急性脑卒中患者的生活质量及其影响因素
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摘要
目的 了解对脑卒中患者的生活质量及其影响因素。方法 将80例脑卒中偏瘫患者随机分成康复组(40例)和对照组(40例)，进行临床对照研究，两组均常规进行神经内科的药物治疗，康复组增加运动疗法、言语治疗等现代康复治疗方法，对每例患者在进入课题时和6个月后分别利用世界卫生组织生活质量评定量表简表(WHOQOL-BEEF)中文版，Barthel Index(BI)对其生活质量(QOL)、日常生活活动能力(ADL)进行评定，比较分析影响生活质量的影响因素。结果 (1)康复组两次生活质量评分分别为59.85±12.14、76.66±13.62，对照组为59.87±11.45、69.75±10.19；两组前后比较均有显著性差异(p＜0.05)；两组变化均数比较康复组6个月后的QOL恢复优于对照组(p＜0.05)；利用Pearson相关检验QOL的改善程度与ADL的改善程度成正相关。(2)利用logestic回归检验影响生活质量的主要因素为年龄、发病到治疗的时间、职业、早期康复治疗以及婚姻状况。结论 早期康复治疗有利于改善脑卒中患者的生活质量和日常生活活动能力。
Objective To investigate the status of the quality of life (QOL) and its influencing factors among acute stroke survivals. Methods 80 hemipaligic patients who suffered from acute stroke were randomly divided into two groupes:40 cases in the early rehabilitation group,40 cases in the control group. Patients in the rehabilitation group were given clinical treatment electrical stimulation therapy and regularly physical therapy and speech therapy and so on. While those in control group were given clinical treatment, and the evaluation was done in pre-treatment and post 6 months respectively .QOL was assessed with WHO-BEEF questionnaire of Chinese version .Activity of daily life(ADL) was assessed with Barthel Index (BI). Result (1) The QOL scores and BI scores in each groups rised had a significant difference (p<0.05),the process of scores in the rehabilitation group were obviously superior to that in the control group. (2)The main factors influencing the quality of life include age job, early rehabilitation ,marry. and the time from onset to the beginning of treatment. Conclusion Early rehabilitation training on hemiplegias after stroke may obviously improve QOL scores.
Objective To investigate the status of the quality of life (QOL) and its influencing factors among acute stroke survivals. Methods 80 hemipaligic patients who suffered from acute stroke were randomly divided into two groupes:40 cases in the early rehabilitation group,40 cases in the control group. Patients in the rehabilitation group were given clinical treatment electrical stimulation therapy and regularly physical therapy and speech therapy and so on. While those in control group were given clinical treatment, and the evaluation was done in pre-treatment and post 6 months respectively .QOL was assessed with WHO-BEEF questionnaire of Chinese version .Activity of daily life(ADL) was assessed with Barthel Index (BI). Result (1) The QOL scores and BI scores in each groups rised had a significant difference (p<0.05),the process of scores in the rehabilitation group were obviously superior to that in the control group. (2)The main factors influencing the quality of life include age job, early rehabilitation ,marry. and the time from onset to the beginning of treatment. Conclusion Early rehabilitation training on hemiplegias after stroke may obviously improve QOL scores.
引文
1，王维治，罗祖明等，神经内科学第四版 人民卫生出版社；2001：187
2, Hopman WM, Verner J.Quality of life during and after inpatient stroke rehabilitation. [J] Stroke.2003;34:801-805.
3, Claesson L, Gosman-Hedstrom G, Johannesson M.et al. Resource utilization and costs of stroke unit care integrated in a care control. [J] Stroke.2000;31: 2569-2577.
4，王拥军主编·卒中单元·北京：科学技术文献出版社，2003
5, Hann RD, Aaronson N, Limburg M, et al. Measuring quality of life in stroke. [J] Stroke.1993;24: 320-327.
6, Tammy O, Michelle YU, Elvinaluistyo M. Health-related quality of life after stroke a comprehensive review. [J] Stroke.2001;32: 964-972.
7, Ronning OM, Guldvog B. Outcome of stroke rehabilitation a randomized controlled trial. Stroke. 1998;29: 779-784.
