Κοινωνική επανένταξη και ποιότητα ζωής ατόμων με κάκωση νωτιαίου μυελού στην Ελλάδα

Doctoral Dissertation uoadl:1306937 71 Read counter

Unit:
Τομέας Χειρουργικής
Library of the School of Health Sciences
Deposit date:
2015-09-21
Year:
2015
Author:
Τζάνος Ιωάννης - Αλέξανδρος
Dissertation committee:
Καθ. Παναγιώτης Παπαγγελόπουλος
Original Title:
Κοινωνική επανένταξη και ποιότητα ζωής ατόμων με κάκωση νωτιαίου μυελού στην Ελλάδα
Languages:
Greek
Summary:
Aims: The quantitative assessment of social reintegration and quality of life
in people with spinal cord injury (SCI) who have completed the rehabilitation
program in Greece and the correlation of these findings with the demographic
characteristics of the participants in this research and clinical parameters
associated with spinal cord injury and its complications. This comparison leads
to useful conclusions for the scientific community and the state.
Methods: One hundred sixty four individuals with a history of SCI of different
causes were studied in this survey. They were residents of urban, suburban and
rural areas of the Greek territory. Questionnaires were completed for each one
in interview form and when needed, clinical examination was performed for data
collection. The ASIA scale was used for the SCI classification while pain was
evaluated by visual analog scale from 0 to 10 and was identified depending on
the type of it (nociceptive and neuropathic pain) and the level of the injury.
The questionnaire included demographic and clinical characteristics. The scales
used were: Satisfaction with Life Scale (SLS) to assess life satisfaction,
Patient Health Questionnaire-9 (PHQ-9) for assessing the existence of
depression, Spinal Cord Independence Measure (SCIM) to assess functional
ability, World Health Organization Quality of Life Instrument (WHOQOL-BREF) for
quality of life assessment and finally Craig Handicap Assessment and Reporting
Technique (CHART) to assess social reintegration. Statistical analysis of the
findings and correlation with demographic - clinical features with unιfactorial
and multifactorial analysis were also performed.
Results: The place of residence of persons with SCI in our study has a
statistically significant correlation with field CHART-economic
self-sufficiency only in the univariate analysis (p=0,053) with the residents
in urban areas having greater economic independence than those who live in
suburban areas or in countryside. Gender was found to have a statistically
significant correlation with CHART-occupation (p=0,012), CHART-mobility
(p=0,002) and CHART-social integration (p=0,033) fields, with women showing
better vocational rehabilitation after injury compared with men, and men having
a higher degree of accessibility in the environment and interaction with their
social context. The marital status was found having a statistically significant
correlation with SLS (p=0,029) and PHQ9 (p=0,038) with the married patients
having higher life satisfaction and less depression. On the other hand,
CHART-cognitive independence (p<0,0005) and CHART-mobility (p=0,001) domains
but only in univariate analysis had statistically significant correlation with
marital status where unmarried persons exhibit higher social reintegration in
terms of cognitive independence and mobility. The educational level was found
having statistically significant correlation with PHQ9 (p=0,040) and with
CHART-occupation field (p=0,038) and in the univariate analysis of WHOQOL
BREF-physical health (p=0,054), WHOQOL BREF-social relationships (p=0,044),
CHART-cognitive independence (p=0,001) and CHART-economic self-sufficiency
(p=0,017) domains. Specifically although tertiary education graduates have more
depression symptoms, they have an edge in specific components of quality of
life regarding physical condition and social relationships and develop better
social reintegration in the dimension of labor market participation, economic
resources and cognitive independence. Employment was found having statistically
significant correlation with WHOQOL BREF-physical health field (p=0,025) and
also with WHOQOL BREF-psychology (p=0,078) and WHOQOL BREF-social relationships
(p=0,008) fields in the univariate analysis. It was also found having
statistically significant correlation with CHART-mobility (p<0,0005),
CHART-occupation (p<0,0005) and CHART-social integration (p=0,008) domains and
