were administered to both the intervention and control groups at the week 4, 8, and 12, and the gait tracking chart was collected during these weeks. In addition, face-to-face interviews regarding walking were provided over the course of 12 weeks. The control group received standardized training provided at the hospital. Information Form, Chemotherapy Induced Peripheral Neuropathy Assessment Tool and Short Form McGill Pain Questionnaire were used as data collection tools. To conduct the study, ethics committee permission, institutional permission and protocol registration (Clinical Trial No: NCT0544820) were obtained. For data analysis, descriptive statistics such as number, percentage, mean, standard deviation, median, minimum, maximum, Pearson chi-square/Fisher exact test for categorical variables, t test in independent groups for intergroup comparison, ANOVA for repeated measures, mixed-order ANOVA to evaluate group-time interaction were used. Signififance level was accepted as p<0.05. The mean age of the patients participating in the study was 50.78±8.39 years in the intervention group and 52.59±9.55 years in the control group. It was determined that the patients had a similar distribution in terms of sociodemographic and disease characteristics (p>0.05). In the intervention group, it was determined that the mean CIPNAT scores decreased according at the 4th, 8th, and 12th weeks scores compared to the control group after 12 weeks of walking exercise (p<0.05). After the intervention, it was found that the mean McGill Pain scores and sub-dimensions decreased in the intervention group compared to the control group at the 4th, 8th and 12th weeks (p<0.05). The mean scores of CIPNAT and McGill Pain increased faster in the control group than the intervention group at weeks of 4, 8 and 12 (p<0.05). Given that, changes in scores in both the intervention and control groups over time were in favor of the intervention group, the effect size for the CIPNAT group x time interaction was η2=0.278, and the effect size for the McGill Pain group x time interaction was η2=0.147. The study found that walking exercise based on the Theory of Disturbing Symptoms is effective in reducing peripheral neuropathy and arthralgia-myalgia in patients with breast cancer. Since walking exercise can be applied in any environment, patients should be motivated and its effect should be evaluated in other cancer types, chemotherapy drugs and symptoms as well.
Chemotherapy-induced peripheral neuropathy and arthralgia-myalgia can hinder the patient's actively participation in daily life, leading to a modification or termination of treatment. Therefore, this study was conducted to determine the effect of walking exercise based on the Theory of Disturbing Symptoms on peripheral neuropathy and arthralgia-myalgia in women with breast cancer receiving paclitaxel. The study took place at the outpatient treatment unit of a city hospital's medical oncology clinic between July 2022 and July 2023. It was conducted with a prospective, single-blind, parallel group randomized controlled design. A total of 82 patients were included in the sample through block randomization, with 41 in the intervention group and 41 in the control group. The intervention group received information about the benefits of physical activity according to the TOUS theory, were provided pedometers, and were asked to record their step counts by walking with the pedometer for an average of 30 minutes at least 3 days per week. Initianlly, motivational interviews were conducted at the week 4 and week 8 and gait status was monitored. Scales were administered to both the intervention and control groups at the week 4, 8, and 12, and the gait tracking chart was collected during these weeks. In addition, face-to-face interviews regarding walking were provided over the course of 12 weeks. The control group received standardized training provided at the hospital. Information Form, Chemotherapy Induced Peripheral Neuropathy Assessment Tool and Short Form McGill Pain Questionnaire were used as data collection tools. To conduct the study, ethics committee permission, institutional permission and protocol registration (Clinical Trial No: NCT0544820) were obtained. For data analysis, descriptive statistics such as number, percentage, mean, standard deviation, median, minimum, maximum, Pearson chi-square/Fisher exact test for categorical variables, t test in independent groups for intergroup comparison, ANOVA for repeated measures, mixed-order ANOVA to evaluate group-time interaction were used. Signififance level was accepted as p<0.05. The mean age of the patients participating in the study was 50.78±8.39 years in the intervention group and 52.59±9.55 years in the control group. It was determined that the patients had a similar distribution in terms of sociodemographic and disease characteristics (p>0.05). In the intervention group, it was determined that the mean CIPNAT scores decreased according at the 4th, 8th, and 12th weeks scores compared to the control group after 12 weeks of walking exercise (p<0.05). After the intervention, it was found that the mean McGill Pain scores and sub-dimensions decreased in the intervention group compared to the control group at the 4th, 8th and 12th weeks (p<0.05). The mean scores of CIPNAT and McGill Pain increased faster in the control group than the intervention group at weeks of 4, 8 and 12 (p<0.05). Given that, changes in scores in both the intervention and control groups over time were in favor of the intervention group, the effect size for the CIPNAT group x time interaction was η2=0.278, and the effect size for the McGill Pain group x time interaction was η2=0.147. The study found that walking exercise based on the Theory of Disturbing Symptoms is effective in reducing peripheral neuropathy and arthralgia-myalgia in patients with breast cancer. Since walking exercise can be applied in any environment, patients should be motivated and its effect should be evaluated in other cancer types, chemotherapy drugs and symptoms as well.
Açıklama
Doktora Tezi
Anahtar Kelimeler
Artralji-Miyalji, Kemoterapiye Bağlı Periferal Nöropati, Meme Kanseri, Rahatsız Edici Semptomlar Teorisi, Yürüyüş Egzersizi, Arthralgia-Myalgia, Breast Cancer, Chemotherapy-Induced Peripheral Neuropathy, Theory of Unpleasant Symptoms, Walking Exercise
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Özdemir, D. (2024). Paklitaksel alan meme kanserli kadınlarda Rahatsız Edici Semptomlar Teorisi'ne dayalı yapılan yürüyüş egzersizinin periferal nöropati ve artralji-miyalji üzerine etkisi: Randomize kontrollü pilot uygulama. (Yayımlanmamış doktora tezi). Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı, Konya.
