与健康有关的生存质量的研究概况

开栏导语：（卓大宏）世界卫生组织新任总干事布伦特博士（Ｄｒ．Ｇ．Ｈ．Ｂｒｕｎｄｔｌａｎｄ）曾说过：２１世纪人类卫生问题最大的挑战将是改善生存质量,健康将成为人们享受生活最重要的前提。由于康复医学重视包括身体、心理、职业、教育、社会生活等方面的全面康复,因此,康复医学把提高生存质量（ｑｕａｌｉｔｙｏｆｌｉｆｅ,ＱＯＬ,亦称生活质量）作为其工作目标与工作原则之一。近年来,国际康复医学界也开始把康复医师称为“提高生存质量的医师”（ｐｈｙｓｉｃｉａｎｓａｄｄｉｎｇｑｕａｌｉｔｙｏｆｌｉｆｅ）。有鉴于此,…     

Cross-sectional and longitudinal associations between sleep and health-related quality of life in pregnant women: A prospective observational study

BackgroundSleep disturbances are common in women, especially during pregnancy. Previous studies have confirmed the importance of sleep disturbances as a risk factor of adverse pregnancy outcomes and the need for screening and treatment of inadequate sleep. These reports, however, did not examine health-related quality of life which may be affected by sleep long before adverse clinical consequences are detectable in women during pregnancy.ObjectivesTo examine the cross-sectional and longitudinal association between sleep and health-related quality of life in pregnant women.DesignA prospective observational study.SettingA university-affiliated hospital in Taiwan and participants’ homes.ParticipantsA total of 164 pregnant women completed questionnaires and wore a wrist actigraphy monitor for 7 days each trimester.MethodsObjective sleep was measured by actigraphy, subjective sleep was measured by the Pittsburgh Sleep Quality Index, and health-related quality of life was measured using the SF-12v2 questionnaire across three trimesters. Multiple linear regression analyses were performed to evaluate the cross-sectional and longitudinal associations between sleep and health-related quality of life.ResultsSixty-four (39.0%) women consistently had an average sleep efficiency < 85% by actigraphy and 40 (24.4%) had a Pittsburgh Sleep Quality Index global score > 5 in all three trimesters. Cross-sectionally, more actigraphic daytime sleep (p = 0.04) and better subjective sleep quality (p < 0.01) were associated with better physical health-related quality of life in first-trimester pregnant women. Better actigraphic sleep efficiency (p = 0.04) and better subjective sleep quality (p < 0.01) were associated with better mental health-related quality of life in second-trimester pregnant women. Longer actigraphic total nighttime sleep (p < 0.01) and better subjective sleep quality (p < 0.01) were associated with better mental health-related quality of life in third-trimester pregnant women. Longitudinally, first-trimester actigraphic total nighttime sleep (p < 0.05) and subjective sleep quality (p < 0.01) predicted mental health-related quality of life in the second and third trimester.ConclusionsSleep disturbances are a highly prevalent and persistent problem in pregnant women. Adequate sleep is essential for women at all pregnancy stages and improving nocturnal sleep quantity and quality in early gestation is of utmost importance for an optimal health-related quality of life later in pregnancy.     

The effect of acute kidney injury on long-term health-related quality of life: a prospective follow-up study

Introduction

Acute kidney injury (AKI) is a serious complication in critically ill patients admitted to the Intensive Care Unit (ICU). We hypothesized that ICU survivors with AKI would have a worse health-related quality of life (HRQOL) outcome than ICU survivors without AKI.

Methods

We performed a long-term prospective observational study. Patients admitted for > 48 hours in a medical-surgical ICU were included and divided in two groups: patients who fulfilled RIFLE criteria for AKI and patients without AKI. We used the Short-Form 36 to evaluate HRQOL before admission (by proxy within 48 hours after admission of the patient), at ICU discharge, hospital discharge, 3 and 6 months following ICU discharge (all by patients). Recovery in HRQOL from ICU-admission onwards was assessed using linear mixed modelling.