8，方积乾，万崇华，郝元涛：与健康有关的生活质量的研究概况．中国康复医学杂志．2001．15(1)：40～43
9, Devereaux P.J, Manns BJ., Ghali WA, et al. Reviewing the reviewers: the quality of reporting in three secondary journals Can. Med. Assoc. J., May 1, 2001; 164(11): 1573-1576.
10, Indredavik B, Bakke F, Sl(?)rdahl SA, Rokseth R, H(?)heim LL. Stroke unit treatment improves long-term quality of life: a randomized controlled trial. Stroke. 1998; 29: 895-899.
11, Hilari K, Byng k, Lamping DL, et al. Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39): Evaluation of Acceptability, Reliability, and Validity. Stroke, August 1, 2003; 34(8): 1944-1950.
12, Robinson-Smith G, Johnston MV, Allen J. Self-care self-efficacy, quality
of life, and depression after stroke.[J] Arch Phys Med Rehabil. 2000; 81: 460-464.
13, Williams LS, Weinberger M, Harris LE, Clark DO, Biller J. Development of a stroke-specific quality of life scale. [J]Stroke. 1999; 30: 1362-1369.
14, Williams LS, Weinberger M, Harris LE, Biller J. Measuring quality of life in a way that is meaningful to stroke patients. Neurology. 1999; 53: 1839-1843.
15, Andresen EM, Meyers AR. Health-related quality of life outcomes measures. Arch Phys Med Rehabil. 2000; 81: S30-S45.
16, Marks G, Solis J, et al .Health behavior of elderly hispanic women: does cultural assimilation make a different?Am J Public Health, 1987,7:1315-1319.
17, De Haan RJ, Limburg M, Jacobs HM, et al. Quality of life after stroke: impact of stroke type and lesion location. Stroke. 1995; 26: 402-408.
18, Sulch D, Melbourn A, Perez I, et al Integrated care pathways and quality of life on a stroke rehabilitation unit.Stroke.2002; 33:1600-1604.
19，卓大宏．社区康复与社区卫生服务．中国全科医学．2002，5(5)：337～339
20，方积乾，郝元涛，李彩霞·世界卫生组织生活质量量表中文版的信度与效度·中国心理卫生杂志，1999，13；203-205．
21, Marja LN, Laaksonen R, Oseberg TS, et al. Quality of life 4 years after stroke [J].Stroke, 1988; 19:1101-1107.. Pordal V, Borsen G. Direct cost of transient ischemic attacks a hospital-based study of resource used during the first year after transient ischemic attacks indenmark.
22, Wade DT. Out come measures for clinical rehabilitation trials impairment, function, quality of life, or value? Am J Phys Med Rehabil. 2003;82(Suppl):S26-S31.
23, Ahlsio B, Brlttoa M, Testa MA. et al. Disablement and quality of life after
stroke.[J].Stroke,1984;15:886-890.
24, Sturm JW, Osnorne RH, Dewey HM, et al. Brief comprehensive quality of life assessment after stroke the assessment of quality of life instrument in the north east melbourne stroke incidence study (NEMESIS). Stroke 2002;33:2888-2894
25, Mayo NE, Wood-Dauphinee s, Cote R, et al. Activity, participation, and quality of life months poststroke. Arch Phys Med Rehabil. 2002; 83:1035-1042.
26, Robinsion-Smith G, Johnston MV, Alien J, et al. Self-care self-efficacy, quality of life, and depression after stroke. Arch Phy Med Rehabil. 2000: 81: 460-464.
27, Holroyol-Leduc JM, Kapral MK, Austin PC, et al. Sex difference and similarities in the management and outcom of stroke patients. Stroke,2000;31:1833-1837.S
28, Tulsky DS, Rosenthal M, Measurement of quality of life in rehabilitation medicine: emerging issues. Arch Phys Med Rehabil. 2003;84 supply 2: S1-S2.
29，郑良成，罗祖明，胡艳等·脑梗死患者生存质量及改善相关影响因素研究·中国康复医学杂志，2001，5(12)：28-29．
30, Kaplan RM. Quality of life: an outcome perpective. Arch Phys Med Rehabil. 2003; 84 supply 2: S44-S50.
