[[alternative]]Effects of breathing relaxation training in patients with migraine

[[abstract]]偏頭痛是一種常見的神經系統疾病，根據國際頭痛協會調查，全球盛行率為14.2%，推估超過一億人遭受偏頭痛所困擾，長時間嚴重偏頭痛易演變成慢性偏頭痛，而世界衛生組織全球調查指出慢性偏頭痛是造成成人失能排名第二位的疾病，影響生理、心理，社會問題各層面，因此，偏頭痛預防與管理方法是減輕失能和對身心衝擊極為重要的議題。本研究運用呼吸放鬆訓練搭配生理回饋探討對偏頭痛患者壓力、焦慮、憂鬱、失能及生活品質之成效，採實驗性研究設計，收案期間為2017年2月至2017年12月，以北部某醫學中心神經內科病房偏頭痛住院患者為對象，共收案74位隨機分派為兩組，實驗組每日1次，每次30分鐘，連續3天進行一對一教導呼吸訓練，並使用行動應用軟體進行導引每分鐘6次慢速呼吸，過程輔以生理回饋儀監測，爾後每日自行練習一次，每次20分鐘，持續3個月，對照組接受病房一般常規治療，兩組後續皆給予每月一次電話諮詢與關懷。以疼痛數字量表（NRS）、壓力知覺量表（PSS-14）、醫院焦慮及憂鬱量表（HADS）、偏頭痛失能量表（MIDAS）、世界衛生組織生活品質量表（WHOQOL）為研究工具，於收案第一天、第三天、第三個月分別進行前中後測量，研究採用意向分析，以SPSS 20.0進行資料分析與檢定。研究結果顯示：1. 實施呼吸放鬆訓練期間肌電位、指溫、心率、膚電流在統計學上有顯著差異（p < .001），證實達生理放鬆效果。2.實施呼吸放鬆訓練三天後可立即減輕頭痛34%，且第三個月有效減少頭痛57%，壓力減少16.63%，更明顯減少失能67.88%，兩組間達統計學上顯著差異（p < .001）。3.焦慮憂鬱與生活品質呈改善趨勢，但於兩組間則未達顯著差異。本研究提供呼吸訓練介入的治療性護理處置實證基礎，所設計的標準化的訓練方案能有效改善偏頭痛患者的生理狀態、並有助於心理及社會層面的提升，建議將呼吸放鬆訓練納入偏頭痛患者的常規治療計畫中，鼓勵患者透過學習呼吸技術來幫助預防及管理偏頭痛，強化護理專業的品質。[[abstract]]According to World Health Organization, migraine, the global prevalence rate is 14.2% surveyed by International Headache Society, is No. 2 caused disability for all diseases. Chronic migraine lead to physical, mental, social issue. It is better to use both of pharmacological and non-pharmacological method for treatment.This research implemented breathing relaxation training to obtain effect of patient’s migraine stress, anxiety, depression, disability, quality of life. The experiment was executed at Neurology ward of Medical Center, North Taiwan, from February to December, 2017. The 74 patients were randomly assigned into two groups. The experimental group, in continually three days, was accept 30 minutes training for once within day. The progress was implemented with application software to lead patient slowly breathe for six times within one minute, monitoring by bio-feedback machine. While finishing training, they practiced once with 20 minutes for each day. The control group only accept usual care. Researcher gave them phone call to trace. This research used NRS、PSS-14、HADS、MIDAS and WHOQOL to evaluate. And the surveys were collected at first day, third day and three months while patients came back to hospital. This study used intention-to-treat (ITT) analysis and used SPSS 20.0. The result indicates: (1) during training period, the change of EMG、BVP、TEMP and SC were statistical difference (P < .001); (2) for experimental group, the score of NRS was immediately reduced 34% at third day, which got decreasing 57% for NRS, 16.63% for PSS-14 and 67.88% for MIDAS, after three months and it was obvious difference between two group (p < .001); (3) it is not obvious difference between two group for HADS and WHOQOL.Through standard training progress, patients improved physiological, psychological and social states. The result suggests that breathing training should be adopted in the treatment schedule for migraine. This research provides evidence base for improving quality of nursing and ability of clinical research