| Abstract | Cilj rada bila je analiza funkcionalnog ishoda protetičke rehabilitacije ispitanika upitnikom PPA, analiza kvalitete života osoba nakon amputacije donjega uda upitnikom SF-36 te analiza istih ispitanika uz pomoć MKF klasifikacije i usporedba dobivenih rezultata na temelju svih triju metoda.
Istraživanje je provedeno u Kliničkom zavodu za rehabilitaciju i ortopedska pomagala KBC-a Zagreb na uzorku od 140 ispitanika i trajalo je godinu dana. U ispitivanje su uključeni ispitanici koji su zadovoljili odgovarajuće uključujuće kriterije i pritom nisu imali niti jedan isključujući kriterij. Svi ispitanici su prije početka istraživanja potpisali informirani pristanak za sudjelovanje. Potom su ispunili dva upitnika – generički upitnik kvalitete života SF-36 i PPA upitnik kojim se ocjenjuje funkcionalni ishod protetičke rehabilitacije. Nakon ispunjavanja upitnika, autorica istraživanja je s ispitanicima provela odgovarajući intervju. Potom je provela ispravno šifriranje po zadanim kategorijama MKF-a uz pomoć određenih atributa, sukladno pravilima MKF klasifikacije.
Statistička analiza podataka provedena je s pomoću softverskog programa Statistica (StatSoft, USA, 2014., verzija 12). Kvalitativne i kategorijalne varijable prikazane su kontingencijskim tablicama dok su vrijednosti kvantitativnih varijabli prikazane odgovarajućim deskriptivnim mjerama. Razlike među pojedinim skupinama s obzirom na vrijednosti dimenzija kvalitete života procijenjene su Studentovim t-testom za neovisne uzorke ili Mann Whitneyjevim U testom, ovisno o normalnosti distribucije. Razlike u kategorijskim vrijednostima analizirane su X2 testom. Povezanost PPA upitnika i MKF klasifikacije s pojedinim dimenzijama kvalitete života procijenjene su odgovarajućim korelacijskim koeficijentima (Pearsonov ili Spearmanov) te odgovarajućim regresijskim modelom. Granica statističke značajnosti postavljena je na 0,05.
U istraživanju je šest od osam mjerenih dimenzija kvalitete života bilo ispod prosječne razine u usporedbi s općom populacijom u Hrvatskoj. Iznad prosječne razine uzorka bile su dimen-zije: ograničenja zbog psihičkih problema i psihičko zdravlje. Ovakve rezultate vjerojatno možemo objasniti “teorijom pomaka u razmišljanju” (engl. Response Shift). Ovom se teorijom objašnjavaju promjene u sustavu vrijednosti pojedinaca i promjene u doživljaju koncepcije kao što je kvaliteta života, a sve nakon što se zdravstveni status pojedinca znatno promijeni. Povezanost PPA upitnika s pojedinim dimenzijama kvalitete života SF-36 upitnika
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procijenjena je odgovarajućim regresijskim modelom te su identificirani važni prediktori uspješne protetičke rehabilitacije za što veću kvalitetu života ispitanika. Dobiveni rezultati upućuju na to da su mobilnost s protezom, njezina što češća upotreba, njezino prihvaćanje od strane okoline te manji broj komorbiditeta – najvažniji prediktori veće kvalitete života ispitanika. Povezanost dimenzija kvalitete života SF-36 upitnika i MKF klasifikacije prema MKF provjernoj listi procijenjena je također odgovarajućim regresijskim modelom, a iz rezultata proizlazi da su mobilnost s protezom, veća sposobnost izvođenja zadataka, moguć-nost brige za sebe i svoju obitelj (kućanski poslovi, pribavljanje dobara i usluga) te skladni odnosi u obitelji i emocionalna stabilnost važni prediktori veće kvalitete života, a time i pokazatelji uspješne protetičke rehabilitacije.
Analiza kvalitete života i usporedba s PPA i MKF klasifikacijom pokazala je da je veća kvaliteta života proporcionalna učestalijem korištenju proteze, povećanoj mobilnosti osobe, manjem broju komorbiditeta, mlađoj životnoj dobi, muškom spolu, prihvaćanju proteze od strane okoline ispitanika, mogućnosti brige za sebe i svoju obitelj, skladnim odnosima u obitelji i emocionalnoj stabilnosti ispitanika. Neočekivano se pokazalo da razina amputacije nije utjecala na dimenzije kvalitete života te da su dimenzije kvalitete života ograničenja zbog psihičkih problema i psihičkog zdravlja imale veće vrijednosti u usporedbi s općom populacijom u Hrvatskoj.