31, Indredavik B, Bakke F, Slordahl SA. et al. Stroke unit treatment improves long-term quality of life a randomized controlled. Stroke. 1998; 29: 895-889.
32，王拥军·脑血管病医疗模式正在转变之中·中华内科杂志，2002，41：721-723
33, Roberts L, Counsell C. Assessment of clinical outcomes in acute stroke trials. Stroke. 1998; 29: 986-991.
34, Testa MA, Lenderking WR. Quality-of-life considerations in AIDS clinical
trials. In: Finkelstein DM, Schoenfeld DA, eds. AIDS clinical trials. New York: Wiley-Liss, 1995:213-41.
35, Fayers PM, Hand DJ, Bjordal K, Groenvold M. Causal indicators in quality of life research. Qual Life Res. 1997;6:393—406
36，倪朝民主编·脑血管病的临床康复·安徽：安徽大学出版社，1998．
37, Teasell R. Stroke recovery and rehabilitation.Stroke.2003; 34:365-366.
38，高磊，王茂斌·脑的可塑性与卒中康复·国外医学脑血管疾病分册，2000，8(12)：368-370．
39，郑洪波，刘鸣·亚太地区卒中管理论坛及墨尔本宣言·国外医学脑血管疾病分册，1999，7(8)：235-238．
40, Roberts L, Counsell C. Assessment of clinical outcomes in acute stroke trials. Stroke. 1998; 29:986-991.
41, Fayers PM, Hand DJ, Bjordal K, Groenvold M. Causal indicators in quality of life research. Qual Life Res. 1997;6:393—406
2, Hopman WM, Verner J.Quality of life during and after inpatient stroke rehabilitation. [J] Stroke.2003;34:801-805.
3, Claesson L, Gosman-Hedstrom G, Johannesson M.et al. Resource utilization and costs of stroke unit care integrated in a care control. [J] Stroke.2000;31: 2569-2577.
4，王拥军主编·卒中单元·北京：科学技术文献出版社，2003
5, Hann RD, Aaronson N, Limburg M, et al. Measuring quality of life in stroke. [J] Stroke.1993;24: 320-327.
6, Tammy O, Michelle YU, Elvinaluistyo M. Health-related quality of life after stroke a comprehensive review. [J] Stroke.2001;32: 964-972.
7, Ronning OM, Guldvog B. Outcome of stroke rehabilitation a randomized controlled trial. Stroke. 1998;29: 779-784.
8，方积乾，万崇华，郝元涛：与健康有关的生活质量的研究概况．中国康复医学杂志．2001．15(1)：40～43
9, Devereaux P.J, Manns BJ., Ghali WA, et al. Reviewing the reviewers: the quality of reporting in three secondary journals Can. Med. Assoc. J., May 1, 2001; 164(11): 1573-1576.
10, Indredavik B, Bakke F, Sl(?)rdahl SA, Rokseth R, H(?)heim LL. Stroke unit treatment improves long-term quality of life: a randomized controlled trial. Stroke. 1998; 29: 895-899.
11, Hilari K, Byng k, Lamping DL, et al. Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39): Evaluation of Acceptability, Reliability, and Validity. Stroke, August 1, 2003; 34(8): 1944-1950.
12, Robinson-Smith G, Johnston MV, Allen J. Self-care self-efficacy, quality
of life, and depression after stroke.[J] Arch Phys Med Rehabil. 2000; 81: 460-464.
13, Williams LS, Weinberger M, Harris LE, Clark DO, Biller J. Development of a stroke-specific quality of life scale. [J]Stroke. 1999; 30: 1362-1369.
14, Williams LS, Weinberger M, Harris LE, Biller J. Measuring quality of life in a way that is meaningful to stroke patients. Neurology. 1999; 53: 1839-1843.
15, Andresen EM, Meyers AR. Health-related quality of life outcomes measures. Arch Phys Med Rehabil. 2000; 81: S30-S45.
16, Marks G, Solis J, et al .Health behavior of elderly hispanic women: does cultural assimilation make a different?Am J Public Health, 1987,7:1315-1319.
