Quinn Audrey C, Bhargava Deepti, Al-Tamimi Yahia Z, Clark Matthew J, Ross Stuart A, Tennant Alan
Department of Anaesthesia, Leeds General Infirmary, Leeds, UK.
BMJ Open. 2014 Apr 3;4(4):e003932. doi: 10.1136/bmjopen-2013-003932.
The objective of the study was to assess the long-term self-reported health status and quality of life (QoL) of patients following an aneurysmal subarachnoid haemorrhage (ASAH) using a self-completed questionnaire booklet.
A two-cohort study.
A regional tertiary neurosurgical centre.
2 cohorts of patients with ASAH treated between 1998 and 2008 and followed up at approximately 1 year.
Routine care.
A range of standardised scales included: AKC Short Sentences Test, the Barthel Index, the Self-Report Dysexecutive Questionnaire, the Everyday Memory Questionnaire, Stroke Symptom Checklist, Wimbledon Self-Report Scale, Modified Rankin Score (MRS) and a new Stroke-QoL. The data from summated scales were fit to the Rasch measurement model to validate the summed score.
214 patients (48%) returned the questionnaires; the majority (76%) had a World Federation of Neurosurgeons grade of 1 or 2. The most frequent aneurysm type was that of the anterior communicating artery (28%) with approximately 90% of aneurysms of the anterior circulation. Of those previously in full or part-time employment, 48.9% were unemployed at follow-up. All summated scales satisfied the Rasch measurement model requirements, such that their summed scores were a sufficient statistic. Given this, one-third of patients were noted to have a significant mood disorder and 25% had significant dysexecutive function. Patients with an MRS of 3, 4 or 5 had significantly worse scores on most outcome measures, but a significant minority of those with a score of zero had failed to return to work and displayed significant mood disorder.
A range of self-reported cognitive and physical deficits have been highlighted in a cohort of patients with ASAH. While the MRS has been shown to provide a reasonable indication of outcome, in routine clinical follow-up it requires supplementation by instruments assessing dysexecutive function, memory and mood.
本研究的目的是使用一份自我填写的问卷手册，评估动脉瘤性蛛网膜下腔出血（ASAH）患者的长期自我报告健康状况和生活质量（QoL）。
一项双队列研究。
一个地区三级神经外科中心。
1998年至2008年间接受治疗并在大约1年后进行随访的2组ASAH患者。
常规护理。
一系列标准化量表包括：AKC短句测试、巴氏指数、自我报告执行功能障碍问卷、日常记忆问卷、中风症状清单、温布尔登自我报告量表、改良Rankin评分（MRS）和一个新的中风生活质量量表。将汇总量表的数据拟合到Rasch测量模型以验证汇总分数。
214名患者（48%）返回了问卷；大多数（76%）的世界神经外科医师联合会分级为1级或2级。最常见的动脉瘤类型是前交通动脉（28%），约90%的动脉瘤位于前循环。在那些之前有全职或兼职工作的人中，48.9%在随访时失业。所有汇总量表均满足Rasch测量模型要求，因此其汇总分数是一个充分统计量。据此，三分之一的患者被发现有明显的情绪障碍，25%有明显的执行功能障碍。MRS评分为3、4或5的患者在大多数结局指标上的得分明显更差，但少数评分为零的患者未能重返工作岗位并表现出明显的情绪障碍。
一组ASAH患者中突出显示了一系列自我报告的认知和身体缺陷。虽然MRS已被证明能合理地指示预后，但在常规临床随访中，它需要通过评估执行功能障碍、记忆和情绪的工具进行补充。
