类风湿关节炎患者躯体功能受限影响因素研究
|
摘要
目的了解类风湿关节炎(RA)患者躯体功能受限状况并分析相关影响因素。方法采用一般资料调查表、健康评估问卷-残疾指数、Morisky服药依从性量表-8、类风湿关节炎自我效能量表、病人健康问卷-9及医学应对方式量表对天津市第一中心医院住院治疗的237例RA患者进行横断面研究。结果 RA患者躯体功能受限得分为[1.65(1.20～2.20)]分,多元逐步回归分析显示自我效能、面对、服药依从性、疼痛、文化程度、抑郁、是否规律锻炼、疲劳及疾病活动度对躯体功能有显著影响(P<0.05),可解释总变异量的60.8%。结论 RA患者存在中度躯体功能受限,自我效能、面对、服药依从性、疼痛、文化程度、抑郁、是否规律锻炼、疲劳及疾病活动度是RA患者躯体功能受限的影响因素。医务人员应为患者提供个性化的功能锻炼指导,从而维持躯体功能,延缓关节功能丧失,提高生存质量。
Objective To investigate the status and to explore the influencing factors of functional disability among patients with rheumatoid arthritis(RA).Methods 237 inpatients with RA in Tianjin First Central Hospital were investigated by general information questionnaire,health assessment questionnaire-disability index,Morisky medication adherence scale-8,rheumatoid arthritis self-efficacy scale,patient health questionnaire-9 and medical coping questionnaire.Results The total score of functional disability was 1.65(1.20-2.20),and the results of multiple stepwise regression analysis showed that 9 factors were of significance,including self-efficacy,confrontation coping,medication adherence,pain,educational level,depression,whether exercise regularly,fatigue,and disease activity(P<0.05),which explained 60.8% of the total variance.Conclusion Patients with RA present moderate functional disability,self-efficacy,confrontation coping,medication adherence,pain,educational level,depression,whether exercise regularly,fatigue,and disease activity were influencing factors of functional disability in patients with RA.Medical staff should provide individual instructions on exercise for patients with RA,in order to maintain physical function and enhance their quality of life.
Objective To investigate the status and to explore the influencing factors of functional disability among patients with rheumatoid arthritis(RA).Methods 237 inpatients with RA in Tianjin First Central Hospital were investigated by general information questionnaire,health assessment questionnaire-disability index,Morisky medication adherence scale-8,rheumatoid arthritis self-efficacy scale,patient health questionnaire-9 and medical coping questionnaire.Results The total score of functional disability was 1.65(1.20-2.20),and the results of multiple stepwise regression analysis showed that 9 factors were of significance,including self-efficacy,confrontation coping,medication adherence,pain,educational level,depression,whether exercise regularly,fatigue,and disease activity(P<0.05),which explained 60.8% of the total variance.Conclusion Patients with RA present moderate functional disability,self-efficacy,confrontation coping,medication adherence,pain,educational level,depression,whether exercise regularly,fatigue,and disease activity were influencing factors of functional disability in patients with RA.Medical staff should provide individual instructions on exercise for patients with RA,in order to maintain physical function and enhance their quality of life.
引文
[1] 栗占国,张奉春,鲍春德.类风湿关节炎[M].北京:人民卫生出版社,2009.
[2] Smolen JS,Aletaha D,Mclnnes IB.Rheumatoid arthritis[J].Lancet,2016,388(10055):2023-2038.
[3] 栗占国.类风湿关节炎在我国的低认知度和高致残率不容忽视[J].中华医学杂志,2009,89(27):1873-1875.
[4] 周云杉,王秀茹,安媛,等.全国多中心类风湿关节炎患者残疾及功能受限情况的调查[J].中华风湿病学杂志,2013,17(8):526-532.
[5] 孙垚,史宝欣.类风湿关节炎患者躯体功能障碍的研究进展[J].中国实用护理杂志,2018,34(12):951-955.
