抑郁介导的残疾和性别对希腊亚急性康复期卒中患者健康相关生活质量的影响：一项前瞻性队列研究。
The effect of disability and gender mediated by depression on health-related quality of life of Greek stroke patients in the subacute rehabilitation phase: a prospective cohort study.
作者信息
Ploumis A, Papadopoulou S L, Siafaka V, Bekou S, Zika J, Dimakopoulos G, Hyphantis T N
机构信息
Division of Physical Medicine and Rehabilitation, Department of Surgery, University Hospital of Ioannina, School of Medicine, University of Ioannina, Ioannina, Greece.
Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece.
出版信息
Hippokratia. 2023 Jan-Mar;27(1):12-17.
BACKGROUND
Stroke has been associated with compromised patient outcomes, such as a decreased quality of life. We aimed in the present study to evaluate the health-related quality of life (HRQοL) of hospitalized Greek stroke patients during the sub-acute rehabilitation period and assess the effect of demographic and clinical characteristics mediated by depressive symptom severity on HRQοL.
METHODS
In a prospective study, a cohort of adult patients hospitalized in the sub-acute phase of their first stroke episode were assessed in the Rehabilitation Clinic of the University Hospital of Ioannina in Greece. Patients' functional status, depressive symptom severity, and HRQοL were evaluated twice, using the Patient Health Questionnaire 9 (PHQ-9), the Barthel Index (BI), and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), respectively. All patients received physical, occupational, and speech therapy during their rehabilitation.
RESULTS
Fifty consecutive adult stroke patients were enrolled. We detected a statistically significant (p <0.001) improvement in WHOQOL-BREF, especially in the "psychological health" and "environment" domains, BI, and PHQ-9 scores, between the initial and follow-up assessments. Mediation analysis revealed that baseline disability had both a significant direct (estimate =0.014, p <0.001) and indirect (estimate =0.010, p <0.001, PHQ-9 as mediator) effect on the total HRQoL score. Gender and stroke localization had significant direct effects on HRQoL total (estimate =-0.432, p =0.009, and estimate =0.395, p =0.031, respectively), while PHQ-9 mediation was insignificant. Antidepressant medications and stroke type did not play a substantial role in HRQoL.
CONCLUSION
By the end of the subacute rehabilitation phase, patients' HRQoL, functionality and depression severity improved. Additionally, baseline functionality, stroke localization, and gender directly or indirectly (mediated by initial depression severity) affected HRQoL, with male patients and patients with stroke non-involving the frontal lobe/basal ganglia showing a better HRQoL by the end of rehabilitation. HIPPOKRATIA 2023, 27 (1):12-17.
背景
中风与患者预后不佳有关，如生活质量下降。在本研究中，我们旨在评估希腊住院中风患者在亚急性康复期的健康相关生活质量（HRQoL），并评估由抑郁症状严重程度介导的人口统计学和临床特征对HRQoL的影响。
方法
在一项前瞻性研究中，对希腊约阿尼纳大学医院康复诊所收治的首次中风发作亚急性期的成年患者队列进行了评估。分别使用患者健康问卷9（PHQ-9）、巴氏指数（BI）和世界卫生组织生活质量简表（WHOQOL-BREF）对患者的功能状态、抑郁症状严重程度和HRQoL进行了两次评估。所有患者在康复期间均接受了物理、职业和言语治疗。
结果
连续纳入了50例成年中风患者。我们发现，在初始评估和随访评估之间，WHOQOL-BREF，尤其是在“心理健康”和“环境”领域、BI和PHQ-9评分有统计学显著改善（p<0.001）。中介分析显示，基线残疾对HRQoL总分既有显著的直接影响（估计值=0.014，p<0.001），也有间接影响（估计值=0.010，p<0.001，以PHQ-9作为中介）。性别和中风部位对HRQoL总分有显著直接影响（估计值分别为-0.432，p=0.009和估计值=0.395，p=0.031），而PHQ-9的中介作用不显著。抗抑郁药物和中风类型在HRQoL中未起实质性作用。
结论
到亚急性康复期末，患者的HRQoL、功能和抑郁严重程度有所改善。此外，基线功能、中风部位和性别直接或间接（由初始抑郁严重程度介导）影响HRQoL，男性患者和中风未累及额叶/基底节的患者在康复期末显示出较好的HRQoL。《希波克拉底》2023年，27（1）：12-17。
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