来自一家三级保健中心的纤维肌痛女性患者的自我报告残疾情况。

Self-reported disability in women with fibromyalgia from a tertiary care center.

机构信息

Department of Rheumatology, Hospital General Regional número 1, Delegación Yucatán, Instituto Mexicano del Seguro Social, Calle 41 S/N, Colonia Industrial, 97150, Mérida, Yucatán, Mexico.

Centro de Investigación en Ciencias de la Salud, Campus Norte Huixquilucan, Universidad Anáhuac México, Ciudad de México, Mexico.

出版信息

Adv Rheumatol. 2019 Oct 23;59(1):45. doi: 10.1186/s42358-019-0086-4.

DOI:10.1186/s42358-019-0086-4

PMID:31647024

Abstract

BACKGROUND

The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient's perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia.

METHODS

One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability.

RESULTS

Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire.

CONCLUSIONS

Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).

摘要

背景

世界卫生组织残疾评估表（WHODAS）2.0 是一种评估残疾的通用工具。疼痛和心理因素在纤维肌痛（FM）中似乎起着明显的致残作用。从患者的角度研究纤维肌痛患者残疾相关因素的研究较少。使用自我报告问卷评估纤维肌痛患者的残疾信息有限。本研究旨在评估有序反应变量（残疾程度）与四个解释变量之间的关系：疼痛强度、抑郁、焦虑和述情障碍。

方法

本横断面研究纳入了 115 名女性纤维肌痛患者。使用 WHODAS 2.0（36 项版本）评估残疾。进行单变量和多变量（有序逻辑回归）分析，以评估疼痛（视觉模拟量表）、抑郁和焦虑（医院焦虑和抑郁量表）、述情障碍（多伦多述情障碍量表修订版）与残疾之间的关系。

结果

通过全球 WHODAS 评分在 114 名患者（99%）中检测到残疾，轻度、中度和重度残疾的相应百分比分别为 11.3%、46.96%和 40.87%。患有抑郁（50 对 36.4，p<0.001，效应量=0.33）和述情障碍（50 对 33.6，p<0.001，效应量=0.38）的患者全球 WHODAS 评分更严重。轻度、中度和重度残疾的疼痛强度平均评分分别为 5.0、6.1 和 7.3（p<0.001，ω平方=0.12）。疼痛强度解释了全球残疾程度及其除认知领域外的所有领域。然而，抑郁解释了认知和个人关系领域。另一方面，述情障碍解释了全球残疾程度和 WHODAS 2.0 问卷的所有领域。