多学科联合护理对慢性肾脏病患者体力活动能力和生活质量的影响

摘要 目的 探索多学科联合护理对慢性肾脏病患者体力活动能力和生活质量的影响。方法 采用随机抽样法选取2018年6月~2020年7月我院123例慢性肾脏病患者作为研究对象,根据护理方法不同进行分组,其中55例实施常规护理,纳入对照组,68例实施多学科联合护理,纳入观察组。比较两组患者干预后入院宣教知晓情况、计划出院情况,入院时、出院6个月后体力活动能力[国际体力问卷（IPAQ）]、生活质量（QOL-100）评分、自我管理能力（自我管理行为量表）变化。结果 干预后,观察组患者入院宣教知晓率、计划出院率均高于对照组（P＜0.05）;出院6个月后,两组患者IPAQ日体力活动消耗量均较入院时提高,且观察组显著高于对照组（P＜0.05）;两组患者QOL-100量表中生理、心理、社会关系、生活状况、独立能力五个方面评分均较入院时提高,且观察组高于对照组（P＜0.05）;两组患者自我管理行为量表遵医嘱、饮食控制、规律锻炼、并发症护理各方面评分均较入院时提高,且观察组高于对照组（P＜0.05）。结论 慢性肾脏病患者实施多学科联合护理,可改善患者入院宣教知晓情况与计划出院情况,提高其自我管理能力,有效患者体力活动能力与生活质量。     

Metastatic castrate‐resistant prostate cancer: a discussion of the physical and psychosocial effects

Management options for metastatic castrate‐resistant prostate cancer (mCRPC) have increased in recent years resulting in more men living for longer with the disease. The implications for patients and health care services are considered through an examination of the literature in relation to the physical and psychosocial effects of mCRPC and its treatment, looking at quality of life (QoL) and service delivery implications. QoL in advanced prostate cancer has been well documented in the literature but studies involving those with mCRPC are sparse. There is a lack of evidence regarding psychological distress and effective psychological interventions for men with mCRPC. There is a need for research to understand the impact of new treatments on QoL of men and their partners, to establish effective psychological interventions for men with mCRPC and to quantify the increased demand for services with prolonged survival. The purpose of this discussion paper is to examine the physical and psychosocial effects of both disease and treatment, alongside QoL issues and consideration of the implications for service delivery.     

慢性肾功能衰竭行维持性血液透析患者生活质量与社会支持的相关性调查分析

目的探讨慢性肾功能衰竭行维持性血液透析患者生活质量与社会支持的相关性。方法调查92例慢性肾衰竭行维持性血液透析患者的社会支持情况,并与正常对照组进行比较,分析慢性肾衰竭行维持性血液透析患者生活质量与社会支持的相关性。结果慢性肾衰竭行维持性血液透析患者的社会支持与正常对照组比较,差异有显著意义（P〈0.05）;生活质量与其社会支持呈正相关（r=0.684,P〈0.05）。结论慢性肾衰竭行维持性血液透析患者得到比正常人高的社会支持,其生活质量与社会支持密切相关,护理过程中重视社会支持可改善护理效果,提高慢性肾衰竭行维持性血液透析患者的生活质量。     

Effective rehabilitation interventions and participation among people with multiple sclerosis: An overview of reviews