Results

Between September 2000 and January 2007 all admissions were screened for study participation. We included a total of 749 patients. At six months after ICU discharge 73 patients with AKI and 325 patients without AKI could be evaluated. In survivors with and without AKI, the pre-admission HRQOL (by proxy) and at six months after ICU discharge was significantly lower compared with an age matched general population. Most SF-36 dimensions changed significantly over time from ICU discharge. Change over time of HRQOL between the different AKI Rifle classes (Risk, Injury, Failure) showed no significant differences. At ICU discharge, scores were lowest in the group with AKI compared with the group without AKI for the physical functioning, role-physical and general health dimensions. However, there were almost no differences in HRQOL between both groups at six months.

Conclusions

The pre-admission HRQOL (by proxy) of AKI survivors was significantly lower in two dimensions compared with the age matched general population. Six months after ICU discharge survivors with and without AKI showed an almost similar HRQOL. However, compared with the general population with a similar age, HRQOL was poorer in both groups.     

Young traffic victims' long-term health-related quality of life: child self-reports and parental reports

OBJECTIVES: To describe the long-term health-related quality of life (HRQOL) reported by young traffic injury victims and to assess the child-parent agreement on the child's HRQOL. DESIGN: Cohort study with a mean follow-up of 2.4 years. SETTING: Traumatology department in a university hospital in The Netherlands. PARTICIPANTS: All traffic injury victims treated at the traumatology department in 1996-1997 and aged 8 to 15 years at follow-up (N = 254). The data of 157 child-parent pairs were available for analysis (mean follow-up age, 12+/-2.4 y; 57% boys; 24% hospitalized). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: TNO-AZL Children's Quality of Life parent and child questionnaires. RESULTS: Young traffic injury victims reported a significantly lower HRQOL in the motor and autonomy scales compared with contemporaries in the reference group. The child-parent agreement ranged from low to moderate (intraclass correlations,.35-.67). A comparison made between the children and their parents found that the children were more negative regarding the physical complaints and the motor, autonomy, and positive-emotion scales. CONCLUSIONS: Young traffic injury victims reported a reasonably good long-term HRQOL, and, surprisingly, few psychologic problems were revealed. Physicians who rely only on parental reports may overestimate the child's HRQOL, especially when assessing the physical functioning. The child's own reports should not be neglected in the assessment of a comprehensive picture of the child's HRQOL.     

Trajectories of health-related quality of life after stroke: results from a one-year prospective cohort study

Purpose: To identify trajectories of physical and psychosocial health-related quality of life (HRQoL) from two months to one-year post stroke and to determine the factors that are associated with trajectory membership.

Method: Multicenter prospective cohort study in which 351 stroke patients were followed up at 2, 6, and 12?months post stroke. Latent class growth mixture modeling was used to determine trajectories of physical and psychosocial HRQoL. Multinomial regression analyses were performed to predict trajectory membership. Potential predictors were demographic, stroke-related, and psychological factors.

Results: Four trajectories were identified for both physical and psychosocial HRQoL: high, low, recovery, and decline. Comparing the low and recovery trajectories, the groups with low HRQoL were more likely to have higher scores for neuroticism. Comparison of the decline and high trajectories yielded the following predictors of physical HRQoL: discharged to a rehabilitation setting, less acceptance and more neuroticism, pessimism, helplessness, and passive coping. Predictors of psychosocial HRQoL were: discharged to a rehabilitation setting, less self-efficacy, and proactive coping, and more helplessness and passive coping.

Conclusions: The present study identified four distinct trajectories of physical and psychosocial HRQoL. The findings indicate that psychological factors are the most important factors in identifying stroke patients at risk of unfavorable HRQoL trajectories. Using these factors will help to identify vulnerable patients and guide rehabilitation in the early stages post stroke.

• Implications for rehabilitation

• Clinicians should be aware that health-related quality of life follows distinct trajectories stable high, stable low, recovery, or decline, after onset of stroke.

• Determining relevant psychological factors, in particular helplessness and passive coping, in stroke patients early after stroke is important because these are predictors of unfavorable health-related quality of life trajectories.

     

Depression, fatigue, and health-related quality of life in head and neck cancer patients: a prospective pilot study

Purpose

To assess the prevalence of depression and fatigue symptoms in head and neck cancer patients during radiotherapy treatment and relate them symptoms with these patients’ quality of life.

