探討門診血液透析病人之疲憊、運動益處感與生活品質之相關性

背景：台灣血液透析病人不運動比率佔53%，疲憊是造成不運動的關鍵因素，疲憊與運動益處感低亦影響生活品質。故血液透析病人運動益處感、疲憊與生活品質之相關性有需要進一步探究。目的：探討門診血液透析病人疲憊、運動益處感與生活品質之相關性。方法：本研究使用橫斷式量性研究設計，針對中部某醫學中心血液透析室病人，以方便取樣的方式，採用結構式問卷調查收集基本資料、尿毒症疲憊量表、透析病人運動益處/障礙量表、臺灣版世界衛生組織生活品質問卷等完成資料收集，取樣102人，並以SPSS 26.0版本進行統計分析及Amos 27.0版本進行結構方程式模型分析。結果：以皮爾森積差相關係數分析與結構方程式分析發現疲憊對於運動益處感呈顯著性負相關（r = -.419, p < .01；路徑係數-.48，p值 .007），疲憊對於生活品質呈顯著性負相關（r = -.591， p < .01；路徑係數-.541，p < .001），運動益處感對於生活品質呈顯著性正相關（r = .523， p < .01；路徑係數.586，p值 < .001）。進一步以結構方程式分析運動益處感對於疲憊與生活品質之中介效果，疲憊對生活品質有負向的直接與間接影響效果，其總效果為-.542；其次，疲憊對運動益處感有負向的直接影響效果，總效果為-.534。根據疲憊對生活品質的影響標準化總效果為-.541(p < .05)，在模型加入中介變數運動益處感後，其影響之直接效果為-.34 (p < .05)、疲憊對運動益處感的影響直接效果為-.534 ( p < .05)、運動益處感對生活品質的影響直接效果為.379 (p < .05) 、疲憊對生活品質影響的間接效果（a*b）為-.202 ，經Sobel test檢定後，Z值為-2.21， p < .05，中介效果顯著，疲憊對生活品質的路徑係數顯著變小，證實疲憊能夠透過運動益處感的中介效果，進而對生活品質產生影響。本研究模型經修正後，最終絕對適配指標P值為.362、GFI值為0.909、AGFI值為0.860；增量配適指標RFI值為0.907；精簡配適指標CN值為117。結論：門診血液透析病人之疲憊與運動益處感呈顯著性負相關、疲憊與生活品質呈顯著性負相關、運動益處感與生活品質呈顯著性正相關，且運動益處感對疲憊與生活品質具有顯著性中介效果。關鍵字：血液透析、疲憊、運動益處感、生活品質

Background: The inactivity rate of hemodialysis patients in Taiwan accounts for 53%. Fatigue is a key factor causing inactivity. Fatigue and low perception of the benefits of exercise also affect the quality of life. Further research is needed on the correlation between the sense of perception benefits of exercise, fatigue and quality of life.Objective: To explore the relationship between fatigue, perceived benefits of exercise and quality of life in hemodialysis outpatients.Methods: This study used a cross-sectional quantitative research design, focusing on patients in the hemodialysis unit of a medical center in central Taiwan, using a convenient sampling method to collect basic information using a structured questionnaire, the Uremic Fatigue Scale, the Dialysis patirnt-perceived exercise benefits and barriers scale, and the WHOQOL-BREF scale and other data collection to complete the data collection, sampled 102 people, and used SPSS version 26.0 for statistical analysis and Amos version 27.0 for structural model analysis.Results: Pearson's correlation coefficient analysis and structural equation modeling revealed a significant negative correlation between fatigue and perceived benefits of exercise (r = -.419, p < .01; path coefficient = -.48, p = .007). Fatigue was also significantly negatively correlated with quality of life (r = -.591, p < .01; path coefficient = -.541, p < .001), while perceived benefits of exercise were significantly positively correlated with quality of life (r = .523, p < .01; path coefficient = .586, p < .001). Further structural equation modeling showed that perceived benefits of exercise mediated the relationship between fatigue and quality of life, with fatigue having both direct and indirect negative effects on quality of life, with a total effect of -.542. Additionally, fatigue had a direct negative effect on the perceived benefits of exercise, with a total effect of -.534. The standardized total effect of fatigue on quality of life was -.541 (p < .05). After including the perceived benefits of exercise as a mediating variable, the direct effect of fatigue on quality of life was -.34 (p < .05), the direct effect of fatigue on perceived benefits of exercise was -.534 (p < .05), and the direct effect of perceived benefits of exercise on quality of life was .379 (p < .05). The indirect effect of fatigue on quality of life (a*b) was -.202, with a Sobel test Z-value of -2.21 (p < .05), indicating a significant mediating effect. The path coefficient of fatigue on quality of life significantly decreased, confirming that fatigue can influence the quality of life through the mediating effect of perceived benefits of exercise. After modification, the final model's absolute fit indices were: p-value = .362, GFI = 0.909, AGFI = 0.860, incremental fit indices: RFI = 0.907, and parsimonious fit index: CN = 117.Conclusions: There is a significant negative correlation between fatigue and the sense of perceived benefits of exercise and quality of life among outpatient hemodialysis patients. There is a significant positive correlation between the sense of perceived benefits of exercise and quality of life. The sense of perceived benefits of exercise has a significant mediating effect on fatigue and quality of life.Key word: Hemodialysis、Fatigue、Perceived benefits of exercise、Quality of life