Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa.
Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa.
J Vasc Surg. 2018 Oct;68(4):1126-1134. doi: 10.1016/j.jvs.2017.12.074. Epub 2018 Mar 31.
The aim of this study was to identify predictors of baseline measures of health-related quality of life (HRQoL) in symptomatic patients with peripheral artery disease (PAD) from objective markers of severity of PAD, clinical and demographic characteristics, comorbid conditions, cardiovascular risk factors, objectively measured physical activity, and patient-based measures of physical function.
HRQoL measurements of 216 symptomatic men and women with PAD were assessed with the Medical Outcomes Study 36-Item Short Form Health Survey. Patients were further characterized on demographic variables, comorbid conditions, cardiovascular risk factors, ankle-brachial index, peak walking time during a maximal treadmill test, 6-minute walk distance, gait speed, ambulatory activity monitored during 1 week, activities of daily living (ADLs), Mini-Mental State Examination questionnaire, and Walking Impairment Questionnaire (WIQ).
For the physical function HRQoL subscale, the significant predictors included WIQ speed score (P < .001), history of stumbling (P < .001), WIQ stair climbing score (P < .001), ADL associated with bathing (P = .001), 6-minute walk distance (P = .004), and daily walking cadence (P = .043). For the role emotional function HRQoL subscale, the significant predictors included a history of stumbling (P < .001), the ADL associated with transferring from a bed to a chair (P < .001), and the WIQ distance score (P = .022).
Physical and mental subscales of HRQoL in symptomatic patients with PAD are primarily predicted by patient-based physical function rather than by more specific markers of PAD severity and comorbid conditions. The clinical significance is that interventions designed to improve HRQoL should focus on improving the quality of executing functional tasks, such as walking more steadily without stumbling; completing ADLs that are not specific to walking, such as bathing and transferring; and improving patient-based ability to walk various distances and speeds and to climb stairs.
本研究旨在从外周动脉疾病（PAD）严重程度的客观标志物、临床和人口统计学特征、合并症、心血管危险因素、客观测量的身体活动以及基于患者的身体功能测量中，确定有症状 PAD 患者基线健康相关生活质量（HRQoL）测量的预测因素。
使用医疗结局研究 36 项简短健康调查对 216 名有症状的 PAD 男性和女性患者进行 HRQoL 测量。患者还根据人口统计学变量、合并症、心血管危险因素、踝肱指数、最大跑步机测试期间的最大行走时间、6 分钟步行距离、步态速度、1 周内监测的活动、日常生活活动（ADL）、简易精神状态检查问卷和行走障碍问卷（WIQ）进行了进一步描述。
在生理功能 HRQoL 子量表方面，显著的预测因素包括 WIQ 速度评分（P<0.001）、绊倒史（P<0.001）、WIQ 爬楼梯评分（P<0.001）、与洗澡相关的 ADL（P=0.001）、6 分钟步行距离（P=0.004）和日常步行步频（P=0.043）。在角色情感功能 HRQoL 子量表方面，显著的预测因素包括绊倒史（P<0.001）、与从床上转移到椅子上相关的 ADL（P<0.001）和 WIQ 距离评分（P=0.022）。
有症状 PAD 患者的生理和心理 HRQoL 子量表主要由基于患者的生理功能预测，而不是由 PAD 严重程度和合并症的更具体标志物预测。临床意义在于，旨在提高 HRQoL 的干预措施应侧重于提高执行功能任务的质量，例如更稳定地行走而不绊倒；完成不限于行走的 ADL，例如洗澡和转移；并提高患者行走不同距离和速度以及爬楼梯的能力。