[6] Baruth M,Wilcox S,Schoffman DE,et al.Factors associated with disability in a sample of adults with arthritis[J].Disability and Health Journal,2013,6(4):377-384.
[7] Arnett FC,Edworthy SM,Bloch DA,et al.The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis[J].Arthritis and Rheumatism,1988,31(3):315-324.
[8] Hawker GA,Mian S,Kendzerska T,et al.Measures of adult pain:Visual Analog Scale for Pain(VAS Pain),Numeric Rating Scale for Pain(NRS Pain),McGill Pain Questionnaire(MPQ),Short-Form McGill Pain Questionnaire(SF-MPQ),Chronic Pain Grade Scale(CPGS),Short Form-36 Bodily Pain Scale(SF-36 BPS),and Measure of Intermittent and Constant Osteoarthritis Pain(ICOAP)[J].Arthritis Care and Research(Hoboken),2011,63(Suppl 11):S240-S252.
[9] Hewlett S,Dures E,Almeida C.Measures of fatigue:Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire(BRAF MDQ),Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales(BRAF NRS)for severity,effect,and coping,Chalder Fatigue Questionnaire(CFQ),Checklist Individual Strength(CIS20R and CIS8R),Fatigue Severity Scale(FSS),Functional Assessment Chronic Illness Therapy(Fatigue)(FACIT-F),Multi-Dimensional Assessment of Fatigue(MAF),Multi-Dimensional Fatigue Inventory(MFI),Pediatric Quality Of Life(PedsQL)Multi-Dimensional Fatigue Scale,Profile of Fatigue(ProF),Short Form 36 Vitality Subscale(SF-36 VT),and Visual Analog Scales(VAS)[J].Arthritis Care and Research(Hoboken),2011,63(Suppl 11):S263-S286.
[10] Bruce B,Fries JF.The Stanford Health Assessment Questionnaire:dimensions and practical applications[J].Health and Quality of Life Outcomes,2003,1:20.
[11] 吴凡,赵金霞,王天晟,等.中文版MMAS-8测量类风湿关节炎患者用药依从性的信效度分析[J].中国药房,2018,29(2):263-268.
[12] Hewlett S,Cockshott Z,Kirwan J,et al.Development and validation of a self-efficacy scale for use in British patients with rheumatoid arthritis(RASE)[J].Rheumatology(Oxford,England),2001,40(11):1221-1230.
[13] Wang WZ,Bian Q,Zhao Y,et al.Reliability and validity of the Chinese version of the Patient Health Questionnaire(PHQ-9)in the general population[J].General Hospital Psychiatry,2014,36(5):539-544.
[14] Feifel H,Strack S,Nagy VT.Degree of life-threat and differential use of coping modes[J].Journal of Psychosomatic Research,1987,31(1):91-99.
[15] Ji J,Zhang LJ,Zhang QX,et al.Functional disability associated with disease and quality-of-life parameters in Chinese patients with rheumatoid arthritis[J].Health and Quality of Life Outcomes,2017,15(1):89.
[16] Van Der Elst K,De Cock D,Vecoven E,et al.Are illness perception and coping style associated with the delay between symptom onset and the first general practitioner consultation in early rheumatoid arthritis management? An exploratory study within the CareRA trial[J].Scandinavian Journal of Rheumatology,2016,45(3):171-178.
[17] Dougados M,Soubrier M,Perrodeau E,et al.Impact of a nurse-led programme on comorbidity management and impact of a patient self-assessment of disease activity on the management of rheumatoid arthritis:results of a prospective,multicentre,randomised,controlled trial(COMEDRA)[J].Annals of the Rheumatic Diseases,2015,74(9):1725-1733.
[18] Nikiphorou E,Norton S,Young A,et al.The association of obesity with disease activity,functional ability and quality of Life in early rheumatoid arthritis:data from the Early Rheumatoid Arthritis Study/Early Rheumatoid Arthritis Network UK prospective cohorts[J].Rheumatology(Oxford,England),2018,57(7):1194-1202.
