下腰痛患者生活质量及其影响因素的研究
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摘要
目的描述下腰痛患者的生活质量及探讨影响下腰痛患者生活质量的主要因素。
方法本研究为描述性研究,采用便利抽样的方法,调查长春市三家三级甲等医院170名下腰痛患者,应用社会人口学资料调查表、SF—36生命质量测评量表、Oswestry功能不良问卷、抑郁自评量表、社会支持评定量表调查下腰痛患者的生活质量现状及分析其影响因素。所有数据均采用SPSS13.0统计软件进行分析。
结果1、下腰痛患者的基本情况:(1)下腰痛患者组与健康人群组在生活质量总分及各维度的差异均有统计学意义(P＜0.01),下腰痛患者总的生活质量及各领域的生活质量明显低于健康人群。(2)下腰痛患者中,无抑郁的患者35人(20.8%),轻度抑郁的患者74人(43.4%),中度抑郁的患者45人(26.4%),重度抑郁的患者16人(9.4%)。抑郁患者占所调查患者的79.2%。不同抑郁程度的下腰痛患者的生活质量及其各维度差异具有统计学意义(P＜0.01)。(3)30～45周岁成年下腰痛患者Oswestry功能不良指数最小值为8,最大值84,均值32.68,标准差15.42,极差76。8～27和28～46这两个指数范围的患者占所调查下腰痛患者的80.6%。不同Oswestry功能障碍指数范围下腰痛患者的生活质量及其各维度差异具有统计学意义(P＜0.01)。(4)下腰痛患者的社会支持总分(42.06±7.31)高于国内社会支持总分(34.56±7.34),其差异具有统计学意义(P＜0.01),下腰痛患者的生活质量总分与社会支持总分和主观支持呈正相关。2、下腰痛患者生活质量的影响因素:(1)女性下腰痛患者生活质量较男性低。对不同年龄、职业、文化程度、家庭人均月收入、医疗费支付形式、腰痛时间进行最小意义差异的t检验(LSD-t检验),两两比较后差异有统计学意义的有,30～35周岁和41～45周岁这两个年龄段的人群;小学和大专/本科及以上不同文化层次的人群;家庭人均月收入＜1000和3000～这两个不同收入的人群。(2)抑郁、功能障碍指数、社会支持及性别影响下腰痛患者的生活质量,总的决定系数为0.518。
结论(1)下腰痛患者总的生活质量及各领域的生活质量均明显低于健康人群。(2)下腰痛患者大部分存在抑郁情况并影响下腰痛患者的生活质量。(3)腰部功能障碍程度明显影响下腰痛患者的生活质量。(4)社会支持与下腰痛患者的生活质量相关,尤其在主观支持方面。(5)下腰痛患者的生活质量主要受抑郁、功能障碍程度、社会支持、性别的影响,这四个方面对生活质量的影响力为51.8%。
Objectives:To descript the quality of life in low back pain(LBP) patients and explore its main related factors.
Methods:A descriptive method was used in this study.By convenient sampling,170 LBP patients were recruited in this study.The demographic questionnaire,36-Item Short-Form Health Survey,Oswestry Disability Questionnaire,self-Rating Depression Scale,Social Support Rating Scale were used to measure the level of quality of life in LBP patients and to investigate the related factors.All the data were analyzed by software SPSS version 13.0.
Results:1.The status of LBP patients.(1) The patients with LBP have significant poorer quality of lives than healthy people in total and respectively dimensions of 36-Item Short-Form Health Survey,(P＜0.01).(2) There are 35 patients(20.8%) with no depression, 74 patients(43.4%) with slight depression,45 patients(26.4%) with moderate depression, 16 patients(9.4%) with severe depression.79.2%depressive patients in all the recruited ones.Different level of depressive patients have significant different level of QOL (P＜0.01).(3) The range of index of Oswestry Disability is 76,minimum is 8,maximum is 84,mean is 32.68,Std.Deviation is 15.42.There are significant difference in QOL between different range of index of Oswestry Disability(P＜0.01).(4) The score of Social Support is 42.06±7.31 which is significant to that of national model(34.56±7.34) (P＜0.01).The total score of Social Support and subjective support has positive relate to that of QOL.2.The related factors of quality of life with low back pain.(1) Female has lower degree of QOL than that of male.There are some items which have significant difference in QOL:age between 30～35 and 41～45;education background between primary and academic / undergraduate and higher;average month income / one person between＜1000 yuan and 3000～yuan.(2) Related factors of QOL in LBP patients are depression,index of Oswestry Disability.social support and gender,R~2 is 0.518.
