Division of Occupational Therapy and Gerontology, Department of Health Sciences, Lund University, Lund, Sweden.
BMC Musculoskelet Disord. 2010 Dec 22;11:286. doi: 10.1186/1471-2474-11-286.
Our objective was to explore outcome and clinical changes in hand function, satisfaction in daily occupations, sleep disturbances, health and quality of life in consecutive patients after a severe or major hand injury. Our objective was also to investigate possible differences between groups according to severity of injury, presence of peripheral nerve injury and the patients' sense of coherence.
A postal questionnaire, including demographic data, disabilities of the arm, shoulder and hand (DASH), QoL (SF-36), EuroQol (EQ-5D VAS), hand function (VAS), satisfaction in daily occupation (SDO), was sent out 3, 6 and 12 months after injury to 45 consecutive patients with a severe or major hand injury. Sense of coherence (SOC) was evaluated at 6 months. For the descriptive study, non-parametric tests were used since almost all results were measured with ordinal scales, the study sample was small, and most variables not normally distributed.
Almost all self-assessed aspects of hand function, satisfaction in daily occupations, health (DASH), and physical QoL (SF-36) improved statistically for the whole group over time. Large clinical improvement was seen for physical QoL and health, while a low or no improvement was observed for mental QoL, and cold sensitivity. Few differences were found between participants with a severe or major of hand injury or with or without a major nerve injury. No significant differences in demographic data were observed between participants with high or low SOC, but participants with low SOC showed significantly lower satisfaction in daily occupations, higher DASH scores, lower mental QoL, more sleep disturbances, and bodily pain. Correlation was found between SOC, and QoL, health and satisfaction in daily occupations.
SOC had a significant influence on patients with a severe or major traumatic hand injury. Patients with lower SOC would probably benefit from extra support and help to master their daily life, indicating that sense of coherence is an indicator for future rehabilitation focus.
本研究旨在探讨严重或重大手部损伤患者的手部功能结局和临床变化、日常生活活动的满意度、睡眠障碍、健康状况和生活质量，并探讨损伤严重程度、周围神经损伤以及患者的应对能力差异对预后的影响。
我们对 45 例严重或重大手部损伤患者进行了前瞻性队列研究，于伤后 3、6 和 12 个月通过邮寄问卷的方式收集患者的一般资料、上肢功能障碍问卷（DASH）、生活质量量表（SF-36）、欧洲五维健康量表（EQ-5D VAS）、手功能量表（VAS）、日常生活活动满意度（SDO）。应对能力采用社会健康问卷（SOC-13）评估，6 个月时进行评估。由于几乎所有结果均采用等级量表测量，样本量较小，且大多数变量呈非正态分布，因此本研究采用非参数检验进行描述性统计分析。
总体而言，手部功能、日常生活活动满意度、健康状况（DASH）和躯体健康相关生活质量（SF-36）的自我评估在各个时间点均有显著改善。躯体健康相关生活质量和健康状况的临床改善较大，而心理健康相关生活质量和冷感觉的改善较小。严重或重大手部损伤患者之间、合并或不合并主要神经损伤患者之间的差异无统计学意义。高 SOC 组和低 SOC 组的患者在一般资料方面无显著差异，但低 SOC 组的患者日常生活活动满意度较低、DASH 评分较高、心理健康相关生活质量较低、睡眠障碍和躯体疼痛更多。SOC 与生活质量、健康状况和日常生活活动满意度呈正相关。
应对能力对严重或重大手部创伤患者具有显著影响。应对能力较低的患者可能需要额外的支持和帮助来应对日常生活，这表明应对能力是未来康复重点的一个指标。