Multiple sclerosis (MS) is the most common cause of non-traumatic disability in people aged 10–65 years. Evidence exists for the effectiveness of multidisciplinary rehabilitation and exercise. However, the effectiveness of other rehabilitation approaches in MS needs further evaluation. The purposes were to systematically synthesise and evaluate knowledge on effectiveness of rehabilitation interventions and determinants for participation among persons with MS (pwMS) to inform clinical guidelines on rehabilitation. Joanna Briggs Institute methodology was used. PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched for reviews, systematic reviews, meta-analyses, and meta-syntheses published 2009–2019. All types of rehabilitation interventions provided to pwMS at any time and in all settings were eligible. Two reviewers independently screened and extracted data. The most recently published reviews on mixed and specific modalities were included. The findings were reported in a narrative summary and a mixed-method analysis. Among 108 eligible reviews, 6 qualitative or mixed-method reviews and 66 quantitative were included (total pwMS > 90,000). This overview provides solid evidence for effectiveness of a spectrum of modalities. Among the modalities, there was strong evidence for the effectiveness of multidisciplinary, cognitive and exercise approaches, physiotherapy, and occupational therapy including full body training on functioning and participation outcomes. Employment significantly influenced quality of life; thus, vocational rehabilitation should be initiated early. The healthcare professionals should identify personal factors including relations and coping, and the rehabilitation process should involve partners or close family. The mixed-method analysis revealed insufficient consensus between the perspectives of pwMS on their rehabilitation and reported effects indicating that further research should target the experiences of pwMS. Further, results showed that rehabilitation should be patient-centred, focus on the complexity of needs, and be organised and performed by an experienced multidisciplinary team. Evidence-based rehabilitation should be initiated early after pwMS are diagnosed and follow international guidelines.Database registrationPROSPERO ID: CRD42020152422.     

Effectiveness of psychosocial interventions on quality of life of patients with schizophrenia and related disorders: A systematic review

BackgroundImproving the quality of life of patients with schizophrenia is emphasized all over the world.AimTo identify and synthesize the best available evidence on the effectiveness of family interventions, patient education, social skills training and vocational rehabilitation on the quality of life of patients with schizophrenia and related disorders.MethodA systematic literature review.ResultsThere is some but weak evidence that family intervention and vocational rehabilitation may enhance the quality of life of patients with schizophrenia.ConclusionsMore research is needed to determine the effectiveness of psychosocial interventions on the quality of life of patients with schizophrenia.     

Development and evaluation of a problem-focused psychosocial intervention for patients with head and neck cancer

Goals of the work  Patients with head and neck cancer have complex needs that affect many basic functions of life and contribute to substantial psychosocial problems. The aim of this study was to evaluate the effectiveness of a problem-focused intervention for patients with psychosocial dysfunction who had completed treatment for head and neck cancer. Patients and methods  Using a quasi-experimental design, 54 participants who were above pre-determined cutoff points for psychosocial dysfunction (hospital and depression scale, work and social adjustment scale) were given the opportunity to self-select into either the experimental group for the psychosocial intervention programme which was delivered in an individualised format, with bibliotherapy as an adjunct, or the control group for usual care. Main results  Analysis of covariance results demonstrated a reduction in psychological distress (anxiety, p = 0.001; depression, p = 0.005), improving social functioning (p = 0.048) and quality of life scores (p = <0.05) for the experimental group, all of which were sustained into the 3-month follow-up period. No such improvements were evident for the control group. Conclusions  This study suggests that head and neck cancer patients with post-treatment psychosocial dysfunction can benefit from a problem-focused psychosocial intervention. Such evidence can inform practice, policy and future research, aimed at improving post-treatment quality of life for patients with head and neck cancer.     

全身运动对乳腺癌患者生活质量及相关心理指标影响的Meta分析

目的 探讨全身运动对乳腺癌患者生活质量、疲乏感、抑郁感、焦虑感和体象的影响.方法 通过计算机检索Cochrane图书馆、Pubmed、EMBASE、CINAHL、Psycinfo、SportDiscus、中文期刊全文数据库和中国生物医学文献数据库2002年至2011年10年间的英文和中文文献资料.要求文献内容为针对乳腺癌患者进行运动干预的独立随机对照研究(RCT),严格对文献质量进行评价,并提取相关结局指标进行Meta分析.结果 最终纳入文献16篇,其中英文13篇,中文3篇.分别有4篇、6篇、9篇、5篇、3篇、4篇文献纳入对FACT-B总分、FACT-B乳腺癌分量表、疲乏感、抑郁感、焦虑感、体象的Meta分析.结果显示,经过全身运动,干预组FACT-B总分和乳腺癌分量表得分显著高于对照组,疲乏感、抑郁感和焦虑感明显减轻,自尊增强.对各结局指标进行发表偏倚分析,结果显示均无发表偏倚存在.对各结局指标进行敏感性分析,结果与原分析结果相比无明显变化.结论 全身运动对乳腺癌患者生活质量的改善以及相关心理社会问题的缓解都起到了积极的作用.可将运动锻炼融入患者的日常生活,以进一步达到促进患者康复的目的.     