Conclusions:(1) The QOL in LBP patients is lower than that of healthy people.(2) Most patients with LBP have depression.(3) The function of waist can influence the QOL of LBP patients.(4) Social support has positive relate to QOL.(5) The QOL with LBP is influenced by depression,index of Oswestry Disability,social support and gender,which would determine 51.8%quotient for the QOL.
方法本研究为描述性研究,采用便利抽样的方法,调查长春市三家三级甲等医院170名下腰痛患者,应用社会人口学资料调查表、SF—36生命质量测评量表、Oswestry功能不良问卷、抑郁自评量表、社会支持评定量表调查下腰痛患者的生活质量现状及分析其影响因素。所有数据均采用SPSS13.0统计软件进行分析。
结果1、下腰痛患者的基本情况:(1)下腰痛患者组与健康人群组在生活质量总分及各维度的差异均有统计学意义(P＜0.01),下腰痛患者总的生活质量及各领域的生活质量明显低于健康人群。(2)下腰痛患者中,无抑郁的患者35人(20.8%),轻度抑郁的患者74人(43.4%),中度抑郁的患者45人(26.4%),重度抑郁的患者16人(9.4%)。抑郁患者占所调查患者的79.2%。不同抑郁程度的下腰痛患者的生活质量及其各维度差异具有统计学意义(P＜0.01)。(3)30～45周岁成年下腰痛患者Oswestry功能不良指数最小值为8,最大值84,均值32.68,标准差15.42,极差76。8～27和28～46这两个指数范围的患者占所调查下腰痛患者的80.6%。不同Oswestry功能障碍指数范围下腰痛患者的生活质量及其各维度差异具有统计学意义(P＜0.01)。(4)下腰痛患者的社会支持总分(42.06±7.31)高于国内社会支持总分(34.56±7.34),其差异具有统计学意义(P＜0.01),下腰痛患者的生活质量总分与社会支持总分和主观支持呈正相关。2、下腰痛患者生活质量的影响因素:(1)女性下腰痛患者生活质量较男性低。对不同年龄、职业、文化程度、家庭人均月收入、医疗费支付形式、腰痛时间进行最小意义差异的t检验(LSD-t检验),两两比较后差异有统计学意义的有,30～35周岁和41～45周岁这两个年龄段的人群;小学和大专/本科及以上不同文化层次的人群;家庭人均月收入＜1000和3000～这两个不同收入的人群。(2)抑郁、功能障碍指数、社会支持及性别影响下腰痛患者的生活质量,总的决定系数为0.518。
结论(1)下腰痛患者总的生活质量及各领域的生活质量均明显低于健康人群。(2)下腰痛患者大部分存在抑郁情况并影响下腰痛患者的生活质量。(3)腰部功能障碍程度明显影响下腰痛患者的生活质量。(4)社会支持与下腰痛患者的生活质量相关,尤其在主观支持方面。(5)下腰痛患者的生活质量主要受抑郁、功能障碍程度、社会支持、性别的影响,这四个方面对生活质量的影响力为51.8%。
Objectives:To descript the quality of life in low back pain(LBP) patients and explore its main related factors.
Methods:A descriptive method was used in this study.By convenient sampling,170 LBP patients were recruited in this study.The demographic questionnaire,36-Item Short-Form Health Survey,Oswestry Disability Questionnaire,self-Rating Depression Scale,Social Support Rating Scale were used to measure the level of quality of life in LBP patients and to investigate the related factors.All the data were analyzed by software SPSS version 13.0.
