Koleck Michèle, Gana Kamel, Lucot Claire, Darrigrand Bénédicte, Mazaux Jean-Michel, Glize Bertrand
Bordeaux Population Health Center, INSERM U1219, Team "Psycho-epidemiology of Aging and Chronic Diseases", University of Bordeaux, 3 Place de la Victoire, 33076, Bordeaux Cedex, France.
University Hospital of Bordeaux and Research Group EA 4136 Handicap and Nervous System, University of Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.
Qual Life Res. 2017 Jan;26(1):45-54. doi: 10.1007/s11136-016-1361-z. Epub 2016 Jul 12.
This study had twofold objective: (1) assessing change and dynamic processes over time between severity of aphasia and functional autonomy and (2) examining the temporal relationships between functional autonomy, depressive mood and quality of life in stroke patients with aphasia.
Prospective study of patients with aphasia consecutively included after a first stroke and examined 1 year later at home (n = 101). Assessment included a visual analogical scale assessing QoL, a functional autonomy scale, a severity of aphasia scale, a communication questionnaire and a depression scale. Structural equation modeling was used to estimate competitive models, in which depressive mood or QoL was the ultimate endogenous variable (i.e., vulnerability vs. scar model).
One year after stroke, there were a slight improvement in language impairment (stability coefficient = .61, p < .001) and a moderate improvement in functional autonomy (stability coefficient = .44, p < .001). There were prospective reciprocal effects between severity of aphasia and functional autonomy, i.e., each state exerted a temporal dynamic prediction on the other over time. Cross-sectional results from path analysis showed that depressive mood negatively predicted QoL (i.e., scar model); there was no evidence of the reverse association.
Results and their practical relevance in treatment were discussed. Predicting as soon as possible which factors would be related to late QoL in stroke patients with aphasia is of major importance.
本研究有两个目标：（1）评估失语症严重程度与功能自主性随时间的变化及动态过程；（2）研究失语症中风患者功能自主性、抑郁情绪和生活质量之间的时间关系。
对首次中风后连续纳入的失语症患者进行前瞻性研究，并在1年后在家中对其进行检查（n = 101）。评估包括用于评估生活质量的视觉模拟量表、功能自主性量表、失语症严重程度量表、沟通问卷和抑郁量表。采用结构方程模型来估计竞争模型，其中抑郁情绪或生活质量是最终内生变量（即脆弱性模型与创伤模型）。
中风1年后，语言障碍有轻微改善（稳定系数 = 0.61，p < 0.001），功能自主性有中度改善（稳定系数 = 0.44，p < 0.001）。失语症严重程度与功能自主性之间存在前瞻性相互作用，即随着时间的推移，每种状态对另一种状态都有时间动态预测作用。路径分析的横断面结果显示，抑郁情绪对生活质量有负向预测作用（即创伤模型）；没有证据表明存在反向关联。
对结果及其在治疗中的实际相关性进行了讨论。尽快预测哪些因素与失语症中风患者的晚期生活质量相关至关重要。