[19] 高蕾.类风湿关节炎患者疲劳及影响因素的研究[D].天津:天津医科大学,2017.
[20] Primdahl J,Wagner L,Horslev-Petersen K.Self-efficacy in rheumatoid arthritis:translation and test of validity,reliability and sensitivity of the Danish version of the Rheumatoid Arthritis Self-Efficacy Questionnaire(RASE)[J].Musculoskeletal Care,2010,8(3):123-135.
[21] 张晓翠,高蕾,李苗苗,等.类风湿关节炎患者自我效能感影响因素的研究[J].中华风湿病学杂志,2016,20(11):734-738.
[22] Gong GL,Mao J.Health-Related quality of Life among Chinese patients with rheumatoid arthritis the predictive roles of fatigue,functional disability,Self-Efficacy,and social support[J].Nursing Research,2016,65(1):55-67.
[23] Suh YS,Cheon YH,Kim HO,et al.Medication nonadherence in Korean patients with rheumatoid arthritis:the importance of belief about medication and illness perception[J].The Korean Journal of Internal Medicine,2018,33(1):203-210.
[24] Matcham F,Norton S,Scott DL,et al.Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis:secondary analysis of a randomized controlled trial[J].Rheumatology(Oxford,England),2016,55(2):268-278.
[25] Matcham F,Rayner L,Steer S,et al.The prevalence of depression in rheumatoid arthritis:a systematic review and meta-analysis[J].Rheumatology,2013,52(12):2136-2148.
[26] Sinclair VG,Blackburn DS.Adaptive coping with rheumatoid arthritis:the transforming Nature of response shift[J].Chronic Illness,2008,4(3):219-230.
[2] Smolen JS,Aletaha D,Mclnnes IB.Rheumatoid arthritis[J].Lancet,2016,388(10055):2023-2038.
[3] 栗占国.类风湿关节炎在我国的低认知度和高致残率不容忽视[J].中华医学杂志,2009,89(27):1873-1875.
[4] 周云杉,王秀茹,安媛,等.全国多中心类风湿关节炎患者残疾及功能受限情况的调查[J].中华风湿病学杂志,2013,17(8):526-532.
[5] 孙垚,史宝欣.类风湿关节炎患者躯体功能障碍的研究进展[J].中国实用护理杂志,2018,34(12):951-955.
[6] Baruth M,Wilcox S,Schoffman DE,et al.Factors associated with disability in a sample of adults with arthritis[J].Disability and Health Journal,2013,6(4):377-384.
[7] Arnett FC,Edworthy SM,Bloch DA,et al.The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis[J].Arthritis and Rheumatism,1988,31(3):315-324.
[8] Hawker GA,Mian S,Kendzerska T,et al.Measures of adult pain:Visual Analog Scale for Pain(VAS Pain),Numeric Rating Scale for Pain(NRS Pain),McGill Pain Questionnaire(MPQ),Short-Form McGill Pain Questionnaire(SF-MPQ),Chronic Pain Grade Scale(CPGS),Short Form-36 Bodily Pain Scale(SF-36 BPS),and Measure of Intermittent and Constant Osteoarthritis Pain(ICOAP)[J].Arthritis Care and Research(Hoboken),2011,63(Suppl 11):S240-S252.
[9] Hewlett S,Dures E,Almeida C.Measures of fatigue:Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire(BRAF MDQ),Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales(BRAF NRS)for severity,effect,and coping,Chalder Fatigue Questionnaire(CFQ),Checklist Individual Strength(CIS20R and CIS8R),Fatigue Severity Scale(FSS),Functional Assessment Chronic Illness Therapy(Fatigue)(FACIT-F),Multi-Dimensional Assessment of Fatigue(MAF),Multi-Dimensional Fatigue Inventory(MFI),Pediatric Quality Of Life(PedsQL)Multi-Dimensional Fatigue Scale,Profile of Fatigue(ProF),Short Form 36 Vitality Subscale(SF-36 VT),and Visual Analog Scales(VAS)[J].Arthritis Care and Research(Hoboken),2011,63(Suppl 11):S263-S286.
