社区脊髓损伤患者日常生活活动能力的影响因素分析
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摘要
目的:探讨社区脊髓损伤患者日常生活活动能力的影响因素,提高社区脊髓损伤患者的生活质量。方法:选取2016年3月—2018年2月福州市、十堰市、银川市符合纳入标准的社区脊髓损伤患者203例,采用横断面调查研究方法,对患者进行问卷调查,同时收集治疗师对患者的评估及患者自评的资料。资料包括年龄、性别、病程、文化程度、家庭年收入、支付类型、是否进行康复治疗、损伤水平、焦虑水平、抑郁水平等15个可能影响社区脊髓损伤患者日常生活活动能力的因素。采用自制问卷调查表收录患者的一般资料;应用美国脊髓损伤协会损伤分级评估患者脊髓损伤的水平;采用视觉模拟评分评估患者疼痛水平;采用焦虑自评量表和抑郁自评量表分别评估患者的焦虑和抑郁水平;采用改良Barthel指数评估患者的日常生活活动能力。结果:单因素分析结果显示,家庭年收入、支付类型、是否进行康复治疗、并发症、焦虑水平、疼痛水平与社区脊髓损伤患者日常生活活动能力具有相关性(P<0.05);二分类logistic回归分析中,在校正其他可能影响因素后发现康复治疗(OR=0.927,95%CI:0.329～0.977)、家庭年收入(OR=0.347,95%CI:0.073～0.524)、支付类型(OR=0.871,95%CI:0.006～0.930)及疼痛水平(OR=1.095,95%CI:0.054～0.129)是社区脊髓损伤患者日常生活活动能力的独立影响因素。结论:康复治疗、家庭年收入、支付类型及疼痛水平与社区脊髓损伤患者日常生活活动能力的改善密切相关,是早期关注影响社区脊髓损伤患者日常生活活动能力的关键因素,可有效预防其不良影响,提高患者的日常生活活动能力,从而提高社区脊髓损伤患者的生活质量。
Objective: To explore ways to improve the ability of patients with spinal cord injury in daily life activities, so as to improve the quality of life of patients with spinal cord injury in community. Methods: A total of 203 patients with spinal cord injury who met the inclusion criteria in Fuzhou, Shiyan, and Yinchuan were enrolled from March 2016 to February 2018. A cross-sectional survey was conducted to investigate the patients and collect data from therapists on patient evaluation and patient self-assessment. The data included age, gender, disease duration, education level, annual family income, type of payment, rehabilitation treatment, injury level,anxiety level, depression level and other factors that may affect the activities of daily living of patients with spinal cord injury in the community. The patient's general data were included in the self-made questionnaire. The level of spinal cord injury was assessed by the US Spinal Cord Injury Association injury classification. The visual analog scale was used to assess the pain level. The anxiety self-rating scale and the depression self-rating scale were used to evaluate the patients' anxiety and depression levels; the modified Barthel index was used to assess patients' ability to perform activities of daily living. Results: Univariate analysis showed that family annual income, type of payment, rehabilitation, complications, anxiety level, and pain level were associated with activities of daily living in patients with spinal cord injury(P<0.05); two-class logistic regression analysis, after adjusting for other possible influencing factors,rehabilitation treatment(OR=0.927, 95% CI: 0.329 ～0.977), annual household income(OR=0.347, 95% CI: 0.073 ～0.524), payment type(OR=0.871, 95%CI: 0.006～0.930) and pain level(OR=1.095, 95%CI: 0.054～0.129) were independent factors influencing the activities of daily living of patients with spinal cord injury in the community. Conclusion: Rehabilitation therapy, family income, payment type and pain level are closely related to the improvement of daily living activities of patients with spinal cord injury in the community. Early attention to the key factors affecting the activities of daily living of patients with spinal cord injury in the community can effectively prevent its adverse effects and improve the patient's ability to perform activities in daily life, thereby improving the quality of life of patients with spinal cord injury in the community.