Epidemiology of chronic back pain among adults and elderly from Southern Brazil: a cross-sectional study

BackgroundChronic back pain (CBP) can negatively affect one’s quality of life and health condition, posing significant social and economic burdens.Objectives(1) To determine the prevalence of CBP and analyze associated factors in adult and elderly individuals in a municipality in southern Brazil; (2) to verify who sought medical attention or missed work because of back pain; and (3) to estimate the impact of CBP on selected health outcomes.MethodsThis was a population-based cross-sectional study conducted with individuals aged 18 years and older. CBP was defined as “pain for three consecutive months in the cervical, thoracic, or lumbar regions in the last year.” Demographic, socioeconomic, behavioral, and physical and mental health information was collected. The impact of CBP was assessed by the etiological fraction method.ResultsThe prevalence of CBP was 20.7% (95% CI: 18.3, 23.0) among the 1300 study participants. The factors associated with CBP were women, elderly, smokers, obesity, and sleeping fewer hours per night, as well as those with higher mental stress levels, history of fracture, arthritis/rheumatism, and work-related musculoskeletal disorder/repetitive strain injury. One-third of those with CBP missed work (31%) and 68% visited the physician over a 12-month period. All health outcomes analyzed (poor or very poor sleep quality, regular or poor health perception, worsened quality of life, depressive symptoms, perceived sadness) were significantly associated with CBP.ConclusionOne in five adults or elderly reported having CBP over the previous 12 months. This condition was associated with poorer health perception, poorer quality of life, and depressive symptoms.     

社会支持对老年慢性阻塞性肺疾病患者应付方式的影响

目的 探讨社会支持对老年慢性阻塞性肺疾病(COPD)患者应付生活方式的影响.方法 选择62例老年COPD患者进行应付问卷(WOCS)和世界卫生组织生存质量测定量表简表(WHOQCL-BREF)评定.结果 62例慢性阻塞性肺疾病患者SSRS总分及主观支持、客观支持、支持利用度因子评分分别为(38.46±7.83)分,(18.22±4.13)分,(10.91±1.51)分,(9.32±1.40)分.其中＜35分者(低分组)24例;＞45分者(高分组)16例;35～45分者22例.社会支持高分组慢性阻塞性肺疾病患者生理领域、心理领域、社会关系领域、环境领域评分,显著高于社会支持低分组,差异有显著性(P＜0.05或P＜0.01).结论 社会支持程度对慢性阻塞性肺疾病患者应付方式及生活质量具有重要影响,良好的社会支持有助于患者采取积极的应付方式、提高患者的生活质量.     

Psychometric properties of the community integration questionnaire in a heterogeneous sample of adults with physical disability

Hirsh AT, Braden AL, Craggs JG, Jensen MP. Psychometric properties of the Community Integration Questionnaire in a heterogeneous sample of adults with physical disability.

Objective

To investigate the psychometric properties of the Community Integration Questionnaire (CIQ) in a mixed sample of adults with physical disabilities.

Design

Cross-sectional, survey study.

Setting

Academic and community medical clinics, national registry, and self-referral.

Participants

Community-dwelling adults with spinal cord injury (n=146), multiple sclerosis (n=174), limb loss (n=158), or muscular dystrophy (n=273).

Interventions

Not applicable.

Main Outcome Measures

CIQ, General Health item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Mental Health Scale from the Medical Outcomes Study 36-Item Short-Form Health Survey.

