Gianino J M, York M M, Paice J A, Shott S
Rush University, College of Nursing, Rush Presbyterian-St. Luke's Medical Center, Department of Neurosurgery, Chicago, Illinois 60612, USA.
J Neurosci Nurs. 1998 Feb;30(1):47-54. doi: 10.1097/01376517-199802000-00006.
Severe, uncontrolled spasticity resulting from spinal cord injury (SCI) and multiple sclerosis (MS) can have a profound effect on the patient's ability to function and thus, their quality of life. Spasticity can be dramatically reduced by the continuous infusion of baclofen into the lumbar subarachnoid space using a drug delivery system. The aim of this study was to explore the effect of reduced spasticity on quality of life using intrathecal baclofen therapy. Twenty-five patients with intractable spasticity treated with intrathecal baclofen participated in this prospective study. Spasticity was measured using the Ashworth and spasm scales. Quality of life was measured using the Ferrans and Powers Quality of Life Index (QLI) and the Sickness Impact Profile (SIP). The mean spasm score decreased significantly from 2.6 at baseline to 0.5 after one year (Friedman test; p = 0.000017). The mean Ashworth score decreased significantly from 3.78 at baseline to 1.48 after one year, (Friedman test; p = 0.00000014). Though total QLI scores were not significantly different when comparing baseline with one year, the SIP revealed significant changes in the total score as well as the physical and psychosocial subscales. It is likely the QLI did not demonstrate improvement in quality of life due to the emphasis of this tool on nonphysical domains. A qualitative analysis of two open-ended questions revealed positive statements about the change in quality of life when spasticity is well-controlled. Measuring changes in quality of life after specific interventions is a difficult task, requiring an accurate operational definition of the concept and valid instruments for measurement.
脊髓损伤（SCI）和多发性硬化症（MS）导致的严重、无法控制的痉挛会对患者的功能能力产生深远影响，进而影响他们的生活质量。使用药物输送系统将巴氯芬持续注入腰蛛网膜下腔可显著减轻痉挛。本研究的目的是探讨鞘内注射巴氯芬疗法减轻痉挛对生活质量的影响。25例接受鞘内注射巴氯芬治疗的顽固性痉挛患者参与了这项前瞻性研究。使用Ashworth量表和痉挛量表测量痉挛程度。使用费兰斯和鲍尔斯生活质量指数（QLI）以及疾病影响量表（SIP）测量生活质量。痉挛平均评分从基线时的2.6显著降至一年后的0.5（Friedman检验；p = 0.000017）。Ashworth平均评分从基线时的3.78显著降至一年后的1.48（Friedman检验；p = 0.00000014）。虽然将基线与一年后的QLI总分进行比较时没有显著差异，但SIP显示总分以及身体和心理社会子量表有显著变化。由于该工具侧重于非身体领域，QLI可能未显示生活质量有所改善。对两个开放式问题的定性分析显示，当痉挛得到良好控制时，关于生活质量变化有积极表述。测量特定干预后的生活质量变化是一项艰巨任务，需要对该概念进行准确的操作定义以及有效的测量工具。