also in the univariate analysis of CHART-cognitive independence (p=0,022) and
CHART-economic self-sufficiency (p=0,020) fields. Especially people who are
either working or studying in order to enter the labor market have a better
quality of life and social inclusion compared with those seeking work or
retired persons. Age was significantly correlated with SCIM-respiration and
sphincters (p<0,0005) field, with all fields of WHOQOL BREF except WHOQOL
BREF-environment (p=0,264) field and in all the domains of CHART scale, except
CHART-economic self-sufficiency (p=0,356) domain. Specifically increasing age
seems to adversely affect the reintegration and quality of life sections
assessed by these scales. The time that has elapsed since the SCI was found to
be correlated with the WHOQOL BREF-general health (p=0,018) and WHOQOL
BREF-psychological status (p=0,033) domains with a positive influence on them,
indicating that as the years since injury pass, person’s psychology and
self-perception of health state improves. Moreover, the lapse of years since
injury exerts a beneficial role in social reintegration because the CHART
fields of cognitive independence (p<0,0005), mobility (p=0,003), occupation
(p<0,0005) and economic self-sufficiency (p=0,004) were found with
statistically significant correlation with it. The type of spinal cord injury
(paraplegia or quadriplegia) was found having statistically significant
correlation with SCIM-self-care (p<0,0005), SCIM-respiration and sphincters (p
<0,0005), SCIM-mobility (p<0,0005), WHOQOL BREF-physical health (p=0,002),
WHOQOL BREF-psychology (p=0,038), and the CHART scale domains concerning
physical (p<0,0005) and cognitive independence (p<0,0005) and occupation
(p=0,002), always with burden on the quadriplegic compared with paraplegic
individuals. Th
e severity of the injury, as expressed through ASIA classification, was found
having statistically significant association only with the SCIM-respiration and
sphincters (p=0,004) and SCIM-mobility (p<0,0005) fields. In particular people
with ASIA D have advantage regarding independence in relation to people with
ASIA A, B or C. The presence of pressure ulcers was found having statistically
significant correlation with SCIM-self-care (p=0,052), WHOQOL BREF-general
health (p=0,032) and CHART-social integration (p=0,001) fields, while in
SCIM-respiration and sphincters (p=0,009), SCIM-mobility (p=0,001) and PHQ9
(p=0,059) only in the univariate analysis, always with individuals without
pressure ulcers having advantage. The type of micturition (normal or
intermittent self-catheterizations) was found having statistically significant
correlation with SCIM-respiration and sphincters fields (p<0,0005) and
SCIM-mobility (p=0,030) fields, with greater independence in people who perform
normal micturition. However it seemed that affects neither life satisfaction,
nor quality of life or social reintegration. The correlation between the
questionnaires showed positive correlation between CHART-economic
self-sufficiency and all WHOQOL BREF index domains and SLS and negative
correlation with PHQ9. This suggests that ensuring a higher degree of financial
resources creates conditions for better quality of life, life satisfaction and
less depression symptoms. Pain was found having statistically significant
correlation with SLS (p=0,015), all SCIM fields, all WHOQOL BREF domains except
general health (p=0,153), with PHQ9 (p<0.0005), CHART-physical independence
(p=0,075 tendency) and social integration (p=0,049) fields and in the
univariate analysis of the remaining fields of CHART scale. What was
statistically significant correlated was not the type of pain (nociceptive or
neuropathic), but its intensity, meaning that as it is getting increased, it
affects adversely quality of life, independence, mood and social integration of
the individual.
Conclusion: The level and severity of the injury, the way of bladder emptying,
the pain severity, depression, age, employment, accessibility features in the
community and the presence of pressure ulcers are the most important factors
affecting social reintegration and quality of life in people with spinal cord
injury.
Keywords:
Spinal cord injury, Spinal cord, Social reintegration, Quality of life
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
133
Number of pages:
168
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