Method

This is a prospective study. The Beck Depression Inventory (BDI), Piper Fatigue Scale-revised and Functional Assessment Cancer Therapy Head and Neck (FACT-H&N) were applied to 41 head and neck cancer patients at three times: at the start of treatment (T1), approximately 15?days after the start of treatment (T2) and at the end of treatment (T3), approximately 30?days after the start of the radiotherapy.

Results

The mean BDI and PIPER increased during the radiotherapy treatment. BDI scores did not demonstrate the presence of depression, although the number of symptoms increased, and the presence of fatigue rose as treatment advanced. The mean FACT H&N decreased in the middle and at the end of treatment, indicating worsening in these patients’ Quality of Life.

Conclusions

Depression and fatigue symptoms increased during radiotherapy treatment, while QoL levels decreased. This demonstrates that these symptoms are strongly correlated and that their presence negatively influenced QoL. At the start of treatment, nurses need to advise patients and plan care, offering interventions to decrease these symptoms and improve QoL.     

Outcomes measurement: health-related quality of life

Outcomes research is rapidly expanding and evolving in the assessment of medical treatment and has significant potential contributions to the assistive technology field. Over the past two decades, numerous instruments have been developed and are widely used to collect data for evaluating the efficacy and effectiveness of traditional medical interventions. Although this methodology may not transfer seamlessly to assistive technology, the basis of its instrumentation and many of its concepts are highly relevant. Many current and emerging medical and assistive technology interventions are vigorously advocated but have inadequately demonstrated their positive impact on outcome. A key concept used in medical technology outcomes measurement is health-related quality of life, which represents the functional effect of an illness and its consequent therapy as perceived by the individual receiving treatment. People tend to make decisions about alternative health care services by estimating the effects of an intervention on outcomes important to themselves, by comparing intervention benefits and harms and by deciding whether the outcomes are worth the costs. Numerous valid, reliable, and responsive health-related quality of life instruments are available and are designed to discriminate between individuals, to evaluate change over time, or to predict outcome. Many are worth examining for potential use or adaptation in assistive technology outcomes measurement. Some of these instruments are generic, some specific, and others deal with health state preference. Generic health-related quality of life instruments are broadly applicable across various diseases, conditions, or populations. Specific instruments focus on a given disease, condition, or population. Health state preference instruments assess an individual's desirability for a given health state or outcome. Assistive technology practitioners claim that they improve the quality of life for the individuals they serve. Health-related quality of life must then be considered an integral component of the evaluation of service effectiveness. This paper reviews the concepts and instrumentation used in medical technology assessment for consideration and potential application in assistive technology measurement.     

A longitudinal study of health-related quality of life after traumatic brain injury

OBJECTIVE: To examine the longitudinal course of health-related quality of life from 1 month to 3 to 5 years after traumatic brain injury (TBI). DESIGN: Longitudinal cohort study with 4 evaluation points. SETTING: Level I trauma center. PARTICIPANTS: Consecutive hospital admissions of 133 adolescents and adults with complicated mild to severe TBI who completed the outcome measure at all 4 time points, 111 general trauma patients, and 87 healthy friend controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Sickness Impact Profile. RESULTS: TBI patients reported significant limitations at 1 month postinjury, with substantial improvement occurring by 6 months, especially in the physical domain. Psychosocial improvement was smaller, and perceived cognitive, emotional, and communication difficulties did not change over the time period assessed. Persons with TBI had clear difficulties relative to healthy peers, but their reported level of difficulties was very similar to that of the persons who had sustained a general trauma by 1 year postinjury. CONCLUSIONS: In this sample, TBI was associated with significant early limitations in most aspects of everyday life. Considerable improvement was noted over the first 6 months postinjury, especially in physical domains. Some aspects of psychosocial functioning also improved, although reported limitations in communication, cognitive, and emotional domains remained constant over time. These findings highlight the persistence of injury-related difficulties that compromise quality of life.     

Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: a prospective multicenter cohort study

Introduction  

The aim of the present prospective multicenter cohort study was to examine the prevalence of sleep disturbance and its relation to the patient's reported health-related quality of life after intensive care. We also assessed the possible underlying causes of sleep disturbance, including factors related to the critical illness.     