Results

Based on the original scoring procedures, the CIQ Total scale and Home Integration subscale demonstrated acceptable internal consistency; however, reliability indices for the Social Integration and Productive Activities subscales were suboptimal. The exploratory factor analysis yielded a 4-factor solution (accounting for approximately 63% of the variance) that did not replicate the original factor structure of the CIQ. The results of the confirmatory factor analyses indicated that a modified 3-factor solution provided the best fit to the data from our samples. Using a revised scoring system based on these findings, the CIQ demonstrated improved reliability relative to the original scoring and good concurrent validity.

Conclusions

The results provide general support for the validity of the CIQ as a measure of participation in adults with physical disabilities. However, our results indicate that some small modifications to the original scoring system are needed to optimize its use in this patient group. Additional research is needed to refine the measurement of participation in these and other populations.     

ICF-based functional components and contextual factors as correlates of perceived quality of life for youth with chronic conditions

Abstract

Purpose: To explore International Classification of Functioning, Disability and Health (ICF)-based functional components and contextual factors associated with perceived quality of life (QOL) for youth with chronic conditions from the perspective of youth and parents. Method: Baseline data were obtained from a longitudinal study examining predictors of changes in perceived QOL for youth with chronic conditions. 439 youth aged 11–17 (and one of their parents) completed a questionnaire. Standardized tools were used to measure youth functioning, contextual factors and perceived QOL. Multivariate linear regression analyses, controlling for socio-demographic and health information, were conducted to explore correlations among youth functioning/contextual factors and youth and parent perceptions of youth QOL. Results: Significant (p?≤?0.05) negative correlates with both youth and parent perceptions of youth QOL included pain/other physical symptoms and emotional symptoms. Significant factors positively correlated with youth and parent perceptions of youth QOL included school productivity and spirituality. Other significant positive correlates of youth perspectives were family social support and school belongingness/safety. Family functioning was positively correlated, and youth social anxiety and environmental barriers were negatively correlated, with parent perceptions of youth QOL. Conclusions: This study provides preliminary evidence of factors upon which services aimed at improving perceived QOL of youth with chronic conditions could be based.

• Implications for Rehabilitation

• This study supports the utility of clinicians assessing the QOL of youth with chronic conditions in terms of youths’ and their families’ perspectives.

• This is the first study to identify key factors that impact perceived QOL at one point in time across a group of youth with chronic conditions, offering clinicians a main starting-point for considering youths’ strengths and needs and the supportiveness of the environment.

• Findings suggest youth and families would benefit from the availability of services that encompass the full scope of the ICF.

     

慢性阻塞性肺疾病患者社会支持状况及对生命质量的影响

目的：调查慢性阻塞性肺疾病（ＣＯＰＤ）患者社会支持状况,并分析社会支持对其生命质量的影响。方法：６０例ＣＯＰＤ患者和６０例健康者应用个人资源询问表进行社会支持评分,同时对ＣＯＰＤ患者应用ＣＯＰＤ的生命质量问卷作评估。结果：ＣＯＰＤ患者的社会支持评分低于健康对照组（Ｐ＜０．０５）。年龄、病程和通气功能与ＣＯＰＤ患者的社会支持评分呈显著相关（Ｐ＜０．０５）;社会支持评分与ＣＯＰＤ患者的生命质量中生活能力、社会和抑郁症状评分相关性有统计学意义（Ｐ＜０．０５）。结论：加强社会支持有可能提高ＣＯＰＤ患者的生命质量。     

Effect of psychosocial interventions on outcomes of patients with colorectal cancer: A review of the literature

