社会融合对下肢大截肢术后结局的影响。
The effect of social integration on outcomes after major lower extremity amputation.
作者信息
Hawkins Alexander T, Pallangyo Anthony J, Herman Ayesiga M, Schaumeier Maria J, Smith Ann D, Hevelone Nathanael D, Crandell David M, Nguyen Louis L
机构信息
Center for Surgery and Public Health, Boston, Mass; Department of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, Mass; Department of Surgery, Massachusetts General Hospital, Boston, Mass.
Department of Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.
出版信息
J Vasc Surg. 2016 Jan;63(1):154-62. doi: 10.1016/j.jvs.2015.07.100. Epub 2015 Oct 21.
OBJECTIVE
Major lower extremity (MLE) amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes.
METHODS
From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form Craig Handicap Assessment and Reporting Technique. Systemic social support was assessed by comparing a United States and Tanzanian population. Walking function was measured using the 6-minute walk test and quality of life (QoL) was measured using the EuroQol-5D.
RESULTS
We recruited 102 MLE amputees. Sixty-three patients were enrolled in the United States with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs slow walk 23% vs fast walk 10%; P = .01) and those with high social integration were more likely to be fast walkers (no walk 10% vs slow walk 59% vs fast walk 74%; P = .01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing QoL scores in a multivariable analysis (β, .002; standard error, 0.0008; P = .02). In comparing the United States population with the Tanzanian cohort (39 subjects), there were no differences between functional or QoL outcomes in the systemic social support analysis.
CONCLUSIONS
In the United States population, increased social integration is associated with both improved function and QoL outcomes among MLE amputees. Systemic social support, as measured by comparing the United States population with a Tanzanian population, was not associated with improved function or QoL outcomes. In the United States, steps should be taken to identify and aid amputees with poor social integration.
目的
下肢大截肢是一种常见手术，会给患者生活带来深刻改变。我们试图确定社会支持与截肢后结局之间的关联。我们假设社会支持较多的患者截肢后结局会更好。
方法
2011年11月至2013年5月，我们开展了一项横断面、观察性、多中心研究。社会融合通过简易克雷格残疾评估与报告技术的社会融合子量表进行测量。通过比较美国和坦桑尼亚人群评估系统性社会支持。步行功能采用6分钟步行试验进行测量，生活质量（QoL）采用欧洲五维健康量表进行测量。
结果
我们招募了102名下肢大截肢患者。美国纳入了63例患者，平均年龄58.0岁。42例（67%）为男性。社会融合程度低的患者更有可能无法行走（不能行走39% vs 缓慢行走23% vs 快速行走10%；P = 0.01），而社会融合程度高的患者更有可能是快速行走者（不能行走10% vs 缓慢行走59% vs 快速行走74%；P = 0.01）。这种关系在多变量分析中持续存在。在多变量分析中，社会融合得分增加也与生活质量得分增加呈正相关（β，0.002；标准误，0.0008；P = 0.02）。在将美国人群与坦桑尼亚队列（39名受试者）进行比较时，系统性社会支持分析中的功能或生活质量结局没有差异。
结论
在美国人群中，社会融合程度提高与下肢大截肢患者功能改善和生活质量结局改善均相关。通过比较美国人群与坦桑尼亚人群来衡量的系统性社会支持与功能或生活质量结局改善无关。在美国，应采取措施识别并帮助社会融合程度差的截肢患者。
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