Results:1.The status of LBP patients.(1) The patients with LBP have significant poorer quality of lives than healthy people in total and respectively dimensions of 36-Item Short-Form Health Survey,(P＜0.01).(2) There are 35 patients(20.8%) with no depression, 74 patients(43.4%) with slight depression,45 patients(26.4%) with moderate depression, 16 patients(9.4%) with severe depression.79.2%depressive patients in all the recruited ones.Different level of depressive patients have significant different level of QOL (P＜0.01).(3) The range of index of Oswestry Disability is 76,minimum is 8,maximum is 84,mean is 32.68,Std.Deviation is 15.42.There are significant difference in QOL between different range of index of Oswestry Disability(P＜0.01).(4) The score of Social Support is 42.06±7.31 which is significant to that of national model(34.56±7.34) (P＜0.01).The total score of Social Support and subjective support has positive relate to that of QOL.2.The related factors of quality of life with low back pain.(1) Female has lower degree of QOL than that of male.There are some items which have significant difference in QOL:age between 30～35 and 41～45;education background between primary and academic / undergraduate and higher;average month income / one person between＜1000 yuan and 3000～yuan.(2) Related factors of QOL in LBP patients are depression,index of Oswestry Disability.social support and gender,R~2 is 0.518.
Conclusions:(1) The QOL in LBP patients is lower than that of healthy people.(2) Most patients with LBP have depression.(3) The function of waist can influence the QOL of LBP patients.(4) Social support has positive relate to QOL.(5) The QOL with LBP is influenced by depression,index of Oswestry Disability,social support and gender,which would determine 51.8%quotient for the QOL.
引文
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[1]徐义明.下腰痛的诊断.中国矫形外科杂志,2007,15(9):675-678
[2]McKenzie R,May S.The lumbar spine mechanical diagnosis & therapy.Waikanae:Spinal Publications New Zealand Ltd 2003
[3]Wood-Dauphinee SL.Assessment of back-related quality of life:the continuing challenge.Spine 2001;26(8):857-861
[4]Salaffi F,De Angelis R,Stancati A.Health-related quality of life in multiple musculoskeletal conditions:a cross-sectional population based epidemiological study.Ⅱ.The MAPPING study.Clin Exp Rheumatol 2005;23(6):829-839
[5]Van Tulder MKoes B.chronic low back pain.Am Faro Physician.2006.Novl;74(9):1577-9
[6]Williams RM,Westmorland MG,Lin CA,et al.Effectiveness of workplace rehabilitation interventions in the treatment of work-related low back pain:A systematic review. Disabil Rehabil.2007,29(8):607-624
[7] Verrills P, Vivian D. Related Articles, Links Interventions in chronic low back pain. Aust FamPhysician.2004,33(6):421-6
[8] Bartleson JD. Low Back Pain. Curr Treat Options Neurol.2001,3(2): 159-168
[9] StranjalisG, T samandourakiK ,Sakas DE,A lamanosY .Low back pain in a representatives ample of Greek population :analysis according to personal and socioeconomic characteristics. Spine, 2004, 29 :1355-1360
[10] RaspeH, Matthis C, Croft P, O 'Ne illT .V ariation in back pain between countries: the example of Britain and Germany. Spine, 2004, 29 :1017-1021
[11] Goo HR, Tanaka S, Cameron LL, et al. Back pain among workers in the United States national estimates and workers at high risk. J A M J Ind Med, 1995,28:591-598
[12] Kaila-Kangas L, Leino-Arjas P, Riihimaki H, et al. Smoking and Over weight as predictors of hospitalization for back disorders. Spine, 2003, 28:1860-1868
[13] Volinn E The epidemiology of low back pain in the rest of the world. Spine, 1997,22:1798-1802
[14] Leigh JP, Sheetz RM.Prevalence of back pain among fulltime United States workers. Br J Ind Med, 1989, 46:651-659