A paediatric trauma study of scooter injuries

Objective: To investigate the incidence and describe the nature of non‐motorized scooter related injuries in children presenting to the ED. Setting: Paediatric ED of a metropolitan tertiary referral hospital. Methods: A prospective observational study of patients aged under 19 years presenting with injuries sustained while using a non‐motorized scooter. Clinicians recorded the data in the patient record. Main outcome measures: type of injury sustained; period of experience on the scooter; the use of protective gear; the presence of adult supervision; the place of accident; and the patient outcome. Results: Sixty‐two eligible patients were recruited over an 18 month period. The incidence of scooter‐ related injuries was 1.3% of all paediatric trauma presentations. There was a fall in scooter injury presentations over the study period; however, this was not statistically significant. The most common injury sustained using a scooter was an upper limb fracture (41.9%). Closed head injury comprised 8.1% of all scooter related injuries. The majority of patients were not wearing protective gear and were unsupervised at the time of their accident. Most patients (79%) were managed in the ED and discharged. Conclusions: There has been no significant change in scooter injury presentations over the two summer periods of 2000 and 2001. Children presenting to the ED with a scooter related injury tend to be primary school aged, which may have implications on scooter design, age recommendations and safety guidelines.     

与健康有关的生存质量评定探讨

随着医学科学的发展和人类健康观念的转变 ,医学模式已经由原来的生物医学模式转变为生物—心理—社会模式 ,健康已不再是简单的没有疾病 ,而是身体上、精神上和社会活动的完好状态。ＷＨＯ的布伦特博士 (Ｄｒ.Ｂｒｕｎｄｔｌａｎｄ)曾经指出 :2 1世纪人类卫生问题最大的挑战将是改善生存质量 ,健康将成为人们享受生活最重要的前提。因此 ,广大的医学工作者进行了生存质量测评的探讨 ,并提出了与健康有关的生存质量概念。近 2 0年来 ,生存质量的研究在国外已成为一个被各学科重视的研究热点 ,为药物筛选、评价临床治疗方法提供了重要依据。…     

Negative affectivity and health-related quality of life

OBJECTIVES: Although personality is known to influence patients' self-ratings of health, its effects on reports of health-related quality of life (HRQOL) have not been fully described. We examined the relationship between a dimension of personality called negative affectivity (NA; a general disposition to experience negative mood states) and HRQOL, controlling for age and common chronic physical and mental diseases. METHODS: We used data from 3 samples of veterans: the Department of Veterans Affairs (VA) Normative Aging Study (NAS), the Veterans Health Study (VHS), and the VA Women's Health Project (VA WHP). For each of the 8 SF-36 scales and the physical and mental component summary scales, 2 regression models were estimated, the first of which included only chronic diseases and age and the second of which added NA. RESULTS: NA was consistently negatively associated with SF-36 scale scores in bivariate analyses. The regression models indicated that across the 3 samples, NA explained between 0% and 13.9% additional variance in the scales, with the least additional variance in the physical function domains (range 0-2.6%) and the most in the mental function domains (range 0-13.9%). Results from the summary scales were similar: NA explained none of the variance in the physical component summary and 3.5% to 10.4% in the mental component summary. These results were largely consistent across the 3 samples. CONCLUSIONS: These results suggest the importance of NA in patients' ratings of HRQOL beyond that of age and chronic conditions. Thus, clinicians and researchers who rely on measures such as the SF-36 to assess health status should consider that personality, as well as underlying health, can affect self-ratings of HRQOL.     

Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash

BackgroundHealth-related quality of life (HRQoL) is an important patient-reported outcome that warrants greater attention in individuals who sustained a non-catastrophic injury in a road traffic crash. Additional robust data on HRQoL outcomes after a non-catastrophic injury are needed to effectively identify potential targets for studies of tertiary prevention of poor recovery after a crash.ObjectiveWe assessed the association between non-catastrophic road traffic crash injuries and HRQoL and factors that independently affect long-term HRQoL.MethodsIn this inception cohort study, injured participants (≥ 17 years old) were identified from various sources including hospital emergency departments by a medical examination by a registered healthcare professional in New South Wales (Australia) and followed up after 12 months. HRQoL was measured by the European Quality of Life–5 Dimensions (EQ-5D-3L) and Medical Outcomes Survey Short Form 12 items (SF-12). A range of socio-demographic, pre-injury health, psychological, and injury-related factors were considered potential predictors of HRQoL in regression analyses.ResultsAmong 2019 individuals identified, 1201 (59.5%) were followed up after 12 months. HRQoL significantly improved between baseline and 12-month follow-up: EQ-5D-3L summary score (0.41-unit difference); SF-12 physical component summary score (PCS; 13.6-unit difference) and mental component summary score (MCS; 3.5-unit difference). Over 12 months, HRQoL score was lower for people claiming compensation than others (P < 0.0001). Key predictors of better 12-month EQ-5D-3L summary score and visual analogue scale score for pain were age, not claiming compensation, reduced body mass index, less pain severity, less pain-related disability, and less general psychological distress. Significant predictors of SF-12 PCS score were injury to the neck (P = 0.02) or head or face (P = 0.01), being a driver or passenger at the time of the crash (P < 0.0001), hospital admission (P < 0.0001) and pain severity (P < 0.0001). Baseline variables associated with 12-month SF-12 MCS scores were head or face injury (P = 0.02), pre-injury health (P = 0.04), pre-injury psychological conditions (P = 0.04), trauma-related distress (P = 0.0002) and general psychological distress (P < 0.0001).ConclusionsA wide spectrum of biopsychosocial factors contribute to HRQoL after a road traffic crash injury. These epidemiological data are potentially important because they could identify potential targets for studies of tertiary prevention of persistently poor HRQoL after such an injury.     

Research on health-related quality of life and cardiac conditions

According to the , health-related quality of life (HRQoL) is a broad multidimensional concept that typically encompasses self-reported measures of physical and mental health. HRQoL is an individually based, multidomain concept referring to how a health condition impacts a person's perception of their well- being. HRQoL encompasses several domains to include functional ability, psychological state, social function, and an individual's perception of his or her health. As life expectancy continues to increase, the rates of chronic disease will also continue to grow. Patient-centric outcomes that include HRQoL will become even more important as individuals adjust to living with chronic conditions such as heart failure (HF) and other cardiac conditions. This article features 4 HRQoL-related studies. The 1st article presents data on the ability to use HRQoL measurement to predict event-free survival in HF patients. The results have implications for potentially determining those most in need of additional intervention. The 2nd article looks at the relationship between cognitive impairment and HRQoL in HF patients. The 3rd and 4th articles present information on the effect of clinical interventions on HRQoL and other outcomes. One article describes a telephone-delivered collaborative care intervention to help postcoronary artery bypass graft patients with depressive symptoms. The other intervention article describes the success of a home-based cardiac rehabilitation program. Interested readers are encouraged to read the original articles for full information about the study methods and findings.     

Symptom status and health-related quality of life: clinical relevance

BACKGROUND: Nursing continues to struggle to identify outcomes that measure quality of care. Health-related quality of life (HRQOL) has been identified as an outcome indicator that is sensitive to health-care interventions. However, clinicians remain skeptical about its relevance. AIM: This article discusses the conceptual issues surrounding HRQOL research and provides an example that demonstrates how symptom status can serve as a clinically relevant and measurable dimension of HRQOL. METHODS: The study sample (n = 99) were patients presenting to the emergency department of an academic medical centre in the United States of America (USA) between July 1997 and March 1999 with the diagnosis of gastrointestinal bleeding. The mean age was 57.86 (17.52) years and 62.6% of the sample was male. The Short Form-12 (SF-12) (measurement used for HRQOL) and a 15-item symptom checklist were administered within the first 24 hours following the emergency department visit and by phone 1 month after discharge. RESULTS: Regression analysis controlling for age, gender, haematocrit and comorbidities was used to examine the relationships between symptom status and HRQOL. The analysis suggests that symptom status is a key predictor of HRQOL. STUDY LIMITATIONS: The sample was a relatively small convenience sample from one emergency department in the USA. CONCLUSIONS: Nurses are concerned with improving patients' HRQOL. Certainly, symptoms are amenable to nursing interventions. We provide one example that demonstrates the relationship between symptom status and HRQOL. By tracking and studying trends in the number of symptoms over time we can begin to track HRQOL as an outcome of care. Thus, we conclude that by helping patients manage their symptoms their overall HRQOL would improve.     

