Chen L M, Li L, Wu X L, Xiao C X, Chen Z H
School of Nursing, Fujian Medical University, Fuzhou 350108, China.
Department of Burns, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Shao Shang Za Zhi. 2019 Nov 20;35(11):804-810. doi: 10.3760/cma.j.issn.1009-2587.2019.11.007.
To explore the development trajectories of quality of life and acceptance of disability of burn patients in the rehabilitation treatment stage and the influencing factors. Totally 207 burn patients, including 157 males and 50 females, aged (40±13) years, who were in the rehabilitation treatment stage were selected by convenient sampling method from October 2016 to July 2017 in the Department of Burns of Fujian Medical University Union Hospital for this longitudinal study. At discharge and 1, 3, and 6 months after discharge, the patient's quality of life and acceptance of disability were scored using the Burn Specific Health Scale-Brief and Chinese Version of Acceptance of Disability Scale-Revised respectively. Taking the intercept, the slope, and the curve slope as latent variables, the latent second growth curve model was constructed for the quality of life and the acceptance of disability. The robust maximum likelihood estimation (MLR) method was used to estimate the mean, the variance, and the covariance, so as to analyze the discharge level, the growth rate, the acceleration, and the correlation among them. Taking the acceptance of disability, the gender, the cause of burn, the severity of burn, the existence of complications, the payment way, and the education level as covariates, the latent second growth curve model was constructed for the quality of life. The MLR method was used to estimate the influence of covariates on the discharge level, the growth rate, and the acceleration of the quality of life. At discharge and 1, 3, and 6 months after discharge, the quality of life scores of patients were (102±36), (111±36), (118±37), and (122±37) points respectively, and the acceptance of disability scores were (73±17), (75±17), (77±17), and (78±18) points respectively. The estimated mean intercept of the quality of life and the acceptance of disability were 101.680 and 72.993 respectively at discharge, both of which showed a curve increasing trend in 1, 3, and 6 months after discharge (estimated mean slope=11.024, 3.086, =15.376, 7.476, <0.01), and the increasing rate (acceleration) gradually slowed down (estimated mean curve slope=-1.393, -0.426, =-13.339, -4.776, <0.01). There were significant individual differences in the discharge level and the acceleration of quality of life of patients (estimated intercept variance=1 174.527, =9.332; estimated curve slope variance=2.379, =6.402; <0.01). There were significant individual differences in the discharge level, the growth rate, and the acceleration of patients' acceptance of disability (estimated intercept variance=267.017, =9.262; estimated slope variance=32.264, =2.356; estimated curve slope variance=0.882, =2.939; <0.05 or <0.01). There was no significant correlation among the discharge level, the growth rate, and the acceleration of the quality of life and those of the acceptance of disability of patients (estimated intercept and slope=37.273, -1.457, =0.859, -0.131; estimated intercept and curve slope=-6.712, -0.573, =-1.089, -0.248; estimated slope and curve slope=-5.494, -5.988, =-0.930, -2.512; >0.05). Among the time-constant covariates, only the severity of burn and the presence of complications had a significant impact on the quality of life of patients at discharge (estimated intercept=-10.721, 5.522, =-6.229, 1.977, <0.05 or <0.01). At discharge and 1, 3, and 6 months after discharge, the level of acceptance of disability had a positive impact on the quality of life of patients (standardized regression coefficient=0.616, 0.669, 0.681, 0.678, =18.874, 21.660, 22.824, 22.123, <0.01). The initial levels of quality of life and acceptance of disability of burn patients in the rehabilitation treatment stage are relatively low, both with a curve increasing trend over time, and the increasing rate gradually slows down. Patients with complications and serious burns have poor quality of life at discharge, while the acceptance of disability has a positive impact on the quality of life.
探讨烧伤患者康复治疗阶段生活质量和残疾接受度的发展轨迹及其影响因素。采用方便抽样法,选取2016年10月至2017年7月在福建医科大学附属协和医院烧伤科处于康复治疗阶段的207例烧伤患者进行纵向研究,其中男157例,女50例,年龄(40±13)岁。在出院时及出院后1、3、6个月,分别采用烧伤特异性健康量表简表和中文版残疾接受度量表修订版对患者的生活质量和残疾接受度进行评分。以截距、斜率和曲线斜率为潜在变量,构建生活质量和残疾接受度的潜在二次生长曲线模型。采用稳健最大似然估计(MLR)方法估计均值、方差和协方差,分析出院水平、增长率、加速度及其相关性。以残疾接受度、性别、烧伤原因、烧伤严重程度、并发症存在情况、支付方式和教育程度为协变量,构建生活质量的潜在二次生长曲线模型。采用MLR方法估计协变量对生活质量出院水平、增长率和加速度的影响。出院时及出院后1、3、6个月患者生活质量得分分别为(102±36)、(11l±36)、(118±37)、(122±37)分,残疾接受度得分分别为(73±17)、(75±17)、(77±17)、(78±18)分。生活质量和残疾接受度的估计平均截距在出院时分别为101.680和72.993,出院后1、3、6个月均呈曲线上升趋势(估计平均斜率分别为11.024、3.086、15.376、7.476,P<0.01),上升速率(加速度)逐渐减慢(估计平均曲线斜率分别为-1.393、-0.426、-13.339、-4.776,P<0.01)。患者生活质量的出院水平和加速度存在显著个体差异(估计截距方差=1174.527,P=9.332;估计曲线斜率方差=2.379,P=6.402;P<0.01)。患者残疾接受度的出院水平、增长率和加速度存在显著个体差异(估计截距方差=267.017,P=9.262;估计斜率方差=32.264,P=2.356;估计曲线斜率方差=0.882,P=2.939;P<0.05或P<0.01)。患者生活质量和残疾接受度的出院水平、增长率和加速度之间无显著相关性(估计截距与斜率=37.273,-1.457,P=0.859,-0.131;估计截距与曲线斜率=-6.712,-0.573,P=-1.089,-0.248;估计斜率与曲线斜率=-5.494,-5.988,P=-0.930,-2.512;P>0.05)。在时间常数协变量中,仅烧伤严重程度和并发症存在情况对出院时患者生活质量有显著影响(估计截距=-10.721,5.522,P=-6.229,1.977,P<0.05或P<0.01)。出院时及出院后1、3、6个月,残疾接受度水平对患者生活质量有正向影响(标准化回归系数分别为0.616、0.669、0.681、0.678,P=18.874、21.660、22.824、22.123,P<0.01)。康复治疗阶段烧伤患者生活质量和残疾接受度的初始水平较低,均随时间呈曲线上升趋势,且上升速率逐渐减慢。有并发症和严重烧伤的患者出院时生活质量较差,而残疾接受度对生活质量有正向影响。