Objective: To explore ways to improve the ability of patients with spinal cord injury in daily life activities, so as to improve the quality of life of patients with spinal cord injury in community. Methods: A total of 203 patients with spinal cord injury who met the inclusion criteria in Fuzhou, Shiyan, and Yinchuan were enrolled from March 2016 to February 2018. A cross-sectional survey was conducted to investigate the patients and collect data from therapists on patient evaluation and patient self-assessment. The data included age, gender, disease duration, education level, annual family income, type of payment, rehabilitation treatment, injury level,anxiety level, depression level and other factors that may affect the activities of daily living of patients with spinal cord injury in the community. The patient's general data were included in the self-made questionnaire. The level of spinal cord injury was assessed by the US Spinal Cord Injury Association injury classification. The visual analog scale was used to assess the pain level. The anxiety self-rating scale and the depression self-rating scale were used to evaluate the patients' anxiety and depression levels; the modified Barthel index was used to assess patients' ability to perform activities of daily living. Results: Univariate analysis showed that family annual income, type of payment, rehabilitation, complications, anxiety level, and pain level were associated with activities of daily living in patients with spinal cord injury(P<0.05); two-class logistic regression analysis, after adjusting for other possible influencing factors,rehabilitation treatment(OR=0.927, 95% CI: 0.329 ～0.977), annual household income(OR=0.347, 95% CI: 0.073 ～0.524), payment type(OR=0.871, 95%CI: 0.006～0.930) and pain level(OR=1.095, 95%CI: 0.054～0.129) were independent factors influencing the activities of daily living of patients with spinal cord injury in the community. Conclusion: Rehabilitation therapy, family income, payment type and pain level are closely related to the improvement of daily living activities of patients with spinal cord injury in the community. Early attention to the key factors affecting the activities of daily living of patients with spinal cord injury in the community can effectively prevent its adverse effects and improve the patient's ability to perform activities in daily life, thereby improving the quality of life of patients with spinal cord injury in the community.
引文
[1]许光旭,励建安.实用脊髓损伤康复学[M].北京:人民军医出版社,2013:2-4.
[2]唐红,陈菊娣.德国康复医疗的现况与思考[J].护理与康复,2014,13(1):98-99.
[3]李建军.中国康复医学发展的回顾与展望[J].中国康复理论与实践,2011,17(1):1-4.
[4]李建军,王方永.脊髓损伤神经学分类国际标准(2011年修订)[J].中国康复理论与实践,2011,17(10):963-972.
[5]方积乾,陆盈.现代医学统计学[M].北京:人民卫生出版社,2015:525-526.
[6] SAMAKOURI M,BOUHOS G,KADOGLOU M,et al. Standardization of the greek version of zung's self-rating anxiety scale(SAS)[J]. Psychiatriki,2012,23(3):212-220.
[7] CHAGAS M H,TUMAS V,LOUREIRO S R,et al. Validity of a Brazilian version of the Zung self-rating depression scale for screening of depression in patients with Parkinson's disease[J].Parkinsonism Relat Disord,2010,16(1):42-45.
[8]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):34-35.
[9] LEUNG S O,CHAN C C,SHAH S. Development of a Chinese version of the modified Barthel Index-validity and reliability[J].Clin Rehabil,2007,21(10):912-922.
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[12] FEHLINGS M G,FURLAN J C. Effect of age on spinal cord injury[J]. J Neurosurg Spine,2007,7(3):275-276.
[13] WATERS R L,ADKINS R H,YAKURA J S,et al. Motor and sensory recovery following incomplete paraplegia[J]. Arch Phys Med Rehabil,1994,75(1):67-72.
[14]夏娣文,山林林,查甫兵,等.康复治疗对脊髓损伤后抑郁患者生活能力及质量的影响[J].中国康复,2013,28(5):368-369.
[15]陈银海,靳安民,姚红华.脊髓损伤患者的抑郁情绪及其对功能恢复的影响[J].南方医科大学学报,2007,27(6):903-904,907.
[16]陆敏,彭军.脊髓损伤患者抑郁情绪及其影响因素的初步分析[J].中国康复,2002,17(1):29-30.
[17]刘颖,林强,何成奇.汶川地震脊髓损伤患者流行病学特征和ADL能力相关因素分析[C]//中国康复医学会第十届全国运动疗法大会暨“5·12”康复医学国际论坛论文汇编.成都:中国康复医学会,2009:1-2.
