Changes in quality of life and acceptance of disability of burn patients in rehabilitation treatment stage and the influencing factors
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摘要:
目的 探讨烧伤患者康复治疗阶段生活质量、伤残接受度的发展轨迹及影响因素。 方法 采用方便抽样法选择福建医科大学附属协和医院烧伤科2016年10月—2017年7月收治的207例康复治疗阶段烧伤患者[男157例、女50例，年龄(40±13)岁]，进行该纵向研究。出院时及出院后1、3、6个月，分别采用简明版烧伤专用健康量表及修订版汉化伤残接受度量表对患者生活质量、伤残接受度进行评分。以截距、斜率、曲线斜率为潜变量，对生活质量、伤残接受度分别构建潜变量二次增长曲线模型，采用稳健最大似然估计(MLR)法进行均值、方差及协方差估计，分析出院时水平、增长速度和加速度及三者之间的相关性；以伤残接受度、性别、烧伤原因、病情严重程度、是否存在并发症、付费方式、受教育程度为协变量，对生活质量构建潜变量二次增长曲线模型，采用MLR法就协变量对生活质量出院时水平、增长速度和加速度的影响进行估计。 结果 患者出院时及出院后1、3、6个月生活质量评分分别为(102±36)、(111±36)、(118±37)、(122±37)分，伤残接受度评分分别为(73±17)、(75±17)、(77±17)、(78±18)分。患者出院时生活质量、伤残接受度截距均值估计值分别为101.680、72.993，在出院后1、3、6个月均呈曲线递增趋势(斜率均值估计值＝11.024、3.086，
t ＝15.376、7.476，
P <0.01)，递增速度(加速度)逐渐减缓(曲线斜率均值估计值＝－1.393、－0.426，
t ＝－13.339、－4.776，
P <0.01)。患者生活质量出院时水平和加速度均呈现出明显的个体间差异(截距方差估计值＝1 174.527，
t ＝9.332；曲线斜率方差估计值＝2.379，
t ＝6.402；
P <0.01)，患者伤残接受度出院时水平、增长速度及加速度均呈现出明显的个体间差异(截距方差估计值＝267.017，
t ＝9.262；斜率方差估计值＝32.264，
t ＝2.356；曲线斜率方差估计值＝0.882，
t ＝2.939；
P <0.05或
P <0.01)。患者生活质量、伤残接受度的出院时水平、增长速度及加速度之间均不存在显著相关性(截距与斜率估计值＝37.273、－1.457，
t ＝0.859、－0.131；截距与曲线斜率估计值＝－6.712、－0.573，
t ＝－1.089、－0.248；斜率与曲线斜率估计值＝－5.494、－5.988，
t ＝－0.930、－2.512；
P >0.05)。时间恒定的协变量中，仅病情严重程度及是否存在并发症对患者生活质量出院时水平存在显著影响(截距估计值＝－10.721、5.522，
t ＝－6.229、1.977，
P <0.05或
P <0.01)。出院时及出院后1、3、6个月，患者伤残接受度水平对生活质量水平具有正向影响(标准化回归系数＝0.616、0.669、0.681、0.678，
t ＝18.874、21.660、22.824、22.123，
P <0.01)。 结论 烧伤患者康复治疗阶段生活质量、伤残接受度初始水平均不高，随时间延长呈曲线递增趋势，且该递增速度逐渐减缓；存在并发症、病情程度重的患者出院时的生活质量较差，伤残接受度对生活质量具有正向影响。
Abstract:Objective To explore the development trajectories of quality of life and acceptance of disability of burn patients in the rehabilitation treatment stage and the influencing factors. Methods Totally 207 burn patients, including 157 males and 50 females, aged (40±13) years, who were in the rehabilitation treatment stage were selected by convenient sampling method from October 2016 to July 2017 in the Department of Burns of Fujian Medical University Union Hospital for this longitudinal study. At discharge and 1, 3, and 6 months after discharge, the patient′s quality of life and acceptance of disability were scored using the Burn Specific Health Scale-Brief and Chinese Version of Acceptance of Disability Scale-Revised respectively. Taking the intercept, the slope, and the curve slope as latent variables, the latent second growth curve model was constructed for the quality of life and the acceptance of disability. The robust maximum likelihood estimation (MLR) method was used to estimate the mean, the variance, and the covariance, so as to analyze the discharge level, the growth rate, the acceleration, and the correlation among them. Taking the acceptance of disability, the gender, the cause of burn, the severity of burn, the existence of complications, the payment way, and the education level as covariates, the latent second growth curve model was constructed for the quality of life. The MLR method was used to estimate the influence of covariates on the discharge level, the growth rate, and the acceleration of the quality of life. Results At discharge and 1, 3, and 6 months after discharge, the quality of life scores of patients were (102±36), (111±36), (118±37), and (122±37) points respectively, and the acceptance of disability scores were (73±17), (75±17), (77±17), and (78±18) points respectively. The estimated mean intercept of the quality of life and the acceptance of disability were 101.680 and 72.993 respectively at discharge, both of which showed a curve increasing trend in 1, 3, and 6 months after discharge (estimated mean slope=11.024, 3.086,
t =15.376, 7.476,
P <0.01), and the increasing rate (acceleration) gradually slowed down (estimated mean curve slope=-1.393, -0.426,
t =-13.339, -4.776,
P <0.01). There were significant individual differences in the discharge level and the acceleration of quality of life of patients (estimated intercept variance=1 174.527,
t =9.332; estimated curve slope variance=2.379,
t =6.402;
P <0.01). There were significant individual differences in the discharge level, the growth rate, and the acceleration of patients′ acceptance of disability (estimated intercept variance=267.017,
t =9.262; estimated slope variance=32.264,
t =2.356; estimated curve slope variance=0.882,
t =2.939;
P <0.05 or
P <0.01). There was no significant correlation among the discharge level, the growth rate, and the acceleration of the quality of life and those of the acceptance of disability of patients (estimated intercept and slope=37.273, -1.457,
t =0.859, -0.131; estimated intercept and curve slope=-6.712, -0.573,
t =-1.089, -0.248; estimated slope and curve slope=-5.494, -5.988,
t =-0.930, -2.512;
P >0.05). Among the time-constant covariates, only the severity of burn and the presence of complications had a significant impact on the quality of life of patients at discharge (estimated intercept=-10.721, 5.522,
t =-6.229, 1.977,
P <0.05 or
P <0.01). At discharge and 1, 3, and 6 months after discharge, the level of acceptance of disability had a positive impact on the quality of life of patients (standardized regression coefficient=0.616, 0.669, 0.681, 0.678,
t =18.874, 21.660, 22.824, 22.123,
P <0.01). Conclusions The initial levels of quality of life and acceptance of disability of burn patients in the rehabilitation treatment stage are relatively low, both with a curve increasing trend over time, and the increasing rate gradually slows down. Patients with complications and serious burns have poor quality of life at discharge, while the acceptance of disability has a positive impact on the quality of life.
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Key words:
- Burns /
- Quality of life /
- Acceptance of disability /
- Latent growth curve model /
- Longitudinal data
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