[15] Heliovaara M, Knedt P, Aromaa A Incidence and risk factors of herniated lumbar intervertebral disc or sciatica leading to hospitalization.J Chronic Disc, 1987, 40:251-258
[16] Eriksen W, Bruusgaard D, Knardahl S. Work factors as predictors of intense or disabling low back pain; aprospective study of nurses'aides. Occup Environ Med, 2004,61:398-404
[17] Zwerling C, Ryan J, Schootnan M. A case control study of risk factors for industrial low back injury: the utility of replacement screening in defining:high-risk groups.Spine,1993,18:1242-1247
[18] Matsui H, Maeda A, Tsuji H, et al. Risk indicators of low back pain among workers in Japan: association of familial and physical factors with low back pain.Spine,1997, 22:1242-1248
[19] Macfarlane GJ, Thomas E, Papageorgiou AC, et al. Employment and physical workactivities as predictors of future low back pain. Spine, 1997,22:1143-1149. Frymoyer JW, PopeMH, Clements JH, et al. Risk factors in low back pain : an epidemiological survey. Bone Joint Surg (Am ), 1983,65 :213-218
[20]Pope HH,Magnusson M,WilderDG.Low back pain and whole body vibration.Clin Orthop,1988,3:54-61
[21]Sculco AD,Paup DC,Fernhall B,et al.Efects of aerobic exercise on low back pain patients in treatment.Spine J,2001,1:95-101
[22]Breckenridge J,Clark JD.Patient characteristics associated with opioid versus nonsteroidal anti-in-flammatory drug management of chronic low backpain.J Pain,2003,4:344-350
[23]Birbara CA,Puopolo AD,Munoz DR,et al.Treatment of chronic low back pain with etoricoxib,a new cyclo-oxygenase - 2 selective inhibitor:improvement in pain and disability-a random-ized,placebo-controlled,3-month trial.J Pain,2003.4:307-315
[24]Brisby H.Nerve root injuries in patients with chronic low back pain.Orthop Clin North Am,2003.34:221-230
[25]姚孟,董大明,刘庆鹏等.腰神经后支应用解剖与射频热凝的实验研究.中华外科杂志,1999,37:686-688
[26]Leclaire R,Fortin L,Lambert R,et al.Radio-frequency facet joint denen'ation in the treatmentof low back pain:a placebo-controlled clinical trial to assess efficacy.Spine,2001,26:1411-1417
[27]Rakel B,Barrjo.Physical modalities in chronicpain management.Nurs Clin North Am,2003,38:477-494
[28]Gur A,Karakoc M,Cevik R,et al.Eficacy of low power laser therapy and exercise on pain and functions in chronic low back pain.Lasers Surg Med.2003,32:233-238
[29]Schumaker SA,Anderson RT,Czajikowski SM.Psychologicalte st sa nds cales.In Quality of Life Assessment in Clinical Trials.(SpilkerBed).NewYork:Raven press,1990,95-113
[30]Schipper H.Guidelines and caveats for quality of life measurement in clinical practice and research.Oncology,1990,4:51-57
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[32]WHO.The development of the WHO Quality of Life Assessment Instrument.G eneva,WHO,1993
[33]McsweeneyA J,Heaton RK,Grantl,et al.Chronic obstructive pulmonary disease socialemotional adjustment and life quality.Chest,1980,77(2s uppl):309-311
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[35]方积乾.生存质量测定方法及应用[M].北京:北京医科大学出版社,2000.6-92
[36]Walker BF,Muller R,Grant WD.Low back pain in Australian adults:Prevalence and Associated Disability.J.Manipulative Physiological Therapy 2004;27(4):238-244
[37]Currie SR,Wang J.Chronic back pain and major depression in the General canadian population.Pain,2004,107:54-60
[38]孙剑.慢性疼痛病人抑郁性障碍与痛觉阈值的相关性研究.中国行为医学科学,1997,6(1):14-16
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[40]王春芳.心身疾病与神经症患者的述情障碍.中国神经精神疾病杂志,1993,19(2):70-72
[41]Hansen FR,Biering F,Schroll M.Minnesota Multiphasic Personality Inventory Profiles in persons without low back pain.A 20-year follow up study.Spine.1995,20(24):2716-2720
[42]Sieben JM,Portegijs PJ,Vlaeyen JW,et al.Pain-related fear at the start of a new low back pain episode.Eur J pain 2005,9(6):635-641