[18]张达慧,刘静,吴淑卿,等.康复护理对脊髓损伤患者ADL及并发症发生率的影响[J].中国社区医师,2017,33(15):160-162.
[19]葛敬波.早期康复对脊髓损伤患者功能恢复及并发症的影响[J].世界最新医学信息文摘,2017,17(46):1-2.
[20]勾丽洁,许世奇,刘旭东,等.早期康复对脊髓损伤患者功能恢复及并发症的影响[J].中国老年学杂志,2014,34(2):313-315.
[21]李坚.早期康复治疗对脊髓损伤并发症的预防作用(附23例报告)[J].广西医学,2011,33(2):203-205.
[22]汝再华,吴华.社区康复指导对脊髓损伤患者并发症及生存质量的影响[J].中国农村卫生事业管理,2013,33(11):1231-1233.
[23] BOHLMAN H H,ANDERSON P A. Anterior decompression and arthrodesis of the cervical spine:long-term motor improvement.PartI-Improvement in incomplete traumatic quadriparesis[J]. J Bone Joint Surg Am,1992,74(5):671-682.
[24] EASTWOOD E A,HAGGLUND K J,RAGNARSSON K T,et al.Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury--1990-1997[J]. Arch Phys Med Rehabil,1999,80(11):1457-1463.
[25] O'CONNOR P J. Survival after spinal cord injury in Australia[J].Arch Phys Med Rehabil,2005,86(1):37-47.
[26] BURKE D A,LINDEN R D,ZHANG Y P,et al. Incidence rates and populations at risk for spinal cord injury:a regional study[J].Spinal Cord,2001,39(5):274-278.
[27]戴红.脊髓损伤的中枢性疼痛诊断、评价和康复治疗[J].中国临床康复,2002,6(16):2362-2363.
[28] APKARIAN A V,BUSHNELL M C,TREEDE R D,et al. Human brain mechanisms of pain perception and regulation in health and disease[J]. Eur J Pain,2005,9(4):463-484.
[29] HEUTINK M,POST M W,BONGERS-JANSSEN H M,et al.The CONECSI trial:results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury[J]. Pain,2012,153(1):120-128.
[30] NORRBRINK C,LINDBERG T,WAHMAN K,et al. Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury-results from a seated double-poling ergometer study[J]. Spinal Cord,2012,50(6):457-461.
[31] NORRBRINK C, LUNDEBERG T. Acupuncture and massage therapy for neuropathic pain following spinal cord injury:an exploratory study[J]. Acupunct Med,2011,29(2):108-115.
[32] OSTERAKER A L,LEVI R. Indicators of psychological distress in postacute spinal cord injured individuals[J]. Spinal Cord,2005,43(4):223-229.
[2]唐红,陈菊娣.德国康复医疗的现况与思考[J].护理与康复,2014,13(1):98-99.
[3]李建军.中国康复医学发展的回顾与展望[J].中国康复理论与实践,2011,17(1):1-4.
[4]李建军,王方永.脊髓损伤神经学分类国际标准(2011年修订)[J].中国康复理论与实践,2011,17(10):963-972.
[5]方积乾,陆盈.现代医学统计学[M].北京:人民卫生出版社,2015:525-526.
[6] SAMAKOURI M,BOUHOS G,KADOGLOU M,et al. Standardization of the greek version of zung's self-rating anxiety scale(SAS)[J]. Psychiatriki,2012,23(3):212-220.
[7] CHAGAS M H,TUMAS V,LOUREIRO S R,et al. Validity of a Brazilian version of the Zung self-rating depression scale for screening of depression in patients with Parkinson's disease[J].Parkinsonism Relat Disord,2010,16(1):42-45.
[8]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):34-35.
[9] LEUNG S O,CHAN C C,SHAH S. Development of a Chinese version of the modified Barthel Index-validity and reliability[J].Clin Rehabil,2007,21(10):912-922.
[10]李丽,白玉龙,吴毅,等.影响脊髓损伤患者出院时日常生活活动能力的相关因素分析[J].中华物理医学与康复杂志,2010,32(6):442-445.
