Westgren N, Levi R
Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
Arch Phys Med Rehabil. 1998 Nov;79(11):1433-9. doi: 10.1016/s0003-9993(98)90240-4.
To determine associations between major outcome variables after traumatic spinal cord injury (SCI) and quality of life (QL).
Of a total population of 353 SCI patients, 320 participated, 261 men and 59 women living in the greater Stockholm area: 124 were tetraplegic, 176 were paraplegic, and 20 had no classified level. Mean age was 42 years (range, 17 to 78).
The Swedish SF-36 Health Survey was used to assess QL. The SF-36 is a self-administered questionnaire containing 36 items, divided into 8 multi-item dimensions, covering physical function, physical and emotional role function, social function, bodily pain, mental health, vitality and overall evaluation of health. Neurologic, general medical, and psychosocial variables were obtained from the Stockholm Spinal Cord Injury Study (SSCIS) data base. QL indices were analyzed for the SCI group as a whole, as well as for subgroups. Descriptors for subgroups were demographic variables, presence or absence of common medical problems, and subjective evaluation of the degree of impact of the medical problem on well-being/daily activities.
QL in individuals with SCI was significantly lower in all subscales as compared with a normative population. No difference in QL was seen in subgroups according to extent of lesion, with the exception of physical functioning. Several medical complications such as neurogenic pain, spasticity, and neurogenic bladder and bowel problems were associated with lower QL scores.
QL, as defined by SF-36, is better in persons injured many years ago, as compared with those recently injured, suggesting an adaptive process operating over a long period. The presence of complicating medical problems, such as severe pain, problematic spasticity, and incontinence, seem to have more negative effects on QL than the extent of SCI as such.
确定创伤性脊髓损伤（SCI）后主要结局变量与生活质量（QL）之间的关联。
在353例SCI患者的总人群中，320例参与研究，其中261例男性和59例女性居住在大斯德哥尔摩地区：124例为四肢瘫痪，176例为截瘫，20例未分类损伤水平。平均年龄为42岁（范围17至78岁）。
采用瑞典SF - 36健康调查评估生活质量。SF - 36是一份自我填写的问卷，包含36个项目，分为8个多项目维度，涵盖身体功能、身体和情感角色功能、社会功能、身体疼痛、心理健康、活力以及健康总体评价。神经学、普通医学和心理社会变量来自斯德哥尔摩脊髓损伤研究（SSCIS）数据库。对SCI组整体以及亚组的生活质量指标进行分析。亚组的描述指标为人口统计学变量、是否存在常见医疗问题以及对医疗问题对幸福感/日常活动影响程度的主观评价。
与正常人群相比，SCI患者在所有子量表中的生活质量均显著较低。除身体功能外，根据损伤程度划分的亚组在生活质量方面未见差异。几种医学并发症，如神经源性疼痛、痉挛以及神经源性膀胱和肠道问题与较低的生活质量得分相关。
与近期受伤者相比，SF - 36所定义的生活质量在多年前受伤者中更好，这表明存在一个长期的适应过程。诸如严重疼痛、痉挛问题和尿失禁等复杂医疗问题的存在，似乎对生活质量的负面影响比SCI本身的程度更大。