[43]Yamaji S,Demura S,Nagasawa Y,et al.The effect of measurement time when evaluating static muscle endurance during sustained static maximal gripping.J PhysiolAnthropolAppl Human Sci 2002;21(3):151-158
[44]Koleck M,Mazaux JM,Rascle N,et al.Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain:a prospective study.Eur J Pain 2006;10(1):1-11
[45]Cairns MC,Foster NE,Wright C.Randomized controlled trial of specific spinal Stabilization exercises and conventional physiotherapy for recurrent low back pain.Spine2006;31(19):E670-681
[46]刘桂花.社会支持对腰间盘突出症患者下腰痛评分的影响.中国临床康复.2004,8(26):5523-5524
[47]Ellenberg M,Honet JC.Low back pain.In:O'Young B J,Young MA,Stiens SA(eds).Physical medicine and rehabilitation secrets.2nd ed.Philadelphia:Hanley &.Belfus Inc 2002:254-258
[48]Andersson GB,Mekhail NA,Block JE.Treatment of intractable discogenic low back pain.A systematic review of spinal fusion and intradiscal electrothermal therapy (IDET). Pain physician 2006; 9(3): 237-248
[49] Nadler SF, Steiner DJ, Erasala GN, et al. Continuous low-level heatwrap therapy for treating acute nonspecific low back pain. Arch phys Med Rehabil 2003; 84(3): 329-334
[50] Gur A, Karakoc M, Cevik R, et al. Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Lasers Surg Med 2003; 32(3): 233-238
[51] Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ 2006; 333(7569): 623
[52] Witt CM, Jena S, Selim D, et al. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 2006; 164(5): 487-496
[53] Karmisholt K, Gotzsche PC. Physical activity for secondary prevention of disease. Systematic reviews of randomised clinical trials. Dan Med Bull 2005; 52(2): 90-94
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[15]Van Tulder MKoes B.chronic low back pain.Am Faro Physician.2006,Novl; 74(9): 1577-9
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[25] Eriksen W, Bruusgaard D, Knardahl S. Work factors as predictors of intense or disabling low back pain; aprospective study of nurses'aides. Occup Environ Med, 2004,61:398-404
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[47]Thomas KJ,MacPherson H,Thorpe L,et al.Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain.BMJ 2006;333(7569):623
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[1]徐义明.下腰痛的诊断.中国矫形外科杂志,2007,15(9):675-678
[2]McKenzie R,May S.The lumbar spine mechanical diagnosis & therapy.Waikanae:Spinal Publications New Zealand Ltd 2003
[3]Wood-Dauphinee SL.Assessment of back-related quality of life:the continuing challenge.Spine 2001;26(8):857-861
[4]Salaffi F,De Angelis R,Stancati A.Health-related quality of life in multiple musculoskeletal conditions:a cross-sectional population based epidemiological study.Ⅱ.The MAPPING study.Clin Exp Rheumatol 2005;23(6):829-839
[5]Van Tulder MKoes B.chronic low back pain.Am Faro Physician.2006.Novl;74(9):1577-9
[6]Williams RM,Westmorland MG,Lin CA,et al.Effectiveness of workplace rehabilitation interventions in the treatment of work-related low back pain:A systematic review. Disabil Rehabil.2007,29(8):607-624
[7] Verrills P, Vivian D. Related Articles, Links Interventions in chronic low back pain. Aust FamPhysician.2004,33(6):421-6
[8] Bartleson JD. Low Back Pain. Curr Treat Options Neurol.2001,3(2): 159-168
[9] StranjalisG, T samandourakiK ,Sakas DE,A lamanosY .Low back pain in a representatives ample of Greek population :analysis according to personal and socioeconomic characteristics. Spine, 2004, 29 :1355-1360
[10] RaspeH, Matthis C, Croft P, O 'Ne illT .V ariation in back pain between countries: the example of Britain and Germany. Spine, 2004, 29 :1017-1021
[11] Goo HR, Tanaka S, Cameron LL, et al. Back pain among workers in the United States national estimates and workers at high risk. J A M J Ind Med, 1995,28:591-598
