Willems Michelle, Sattin Davide, Vingerhoets Ad J J M, Leonardi Matilde
Neurology, Public Health, Disability Unit-Scientific Directorate, Neurological Institute Carlo Besta Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation, Via Celoria 11, Milan 20133, Italy.
Department of Medical & Clinical Psychology, Tilburg University, P.O. Box 90153, Tilburg 5000 LE, The Netherlands.
Int J Environ Res Public Health. 2015 Apr 1;12(4):3707-30. doi: 10.3390/ijerph120403707.
Disorders of consciousness are neurological conditions associated with low levels of functioning which pose a serious challenge to public health systems. The current study aimed to examine longitudinal changes in functioning in patients with disorders of consciousness and to identify associated biopsychosocial factors using the International Classification of Functioning, Disability, and Health. An Italian sample of 248 patients was assessed longitudinally. Differences in relative variability (an index of change that controls for baseline levels) between acute and chronic patients and predictors of relative variability in "Activities & Participation" were examined. Results showed that there were subgroups of patients whose functioning improved over time. The number of problems in "Activities & Participation" decreased in acute patients over time, whereas in chronic patients, an increase was found. The significant difference in relative variability for the environmental factor "support and relationships" reflects the increase in facilitators in acute patients, whereas the number of facilitators in chronic patients remained unchanged over time. Age at event, time from event, and relative variability in "Environmental Factors" were significant predictors of relative variability in "Activities & Participation". It is of clinical relevance that patients with disorders of consciousness are kept in a supportive and facilitative environment, in order to prevent a decline in their functioning. Moreover, caregivers should receive tailored support in order to enhance and facilitate appropriate care of patients with disorders of consciousness.
意识障碍是与低功能水平相关的神经学状况，对公共卫生系统构成严峻挑战。当前研究旨在考察意识障碍患者功能的纵向变化，并使用《国际功能、残疾和健康分类》确定相关的生物心理社会因素。对248名意大利患者的样本进行了纵向评估。考察了急性和慢性患者之间相对变异性（一种控制基线水平的变化指标）的差异以及“活动与参与”方面相对变异性的预测因素。结果显示，存在功能随时间改善的患者亚组。急性患者“活动与参与”方面的问题数量随时间减少，而慢性患者则有所增加。环境因素“支持与关系”的相对变异性存在显著差异，这反映出急性患者中促进因素增加，而慢性患者中促进因素的数量随时间保持不变。发病年龄、发病时间以及“环境因素”的相对变异性是“活动与参与”方面相对变异性的显著预测因素。具有临床相关性的是，应将意识障碍患者置于支持性和促进性的环境中，以防止其功能下降。此外，护理人员应获得量身定制的支持，以加强并促进对意识障碍患者的适当护理。