17, De Haan RJ, Limburg M, Jacobs HM, et al. Quality of life after stroke: impact of stroke type and lesion location. Stroke. 1995; 26: 402-408.
18, Sulch D, Melbourn A, Perez I, et al Integrated care pathways and quality of life on a stroke rehabilitation unit.Stroke.2002; 33:1600-1604.
19，卓大宏．社区康复与社区卫生服务．中国全科医学．2002，5(5)：337～339
20，方积乾，郝元涛，李彩霞·世界卫生组织生活质量量表中文版的信度与效度·中国心理卫生杂志，1999，13；203-205．
21, Marja LN, Laaksonen R, Oseberg TS, et al. Quality of life 4 years after stroke [J].Stroke, 1988; 19:1101-1107.. Pordal V, Borsen G. Direct cost of transient ischemic attacks a hospital-based study of resource used during the first year after transient ischemic attacks indenmark.
22, Wade DT. Out come measures for clinical rehabilitation trials impairment, function, quality of life, or value? Am J Phys Med Rehabil. 2003;82(Suppl):S26-S31.
23, Ahlsio B, Brlttoa M, Testa MA. et al. Disablement and quality of life after
stroke.[J].Stroke,1984;15:886-890.
24, Sturm JW, Osnorne RH, Dewey HM, et al. Brief comprehensive quality of life assessment after stroke the assessment of quality of life instrument in the north east melbourne stroke incidence study (NEMESIS). Stroke 2002;33:2888-2894
25, Mayo NE, Wood-Dauphinee s, Cote R, et al. Activity, participation, and quality of life months poststroke. Arch Phys Med Rehabil. 2002; 83:1035-1042.
26, Robinsion-Smith G, Johnston MV, Alien J, et al. Self-care self-efficacy, quality of life, and depression after stroke. Arch Phy Med Rehabil. 2000: 81: 460-464.
27, Holroyol-Leduc JM, Kapral MK, Austin PC, et al. Sex difference and similarities in the management and outcom of stroke patients. Stroke,2000;31:1833-1837.S
28, Tulsky DS, Rosenthal M, Measurement of quality of life in rehabilitation medicine: emerging issues. Arch Phys Med Rehabil. 2003;84 supply 2: S1-S2.
29，郑良成，罗祖明，胡艳等·脑梗死患者生存质量及改善相关影响因素研究·中国康复医学杂志，2001，5(12)：28-29．
30, Kaplan RM. Quality of life: an outcome perpective. Arch Phys Med Rehabil. 2003; 84 supply 2: S44-S50.
31, Indredavik B, Bakke F, Slordahl SA. et al. Stroke unit treatment improves long-term quality of life a randomized controlled. Stroke. 1998; 29: 895-889.
32，王拥军·脑血管病医疗模式正在转变之中·中华内科杂志，2002，41：721-723
33, Roberts L, Counsell C. Assessment of clinical outcomes in acute stroke trials. Stroke. 1998; 29: 986-991.
34, Testa MA, Lenderking WR. Quality-of-life considerations in AIDS clinical
trials. In: Finkelstein DM, Schoenfeld DA, eds. AIDS clinical trials. New York: Wiley-Liss, 1995:213-41.
35, Fayers PM, Hand DJ, Bjordal K, Groenvold M. Causal indicators in quality of life research. Qual Life Res. 1997;6:393—406
36，倪朝民主编·脑血管病的临床康复·安徽：安徽大学出版社，1998．
37, Teasell R. Stroke recovery and rehabilitation.Stroke.2003; 34:365-366.
38，高磊，王茂斌·脑的可塑性与卒中康复·国外医学脑血管疾病分册，2000，8(12)：368-370．
39，郑洪波，刘鸣·亚太地区卒中管理论坛及墨尔本宣言·国外医学脑血管疾病分册，1999，7(8)：235-238．
40, Roberts L, Counsell C. Assessment of clinical outcomes in acute stroke trials. Stroke. 1998; 29:986-991.
41, Fayers PM, Hand DJ, Bjordal K, Groenvold M. Causal indicators in quality of life research. Qual Life Res. 1997;6:393—406