[11] PARK J H,KIM J H,ROH S W,et al. Prognostic factor analysis after surgical decompression and stabilization for cervical spinal-cord injury[J]. Br J Neurosurg,2017,31(2):194-198.
[12] FEHLINGS M G,FURLAN J C. Effect of age on spinal cord injury[J]. J Neurosurg Spine,2007,7(3):275-276.
[13] WATERS R L,ADKINS R H,YAKURA J S,et al. Motor and sensory recovery following incomplete paraplegia[J]. Arch Phys Med Rehabil,1994,75(1):67-72.
[14]夏娣文,山林林,查甫兵,等.康复治疗对脊髓损伤后抑郁患者生活能力及质量的影响[J].中国康复,2013,28(5):368-369.
[15]陈银海,靳安民,姚红华.脊髓损伤患者的抑郁情绪及其对功能恢复的影响[J].南方医科大学学报,2007,27(6):903-904,907.
[16]陆敏,彭军.脊髓损伤患者抑郁情绪及其影响因素的初步分析[J].中国康复,2002,17(1):29-30.
[17]刘颖,林强,何成奇.汶川地震脊髓损伤患者流行病学特征和ADL能力相关因素分析[C]//中国康复医学会第十届全国运动疗法大会暨“5·12”康复医学国际论坛论文汇编.成都:中国康复医学会,2009:1-2.
[18]张达慧,刘静,吴淑卿,等.康复护理对脊髓损伤患者ADL及并发症发生率的影响[J].中国社区医师,2017,33(15):160-162.
[19]葛敬波.早期康复对脊髓损伤患者功能恢复及并发症的影响[J].世界最新医学信息文摘,2017,17(46):1-2.
[20]勾丽洁,许世奇,刘旭东,等.早期康复对脊髓损伤患者功能恢复及并发症的影响[J].中国老年学杂志,2014,34(2):313-315.
[21]李坚.早期康复治疗对脊髓损伤并发症的预防作用(附23例报告)[J].广西医学,2011,33(2):203-205.
[22]汝再华,吴华.社区康复指导对脊髓损伤患者并发症及生存质量的影响[J].中国农村卫生事业管理,2013,33(11):1231-1233.
[23] BOHLMAN H H,ANDERSON P A. Anterior decompression and arthrodesis of the cervical spine:long-term motor improvement.PartI-Improvement in incomplete traumatic quadriparesis[J]. J Bone Joint Surg Am,1992,74(5):671-682.
[24] EASTWOOD E A,HAGGLUND K J,RAGNARSSON K T,et al.Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury--1990-1997[J]. Arch Phys Med Rehabil,1999,80(11):1457-1463.
[25] O'CONNOR P J. Survival after spinal cord injury in Australia[J].Arch Phys Med Rehabil,2005,86(1):37-47.
[26] BURKE D A,LINDEN R D,ZHANG Y P,et al. Incidence rates and populations at risk for spinal cord injury:a regional study[J].Spinal Cord,2001,39(5):274-278.
[27]戴红.脊髓损伤的中枢性疼痛诊断、评价和康复治疗[J].中国临床康复,2002,6(16):2362-2363.
[28] APKARIAN A V,BUSHNELL M C,TREEDE R D,et al. Human brain mechanisms of pain perception and regulation in health and disease[J]. Eur J Pain,2005,9(4):463-484.
[29] HEUTINK M,POST M W,BONGERS-JANSSEN H M,et al.The CONECSI trial:results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury[J]. Pain,2012,153(1):120-128.
[30] NORRBRINK C,LINDBERG T,WAHMAN K,et al. Effects of an exercise programme on musculoskeletal and neuropathic pain after spinal cord injury-results from a seated double-poling ergometer study[J]. Spinal Cord,2012,50(6):457-461.
[31] NORRBRINK C, LUNDEBERG T. Acupuncture and massage therapy for neuropathic pain following spinal cord injury:an exploratory study[J]. Acupunct Med,2011,29(2):108-115.
[32] OSTERAKER A L,LEVI R. Indicators of psychological distress in postacute spinal cord injured individuals[J]. Spinal Cord,2005,43(4):223-229.
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