Finlayson Kathleen, Miaskowski Christine, Alexander Kimberly, Liu Wei-Hong, Aouizerat Bradley, Parker Christina, Maresco-Pennisi Diane, Edwards Helen
Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Australia.
Department of Physiological Nursing, University of California, San Francisco, California, USA.
J Pain Symptom Manage. 2017 May;53(5):871-879. doi: 10.1016/j.jpainsymman.2016.12.336. Epub 2017 Jan 4.
Adults with venous leg ulcers frequently experience multiple symptoms that may influence quality of life (QOL).
The objective of this study was to identify patient subgroups based on their experience with a pain-depression-fatigue-sleep disturbance symptom cluster and to identify differences in patient characteristics and wound-healing and QOL outcomes between the subgroups.
Secondary data analysis from previous longitudinal studies of 247 patients with venous leg ulcers. Latent class analysis identified subgroups of patients with distinct experiences with the symptom cluster of pain, depression, fatigue, and sleep disturbance. Hierarchical regression analysis identified relationships between the subgroups and QOL outcomes. Survival analysis identified differences between the subgroups and ulcer healing.
Latent class analysis found 67% of patients were in a mild symptom subgroup (i.e., experiencing no or mild pain, depressive symptoms, fatigue, or sleep disturbance). One-third of the samples were in a severe symptom subgroup, who reported moderate-to-severe levels of these symptoms. Compared with the mild subgroup, patients in the severe subgroup had poorer QOL scores (t = 8.06, P < 0.001). Symptom subgroup membership accounted for 19% of the variance (P < 0.001) within a hierarchical regression model that explained 42% of the variance in QOL (F(7,170) = 16.89, P < 0.001, R = 0.42). Cox proportional hazards regression found that at enrollment into the study, patients in the severe symptom subgroup were 1.5 times (95% confidence interval 1.02-2.08) less likely to heal in the following 24 weeks (P = 0.037).
Significant relationships were found between delayed ulcer healing, decreased QOL, and membership in the severe symptom subgroup. These findings suggest that comprehensive symptom assessment is needed to identify patients at higher risk for poor outcomes and enable early intervention.
患有下肢静脉溃疡的成年人经常经历多种可能影响生活质量（QOL）的症状。
本研究的目的是根据患者在疼痛-抑郁-疲劳-睡眠障碍症状群方面的经历确定患者亚组，并确定亚组之间患者特征、伤口愈合及生活质量结果的差异。
对之前247例下肢静脉溃疡患者的纵向研究进行二次数据分析。潜在类别分析确定了在疼痛、抑郁、疲劳和睡眠障碍症状群方面有不同经历的患者亚组。分层回归分析确定了亚组与生活质量结果之间的关系。生存分析确定了亚组与溃疡愈合之间的差异。
潜在类别分析发现，67%的患者属于轻度症状亚组（即无或有轻度疼痛、抑郁症状、疲劳或睡眠障碍）。三分之一的样本属于重度症状亚组，他们报告这些症状为中度至重度水平。与轻度亚组相比，重度亚组患者的生活质量得分更低（t = 8.06，P < 0.001）。在解释了生活质量42%方差的分层回归模型中，症状亚组归属占方差的19%（P < 0.001）（F(7,170) = 16.89，P < 0.001，R = 0.42）。Cox比例风险回归发现，在研究入组时，重度症状亚组的患者在接下来的24周内愈合的可能性降低了1.5倍（95%置信区间1.02 - 2.08）（P = 0.037）。
延迟溃疡愈合、生活质量下降与重度症状亚组归属之间存在显著关系。这些发现表明，需要进行全面的症状评估，以确定预后不良风险较高的患者，并进行早期干预。