PurposePatients with colorectal cancer experience physical, psychological and social challenges. Psychosocial interventions seem to be effective in improving the physical, psychological and social outcomes of cancer patients. There is a lack of research exploring the effectiveness of pre-operative and post-operative psychosocial interventions on the outcomes of colorectal patients. This literature review aimed to explore the effects of pre-operative and post-operative psychosocial interventions on the outcomes of patients with colorectal cancer, including physical, psychological and social functioning, as well as the quality of life.Methods and sampleA literature search for studies on psychosocial interventions for patients with colorectal cancer published between 2002 and 2012 was undertaken from electronic databases of Medline, CINAHL, Scopus, PsycINFO, Mednar, and Proquest. Hand-searching was conducted to find relevant papers from the reference lists of included articles.Key resultsEleven studies met the inclusion criteria and were included after methodological quality appraisal. A narrative summary was carried out. Various psychosocial interventions, including educational interventions, cognitive-behavioural therapy, relaxation training and supportive group therapy were found to reduce colorectal patients' length of hospital stay, days to stoma proficiency and hospital anxiety and depression, and to improve patients' quality of life. Home visits, telephone sessions, individual teaching sessions and group sessions were commonly conducted.ConclusionsVarious forms of psychosocial interventions were used to improve outcomes of patients with colorectal cancer. Further research is recommended to investigate the effects of psychosocial interventions carried out during both the pre- and post-operative period on colorectal patients' outcomes. Given the small number of studies identified, it is essential to take this into consideration when identifying strategies and conducting future psychosocial interventions for colorectal patients.     

原发性高血压患者生存质量与社会支持的相关性研究

目的探讨原发性高血压患者的生存质量与社会支持的关系。方法采用MOS-SF36、SSRS量表对339例高血压患者进行调查。结果生存质量与社会支持总分及各因子评分呈正相关,差异有显著性(rT=0·227、rI=0·109、rS=0·226、rU=0·149;P<0·05或P<0·01)。配偶健在的患者社会支持总分高于离婚或丧偶者(F=21·202,P<0·01)。患者的文化程度越高获得的社会支持总分也越高(F=2·786,P<0·01)。结论加强高血压患者的社会支持,可提高其生存质量。     

Exercise in elderly patients with chronic heart failure in primary care: Effects on physical capacity and health-related quality of life

Introduction

Chronic heart failure (CHF) limits exercise capacity which influences physical fitness and health-related quality of life (HRQoL).

Aim

The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care.

Methods

An exercise intervention was conducted as a prospective, longitudinal and controlled clinical study in primary care in elderly patients with CHF. Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training. Follow-up on physical capacity and HRQoL was done at 3, 6 and 12 months.

Results

Exercise significantly improved muscle endurance in the intervention group (n = 29, mean age 76.2 years) compared to the control group (n = 31, mean age 74.4 years) at all follow-ups except for shoulder flexion right at 12 months (shoulder abduction p = 0.006, p = 0.048, p = 0.029; shoulder flexion right p = 0.002, p = 0.032, p = 0.585; shoulder flexion left p = 0.000, p = 0.046, p = 0.004). Six minute walk test improved in the intervention group at 3 months (p = 0.013) compared to the control group. HRQoL measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12 months (p = 0.016 and p = 0.034) and SF-36, general health (p = 0.048) and physical component scale (p = 0.026) significantly improved at 3 months compared to the control group.

Conclusion

This study shows that exercise conducted in groups in primary care and in the patients' homes could be used in elderly patients with CHF. The combination of endurance exercise and resistance training has positive effects on physical capacity. However, the minor effects in HRQoL need further verification in a study with a larger study population.     

Effectiveness of a strength-oriented psychoeducation on caregiving competence,problem-solving abilities,psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial

