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研究生: 張育齊
Denny Maurits Ruku
論文名稱: 印尼心臟衰竭病人身體活動表現與健康相關生活品質
The Performance of Physical Activity and Health-Related Quality of Life in Indonesian Patients with Heart Failure
指導教授: 陳幸眉
Chen, Hsing-Mei
學位類別: 博士
Doctor
系所名稱: 醫學院 - 護理學系
Department of Nursing
論文出版年: 2022
畢業學年度: 110
語文別: 英文
論文頁數: 142
中文關鍵詞: 心臟衰竭與健康相關的生活質量體力活動
外文關鍵詞: Heart failure, Health-related quality of life, Physical activity
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  • Background: Heart failure (HF) is a global public health issue, with approximately 1-2% of the adult population and even more than 10% of people aged 70 years and older in developed countries were affected, and most of them report low health-related quality of life (HRQOL) even though they have received evidence-based HF treatments. Identifying and ameliorating potential negative factors that could impact patients’ HRQOL is imperative to create better long-term health-care outcomes for people living with HF, and physical activity (PA) adherence is known to be associated with exercise capacity and clinical outcomes; however, study about PA and HRQOL still limited in Indonesia.
    Purpose: This study examined the relationship between demographic characteristics, illness-related factors, and PA with HRQOL in Indonesian patients with HF.
    Method: A cross-sectional study design was used in this study. A convenience sample of 180 outpatients with heart failure was recruited from the cardiology unit of a hospital located in North Sulawesi, Indonesia. Instruments included demographic characteristics, illness-related factors, self-report health status (SRHS), five times sit to stand test (FTSST), International physical activity questionnaire (IPAQ), and Minnesota living with heart failure questionnaire (MLHFQ). Data were analyzed using descriptive statistics and inferential statistics, including t-tests, Pearson product-moment, one-way analysis of variance, and hierarchical multiple regression analysis.
    Results: A total of 180 participants completed the research. The mean age of the participants was 59.98 (SD= 11.86) years old, and 60% were male. The mean score for HRQOL was 43.14 (SD= 20.74) and for PA was 3007.75 (SD= 4903.54). The health status (r = .24, p < .01), NYHA Class (F = 8.36, p < .01), and FTSST (F = 26.01, p < .01), occupational domain (t = 5.08, p< .01), transportation domain (t = 3.41, p< .001), housework domain (t = 7.44, p< .001), and leisure time (t = 4.76, p< .001) showed significant association with HRQOL. Hierarchical multiple regression analysis showed that after adjusting for education, NYHA Class, Hb, medication and health status; three predictors were significant with HRQOL, including FTSST (β = .36, p< .001), occupational domain (β = -.20 p< .05), and housework domain (β = -.22, p< .05), were predicted 40% of the variance in the HRQOL.
    Conclusion: The study found that the NYHA functional classification, health status, domains of PA, and FTSST significantly associated with HRQOL. The FTSST and occupational domain and housework domain of PA were essential factors associated with HRQOL. In the future, improving HRQOL with increasing routine PA including occupational and housework domains should be applied besides medication therapy in patients with stable HF.