[12] Kaila-Kangas L, Leino-Arjas P, Riihimaki H, et al. Smoking and Over weight as predictors of hospitalization for back disorders. Spine, 2003, 28:1860-1868
[13] Volinn E The epidemiology of low back pain in the rest of the world. Spine, 1997,22:1798-1802
[14] Leigh JP, Sheetz RM.Prevalence of back pain among fulltime United States workers. Br J Ind Med, 1989, 46:651-659
[15] Heliovaara M, Knedt P, Aromaa A Incidence and risk factors of herniated lumbar intervertebral disc or sciatica leading to hospitalization.J Chronic Disc, 1987, 40:251-258
[16] Eriksen W, Bruusgaard D, Knardahl S. Work factors as predictors of intense or disabling low back pain; aprospective study of nurses'aides. Occup Environ Med, 2004,61:398-404
[17] Zwerling C, Ryan J, Schootnan M. A case control study of risk factors for industrial low back injury: the utility of replacement screening in defining:high-risk groups.Spine,1993,18:1242-1247
[18] Matsui H, Maeda A, Tsuji H, et al. Risk indicators of low back pain among workers in Japan: association of familial and physical factors with low back pain.Spine,1997, 22:1242-1248
[19] Macfarlane GJ, Thomas E, Papageorgiou AC, et al. Employment and physical workactivities as predictors of future low back pain. Spine, 1997,22:1143-1149. Frymoyer JW, PopeMH, Clements JH, et al. Risk factors in low back pain : an epidemiological survey. Bone Joint Surg (Am ), 1983,65 :213-218
[20]Pope HH,Magnusson M,WilderDG.Low back pain and whole body vibration.Clin Orthop,1988,3:54-61
[21]Sculco AD,Paup DC,Fernhall B,et al.Efects of aerobic exercise on low back pain patients in treatment.Spine J,2001,1:95-101
[22]Breckenridge J,Clark JD.Patient characteristics associated with opioid versus nonsteroidal anti-in-flammatory drug management of chronic low backpain.J Pain,2003,4:344-350
[23]Birbara CA,Puopolo AD,Munoz DR,et al.Treatment of chronic low back pain with etoricoxib,a new cyclo-oxygenase - 2 selective inhibitor:improvement in pain and disability-a random-ized,placebo-controlled,3-month trial.J Pain,2003.4:307-315
[24]Brisby H.Nerve root injuries in patients with chronic low back pain.Orthop Clin North Am,2003.34:221-230
[25]姚孟,董大明,刘庆鹏等.腰神经后支应用解剖与射频热凝的实验研究.中华外科杂志,1999,37:686-688
[26]Leclaire R,Fortin L,Lambert R,et al.Radio-frequency facet joint denen'ation in the treatmentof low back pain:a placebo-controlled clinical trial to assess efficacy.Spine,2001,26:1411-1417
[27]Rakel B,Barrjo.Physical modalities in chronicpain management.Nurs Clin North Am,2003,38:477-494
[28]Gur A,Karakoc M,Cevik R,et al.Eficacy of low power laser therapy and exercise on pain and functions in chronic low back pain.Lasers Surg Med.2003,32:233-238
[29]Schumaker SA,Anderson RT,Czajikowski SM.Psychologicalte st sa nds cales.In Quality of Life Assessment in Clinical Trials.(SpilkerBed).NewYork:Raven press,1990,95-113
[30]Schipper H.Guidelines and caveats for quality of life measurement in clinical practice and research.Oncology,1990,4:51-57
[31]Hornquist JO.The concept of quality of life.Scand J SocMed,1982,10:57-61
[32]WHO.The development of the WHO Quality of Life Assessment Instrument.G eneva,WHO,1993
[33]McsweeneyA J,Heaton RK,Grantl,et al.Chronic obstructive pulmonary disease socialemotional adjustment and life quality.Chest,1980,77(2s uppl):309-311
[34]Najman JM,Levine S.E valuating the impact of medical care and technologies on the quality of life.Soc Sci-fed,1981,15:107-115
[35]方积乾.生存质量测定方法及应用[M].北京:北京医科大学出版社,2000.6-92
[36]Walker BF,Muller R,Grant WD.Low back pain in Australian adults:Prevalence and Associated Disability.J.Manipulative Physiological Therapy 2004;27(4):238-244
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