[10] Bruce B,Fries JF.The Stanford Health Assessment Questionnaire:dimensions and practical applications[J].Health and Quality of Life Outcomes,2003,1:20.
[11] 吴凡,赵金霞,王天晟,等.中文版MMAS-8测量类风湿关节炎患者用药依从性的信效度分析[J].中国药房,2018,29(2):263-268.
[12] Hewlett S,Cockshott Z,Kirwan J,et al.Development and validation of a self-efficacy scale for use in British patients with rheumatoid arthritis(RASE)[J].Rheumatology(Oxford,England),2001,40(11):1221-1230.
[13] Wang WZ,Bian Q,Zhao Y,et al.Reliability and validity of the Chinese version of the Patient Health Questionnaire(PHQ-9)in the general population[J].General Hospital Psychiatry,2014,36(5):539-544.
[14] Feifel H,Strack S,Nagy VT.Degree of life-threat and differential use of coping modes[J].Journal of Psychosomatic Research,1987,31(1):91-99.
[15] Ji J,Zhang LJ,Zhang QX,et al.Functional disability associated with disease and quality-of-life parameters in Chinese patients with rheumatoid arthritis[J].Health and Quality of Life Outcomes,2017,15(1):89.
[16] Van Der Elst K,De Cock D,Vecoven E,et al.Are illness perception and coping style associated with the delay between symptom onset and the first general practitioner consultation in early rheumatoid arthritis management? An exploratory study within the CareRA trial[J].Scandinavian Journal of Rheumatology,2016,45(3):171-178.
[17] Dougados M,Soubrier M,Perrodeau E,et al.Impact of a nurse-led programme on comorbidity management and impact of a patient self-assessment of disease activity on the management of rheumatoid arthritis:results of a prospective,multicentre,randomised,controlled trial(COMEDRA)[J].Annals of the Rheumatic Diseases,2015,74(9):1725-1733.
[18] Nikiphorou E,Norton S,Young A,et al.The association of obesity with disease activity,functional ability and quality of Life in early rheumatoid arthritis:data from the Early Rheumatoid Arthritis Study/Early Rheumatoid Arthritis Network UK prospective cohorts[J].Rheumatology(Oxford,England),2018,57(7):1194-1202.
[19] 高蕾.类风湿关节炎患者疲劳及影响因素的研究[D].天津:天津医科大学,2017.
[20] Primdahl J,Wagner L,Horslev-Petersen K.Self-efficacy in rheumatoid arthritis:translation and test of validity,reliability and sensitivity of the Danish version of the Rheumatoid Arthritis Self-Efficacy Questionnaire(RASE)[J].Musculoskeletal Care,2010,8(3):123-135.
[21] 张晓翠,高蕾,李苗苗,等.类风湿关节炎患者自我效能感影响因素的研究[J].中华风湿病学杂志,2016,20(11):734-738.
[22] Gong GL,Mao J.Health-Related quality of Life among Chinese patients with rheumatoid arthritis the predictive roles of fatigue,functional disability,Self-Efficacy,and social support[J].Nursing Research,2016,65(1):55-67.
[23] Suh YS,Cheon YH,Kim HO,et al.Medication nonadherence in Korean patients with rheumatoid arthritis:the importance of belief about medication and illness perception[J].The Korean Journal of Internal Medicine,2018,33(1):203-210.
[24] Matcham F,Norton S,Scott DL,et al.Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis:secondary analysis of a randomized controlled trial[J].Rheumatology(Oxford,England),2016,55(2):268-278.
[25] Matcham F,Rayner L,Steer S,et al.The prevalence of depression in rheumatoid arthritis:a systematic review and meta-analysis[J].Rheumatology,2013,52(12):2136-2148.
[26] Sinclair VG,Blackburn DS.Adaptive coping with rheumatoid arthritis:the transforming Nature of response shift[J].Chronic Illness,2008,4(3):219-230.