Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Br J Neurosurg. 2023 Feb;37(1):71-81. doi: 10.1080/02688697.2021.1999390. Epub 2021 Nov 18.
BACKGROUND: Degenerative cervical myelopathy (DCM) is the most common cause of chronic, progressive spinal cord impairment worldwide. Patients experience substantial pain, functional neurological decline and disability. Health-related quality of life (HRQoL) appears to be particularly poor, even when compared to other chronic diseases. However, the determinants of HRQoL are poorly understood. The objective was to perform a systematic review of the determinants of quality of life of people with DCM. METHODS: A systematic search was conducted in MEDLINE and Embase following PRISMA 2020 guidelines (PROSPERO CRD42018115675). Full-text papers in English, exclusively studying DCM, published before 26 March 2020 were eligible for inclusion and were assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias 2 (RoB 2) tool. Study sample characteristics, patient demographics, cohort type, HRQoL instrument utilised, HRQoL score, and relationships of HRQoL with other variables were qualitatively synthesised. RESULTS: A total of 1176 papers were identified; 77 papers and 13,572 patients were included in the final analysis. A total of 96% of papers studied surgical cohorts and 86% utilised the 36-Item Short Form Survey (SF-36) as a measure of HRQoL. HRQoL determinants were grouped into nine themes. The most common determinant to be assessed was surgical technique (38/77, 49%) and patient satisfaction and experience of pain (10/77, 13%). HRQoL appeared to improve after surgery. Pain was a negative predictor of HRQoL. CONCLUSION: Current data on the determinants of HRQoL in DCM are limited, contradictory and heterogeneous. Limitations of this systematic review include lack of distinction between DCM subtypes and heterogenous findings amongst the papers in which HRQoL is measured postoperatively or post-diagnosis. This highlights the need for greater standardisation in DCM research to allow further synthesis. Studies of greater precision are necessary to account for HRQoL being complex, multi-factorial and both time and context dependent.
背景：退行性颈脊髓病（DCM）是全球最常见的慢性、进行性脊髓损伤的原因。患者会经历严重的疼痛、神经功能下降和残疾。健康相关生活质量（HRQoL）似乎特别差，即使与其他慢性疾病相比也是如此。然而，HRQoL 的决定因素还不太清楚。目的是对 DCM 患者生活质量的决定因素进行系统评价。
方法：按照 PRISMA 2020 指南（PROSPERO CRD42018115675），在 MEDLINE 和 Embase 中进行了系统搜索。符合条件的全文论文为英文，专门研究 DCM，发表日期在 2020 年 3 月 26 日之前，且采用纽卡斯尔-渥太华量表和 Cochrane 风险偏倚 2（RoB 2）工具进行评估。定性综合了研究样本特征、患者人口统计学、队列类型、使用的 HRQoL 工具、HRQoL 评分以及 HRQoL 与其他变量的关系。
结果：共确定了 1176 篇论文；最终分析纳入了 77 篇论文和 13572 名患者。96%的论文研究了手术队列，86%的论文使用 36 项简明健康调查问卷（SF-36）作为 HRQoL 的测量工具。HRQoL 决定因素分为九个主题。评估最多的决定因素是手术技术（38/77，49%）和患者满意度和疼痛体验（10/77，13%）。HRQoL 在手术后似乎有所改善。疼痛是 HRQoL 的负面预测因子。
结论：目前关于 DCM 患者 HRQoL 决定因素的资料有限、相互矛盾且具有异质性。本系统评价的局限性包括缺乏对 DCM 亚型的区分，以及在术后或诊断后测量 HRQoL 的论文中存在异质性发现。这突出表明需要在 DCM 研究中进行更大的标准化，以允许进一步综合。需要更精确的研究来解释 HRQoL 的复杂性、多因素性以及时间和环境的依赖性。
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