Simpson Jane, Lekwuwa Godwin, Crawford Trevor
Division of Health Research, Lancaster University , Lancaster , United Kingdom .
Disabil Rehabil. 2014;36(23):1964-70. doi: 10.3109/09638288.2014.883442. Epub 2014 Feb 5.
To assess the determinants of health-related quality of life (HrQoL) in people with Parkinson's disease (PD).
Eighty-one people with a diagnosis of idiopathic PD took part in a cross-sectional questionnaire-based study. Measures were collected in a community setting and included established determinants of HrQoL (demographic, clinical and cognitive variables) but also included a wide range of mental health variables (depression, anxiety and stress) and, for the first time, positive psychological functioning (optimism and self-esteem). HrQoL was measured by the full version of the Parkinson's Disease Questionnaire (PDQ-39) which includes eight domains of functioning.
Mental health measures (depression, anxiety and stress) were more influential than any other block of determinants and influenced a broader array of HrQoL domains including physical ones. There was some evidence of domain-specific relationships, e.g. between physical determinants and the more physically-oriented HrQoL domains, and between mental health determinants and emotional well-being. However, cognitive ability did not influence the HrQoL domain of cognitive impairment.
The contribution of a multi-disciplinary approach is crucial given the many variables which affect HrQoL; in particular, significant overall improvements on HrQoL are unlikely if only physical rehabilitation is offered. Rehabilitation is likely to be beneficial in terms of HrQoL only if it is planned and delivered holistically. Implications for Rehabilitation Interventions to improve physical function may have only limited impact on quality of life and might be limited to more physical HrQoL domains. Psychological interventions have the potential to improve quality of life over a wider range of both emotional and physical HrQoL domains. Clinician-measured level of functioning does not necessarily translate into patient-perceived levels of functional ability and relatively small objective decreases in ability can be appraised much more significantly disabling by people with PD.
评估帕金森病（PD）患者健康相关生活质量（HrQoL）的决定因素。
81名被诊断为特发性PD的患者参与了一项基于问卷调查的横断面研究。在社区环境中收集测量数据，包括已确定的HrQoL决定因素（人口统计学、临床和认知变量），还包括广泛的心理健康变量（抑郁、焦虑和压力），并且首次纳入了积极心理功能（乐观和自尊）。通过帕金森病问卷完整版（PDQ - 39）测量HrQoL，该问卷包括八个功能领域。
心理健康测量指标（抑郁、焦虑和压力）比其他任何一组决定因素的影响都更大，且影响了更广泛的HrQoL领域，包括身体方面的领域。有一些特定领域关系的证据，例如身体决定因素与更侧重于身体方面的HrQoL领域之间的关系，以及心理健康决定因素与情绪幸福感之间的关系。然而，认知能力并未影响认知障碍的HrQoL领域。
鉴于影响HrQoL的变量众多，多学科方法的贡献至关重要；特别是，如果仅提供身体康复，HrQoL不太可能有显著的整体改善。只有进行全面规划和实施，康复才可能对HrQoL有益。康复干预对身体功能改善的影响可能仅对生活质量有有限的影响，并且可能仅限于更多侧重于身体方面的HrQoL领域。心理干预有可能在更广泛的情绪和身体HrQoL领域改善生活质量。临床医生测量的功能水平不一定能转化为患者感知的功能能力水平，并且相对较小的客观能力下降在PD患者看来可能会严重得多地影响其功能。