Technology dependence and health-related quality of life: a model

AIM: This paper presents a new theoretical model to explain people's diverse responses to therapeutic health technology by characterizing the relationship between technology dependence and health-related quality of life (HRQL). INTRODUCTION: Technology dependence has been defined as reliance on a variety of devices, drugs and procedures to alleviate or remedy acute or chronic health problems. Health professionals must ensure that these technologies result in positive outcomes for those who must rely on them, while minimizing the potential for unintended consequences. Little research exists to inform health professionals about how dependency on therapeutic technology may affect patient-reported outcomes such as HRQL. Organizing frameworks to focus such research are also limited. MODEL: Generated from the synthesis of three theoretical frameworks and empirical research, the model proposes that attitudes towards technology dependence affect HRQL through a person's illness representations or commonsense beliefs about their illness. Symptom distress, illness history, age and gender also influence the technology dependence and HRQL relationship. Five concepts form the major components of the model: a) attitudes towards technology dependence, b) illness representation, c) symptom distress, d) HRQL and e) illness history. CONCLUSION: The model is proposed as a guide for clinical nursing research into the impact of a wide variety of therapeutic health care interventions on HRQL. Empirical validation of the model is needed to test its generality.     

Use of Sheng-Hua-Tang and health-related quality of life in postpartum women: A population-based cohort study in Taiwan

Background

Although Sheng-Hua-Tang (comprising Radix Angelicae Sinensis, Ligustici Rhizoma, Semen Persicae, Zingiberis Rhizoma and Glycyrrhizae Radix) use during the postpartum has been popular in Chinese communities over a long period, its benefits have not been evaluated in terms of its effects on the health-related quality of life of postpartum women.

Objectives

This study aims to explore the relation between different patterns of Sheng-Hua-Tang use and the health-related quality of life in postpartum women.

Design

A longitudinal birth cohort follow-up study.

Settings and participants

We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. A structured questionnaire was successfully administered to 87.8% of the sampled population.

Methods

Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the quality of life of the women with different patterns of Sheng-Hua-Tang use.

Results

Compared with those who never used after delivery, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang within 1 month only but decreased in those who continuously used within 1 month and later. In addition, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang regardless of the frequency.

Conclusions

Sheng-Hua-Tang use during the first month of the postpartum period may have a positive effect on women's health-related quality of life especially in terms of role limitations due to physical health and emotional problems. However, continuous use after the first month of the postpartum period might have a negative effect on women's quality of life. Further studies are needed to replicate the results and elucidate the causal relations.     

Effects of a multidisciplinary rehabilitation programme on health-related quality of life in patients with prolonged musculoskeletal disorders: A 6-month follow-up of a prospective controlled study

Purpose: The aim of this prospective, controlled, follow-up study (6 months) was to examine the effects of a multi-disciplinary rehabilitation programme on perceived health-related quality of life (HRQL) in patients with prolonged musculoskeletal disorders (PMSD). The programme focused on body awareness therapy and cognitive and relaxation treatment.

Method: The rehabilitation group comprised 122 patients, and there were 114 patients in the matched control group (CG). Both groups of patients had access to primary health care. Baseline data were compared with 6-month follow-up data within and between the groups. The following measurements were employed: HRQL (Nottingham Health Profile), body awareness, postural control, pain (VAS), pain-related medicine consumption, isometric arm muscle endurance, aerobic capacity, psychosomatic symptoms, physical and psychosocial working environment and sick leave.

Results: Variables that improved significantly as compared with the CG were: HRQL, anxiety, pain related to movements, psychosomatic symptoms and need for pain-related medicines.

Conclusions: The multidisciplinary rehabilitation programme used here improved HRQL in patients with PMSD to a greater extent than the standard treatment provided within primary health care (p = 0–01), at least in the short term.