    TABLE OF CONTENTS ABSTRACT ………………………………………………………………...........…… i ACKNOWLEDGEMENTS………………………………………………................. iii TABLE OF CONTENTS……………………………………………………........... iv LIST OF TABLES……………………………………………………………............. viii LIST OF FIGURES…………………………………………………………..........… x CHAPTER ONE ……………………………………………………………… .................1 INTRODUCTION……………………………………………………………........... 1 1.1. Introduction………………………………………………………….....................1 1.2. Significance of the study…………………………................………… 2 1.3. Research purpose………………………………………………...........… 5 1.4. Research questions……………………………………………............... 6 1.5. Conceptual framework……………………………………….............. 6 1.6. Definition of the terms…………………………………………............ 7 1.6.1. Physical activity…………………………………………................... 7 1.6.2. Health-related quality of life………………………….............. 7 CHAPTER TWO……………………………………………………………............. 8 LITERATURE REVIEW……………………………………………………............. 8 2.1. Overview of heart failure………………………………………........... 8 2.1.1. Comorbidity and HF………..…………………………….............. 9 2.1.2. Type of HF……..………………………………………….................... 9 2.1.3. Clinical signs and symptoms of HF…………………............ 11 2.1.4. Classification of HF………………………………………............... 11 2.1.5. Pharmacological and non-pharmacological……........... 12 2.2. Health-related quality of life…………………………………............ 13 2.2.1. HRQOL in people with HF………………………………............ 15 2.2.2. HRQOL in Indonesian people with HF……………............ 21 2.2.3. Assessment of HRQOL…………………………………............... 23 2.3. Physical activity……………………………………………………............. 25 2.3.1. Assessment of physical activity……………………............... 27 2.3.2. Physical activity and heart failure……………………........... 30 2.4. Relationship between PA and HRQOL in people with HF…………............................................................................................. 32 CHAPTER THREE…………………………………..........………………………… 36 METHODS…………………………………………………..........…………………… 36 3.1. Research design……………………………………...……………….. 36 3.2. Sample and sampling……………………………………………… 37 3.3. Instruments……………………………………………......…………… 37 3.3.1. Demographic and illness-related factors questionnaire….. 38 3.3.1. Charlson Comorbidity Index……………………………… 38 3.3.3. Modified Self-Rated Health Subscale……………………… 38 3.3.4. Five times sit to stand test………………………………….. 39 3.3.5. International physical activity questionnaire……….. 40 3.3.6. Minnesota Living with Heart Failure Questionnaire……… 41 3.4. Data collection and procedure…………………………………… 43 3.5. Statistical analysis……………………………………..……………… 43 3.6. Ethical consideration………………………………………………… 45 CHAPTER FOUR………………………………………………………......………… 47 RESULTS………………………………………………………………………............. 47 4.1. Demographic Characteristics of Participants………………… 47 4.2. Illness-related factors……………………………………………… 48 4.3. Health status, FTSST, and domains of PA based on the NYHA Classes…………………………………………………............... 50 4.4. Physical activity……………………………………………………........ 51 4.5. Health-Related Quality of Life…………….………………………… 52 4.5. Association between demographic characteristics, illness-related factors and HRQO……………………………………. 54 4.6. The association between IPAQ and HRQOL of participants…..56 4.8. Relationship between specific PA domains and HRQOL in different NYHA Classes……………………………………….......…. 57 4.9. Hierarchical Multiple Regression Analysis…………………………… 59 CHAPTER FIVE…………………………………………………………………......... 61 DISCUSSION……………………………………………………………………........ 61 5.1. Summary of the Study………………………………………………. 61 5.2. Discussion of Findings……………………………………………….. 62 5.2.1. Issue Related to the Demographics Characteristics of participants………………………………………………. 62 5.2.2. Issue Related to Illness-Related Factors…………… 63 5.2.3. Issue related to Physical Activity………………………… 67 5.2.4. Issue related to Health-Related Quality of Life..... 67 5.3. Demographic Characteristics and HRQOL…………………… 68 5.4. Illness-Related Factors and HRQOL………………………….. 69 5.5. Physical Activity and HRQOL……………………………………… 70 5.6. Specific domains of PA and HRQOL in different NYHA Classes…… 71 5.7. Predictors of HRQOL……………………………………………….. 72 5.8. Study Limitation……………………………………………………….. 74 5.9. Conclusion…………………………………………………………….... 75 5.10. Study Implication……………………………………………………. 76 REFERENCES……………………………………………………………………........ 79 APPENDIX………………………………………………………………………......... 122 Appendix A. Questionnaires English……………………………………… 122 Demographic Data………………………………………………….......... 123 Illness-Related Factors…………………………………………….......... 124 International Physical Activity Questionnaire……………………. 126 Minnesota Living with Heart Failure Questionnaire.……… 131 Appendix B. Questionnaire Indonesia…………………………………….. 132 Data Demografi……………………………………………………..................... 133 Faktor-faktor yang berhubungan dengan penyakit……………….. 134 International Physical Activity Questionnaire……………………...... 137 Kuesioner Hidup Dengan Gagal Jantung Minnesota…………….. 141 Appendix C. Permission use the IPAQ……………………………………. 143 Appendix D. Permission use the MLHFQ………………………………… 144 Appendix E. IRB Approval……………………………………………….......... 145 Appendix G. Permission Letter from RD Kandou Manado Hospital……… 146 Appendix H. Informed Consent (English)………………………………… 147 Appendix I. Informed Consent (Indonesia)………………………………. 148

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