BackgroundFamily caregivers provide the foundation for long-term home care of stroke survivors. The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external resources to cope with this situation, thereby placing their own health at risk. We conducted a randomised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers.ObjectivesTo evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence, problem-solving coping abilities, caregiver’s depressive symptoms, caregiving burden and resources (family functioning, social support) and physical health (such as caregiving-related injury), as well as potential placement of stroke survivors.DesignA prospective multi-centre and single-blinded randomised controlled trial stratified by survivors’ history of stroke.Setting and participantsAdult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong.MethodsThe design of the trial was based on the relational/problem-solving model. Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of questionnaires before randomisation, immediately, one- and three-months post-intervention. The control group received usual care, whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme (two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions). Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests.ResultsWe recruited 128 caregiver–survivor dyads. The intervention group demonstrated significantly greater improvements throughout the study (p < 0.01) in terms of caregiving competence, problem-solving coping abilities and social support satisfaction. This group also displayed significantly greater improvements in terms of family functioning (p < 0.05) at one-month post-intervention, an increased number of social support (p < 0.001) and a lower level of burden at three-month post-intervention. However, there was no significant effect on enabling stroke survivors to remain in their home. Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities, which suggested its mediating effect on caregiving competence of stroke caregivers.ConclusionsFindings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors.     

Effects on function and quality of life of postoperative home-based physical therapy for patients with hip fracture

OBJECTIVE: To evaluate the effects of a 3-month home-based physical therapy (PT) program for patients with hip fracture after surgery. DESIGN: Randomized controlled trial. SETTING: Home. PARTICIPANTS: Twenty-five patients recently discharged from an acute orthopedic department. INTERVENTIONS: Patients were randomized to the home-based PT group (n=13), where they received home-based PT 8 times from discharge to month 3 postdischarge, or to the control group (n=12). The home-based PT program included exercises for muscle strengthening, range of motion (ROM), balance, and functional training. Patients in the control group were instructed to practice the exercise program given at bedside before discharge. MAIN OUTCOME MEASURES: Patients were evaluated for hip ROM, strength, walking velocity, Harris hip score, and health-related quality of life (HRQOL) at the week of discharge and at 1, 3, and 6 months after discharge. RESULTS: The baseline characteristics showed no difference between the 2 groups. Harris score of the home-based PT group progressed from 58.6+/-8.5 to 90.1+/-5.4 at month 3, whereas Harris score of the control group progressed from 54.6+/-14.5 to 77.4+/-10.0 (P<.01). Scores of the psychologic domain of HRQOL for the home-based PT group were significantly better at month 1 (P<.05) and month 3 (P<.01) after discharge. Moreover, the physical domain score of the home-based PT group was also significantly better (P<.05) at 3 months after discharge. CONCLUSIONS: Home-based PT programs could help patients regain function and HRQOL earlier.     

Examining changes in self-perceived quality of life in children and adolescents with physical disability using a longitudinal design

Purpose.?The study aimed to investigate the changes in self-perceived quality of life (QOL) of children and adolescents with physical disability (PD).

Method.?Two hundred students aged 10–18 with PD were recruited from primary and high schools in Taiwan to participate in this longitudinal study. The Student Version of the Comprehensive Quality of Life Scale (COMQOL-S) was used to measure self-perceived QOL, which was recorded at baseline, and 6, 12 and 18 months post-baseline. Statistically, linear mixed models were used to compare the QOL scores among the four time points.

Results.?At the second, third and fourth visit, 192, 151 and 128 participants completed COMQOL-S, respectively. Significant changes over time were found in overall objective and subjective OQL scores (slope == 0.8, p == 0.002 and slope == ?1.3, p < 0.001, respectively). Specifically, significant reductions of the subjective QOL scores over the period of the four visits were observed in five domains, namely, Productivity (slope == ?1.7, p == 0.005), Intimacy (slope == ?1.6, p == 0.004), Safety (slope == ?1.6, p == 0.008), Place in community (slope == ?1.4, p == 0.019) and Emotional wellbeing (slope == ?2.5, p < 0.001). Age was negatively correlated with the change of overall subjective score. Positive correlation was found between the change in mean objective scores and mean subjective scores in the Intimacy and Productivity domains.

Conclusions.?Even though the conditions of material wellbeing and health can be kept steady, the overall QOL of children and adolescents with PD could still decline over time. This might be attributable to the fact that social life becomes more sophisticated when children become older.