Istraživanjem je definiran prijedlog MKF sržnog seta za osobe s amputacijom donjega uda. Uz njegovu pomoć moguće je – zbog manjeg broja kategorija i njegove specifičnosti za osobe s amputacijom donjega uda – bolje definirati ciljeve rehabilitacije i analizirati njezine rezulta-te te pratiti tijek i razvoj bolesnikova stanja.
Metodologija i rezultati ovog rada pokazuju u kojem smjeru treba revidirati i razvijati instrumente koji se koriste u protetičkoj rehabilitaciji i predlažu specifične smjernice za una-pređenje programa protetičke rehabilitacije u osoba s amputacijom donjega uda. |
| Abstract (english) | The main objective of this study was to analyze the functional outcome of prosthetic rehabilitation using PPA questionnaire, analysis the quality of life of people with lower limb amputation by using questionnaire SF-36 and the analysis of the same participants with ICF classification and comparison of results of all three methods.
The study was conducted at the Department for Rehabilitation and Orthopaedic Devices at Clinical Hospital Centre Zagreb on a sample of 140 patients and lasted for one year. The study involved participants who meet the appropriate inclusive criteria, while they did not have any exclusion criteria. All participants prior to conducting a research signed informed consent form. Then they filled out two questionnaires – a generic quality of life questionnaire SF-36 and PPA questionnaire to assess functional outcome of prosthetic rehabilitation. After participants completed filling out the questionnaires, the author of the study conducted an appropriate interview with them. She then properly encrypted ICF categories with certain attributes in accordance with the rules of ICF classification.
Statistical analysis was performed using Statistic software (StatSoft, USA, 2014, version 12). The qualitative and categorical variables are shown in contingency tables while the values of quantitative variables are shown with appropriate descriptive measures. Differences between groups considering values of quality of life dimensions were evaluated by Student's t-test for independent samples or the Mann Whitney U test, depending on distribution normality. Differences in categorical values were analyzed by X2 test. The association between PPA questionnaire and the ICF classification with individual dimensions of quality of life was assessed by the responding correlation coefficients (Pearson or Spearman) and the corresponding regression model. The limit of statistical significance was set at 0,05.
In the study, six of eight quality of life measures were below average levels that are standardized for the general population in Croatia. Above the standardized level compared to a general population in Croatia were dimensions: role limitation due to emotional problems and mental health. These results probably can be explained by Response Shift Theory. This theory can explain why certain changes in life values of individuals and changes in the general perception of some life concepts, such as quality of life, can happen after health status of the individual changes dramatically. The association between PPA questionnaire and individual dimensions of quality of life of SF-36 questionnaire was estimated with regression
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model. By using the regression model the important predictors of prosthetic rehabilitation for greater quality of life were identified. Results indicate that the mobility with prosthesis, and its frequent application, acceptance of prosthetic use by people in participant surrounding and small number of co-morbidities are the most important factors for greater quality of life for these people. The connection between quality of life dimensions of SF-36 questionnaire and the ICF classification by using the ICF checklist was also estimated by appropriate regression model. These results show that predictors for greater quality of life are: a mobility with a prosthesis, a better ability to perform tasks, the ability to take care of yourself and your family (to do household chores, provision of goods and services) and have harmonious family relations and personal emotional stability.
Analysis of quality of life and comparison with PPA questionnaire and ICF classification has shown that greater quality of life is proportional to frequent use of prosthesis, the increased mobility of a person, small number of co-morbidities, younger age groups, male gender, acceptance of prosthetic use by people in participant surrounding, the ability to take care of yourself and your family, harmonious family relations and an emotional stability of participants. Unexpected results of this study were that the level of amputation did not affect dimensions of quality of life and that dimensions: role limitation due to emotional problems and mental health had higher values compared to the general population in Croatia.
This study defined a proposal of ICF core set for people with lower limb amputation. ICF core set has small number of categories, which allows its use in every day clinical practice, and is specific for people with lower limb amputation. Because of that, with the use of ICF core set, it is possible more effectively to define objectives of a prosthetic rehabilitation, analyze its results and monitor the progress and development of the patient's condition.
The methodology and results of this research have indicated in which direction the new development of prosthetic rehabilitation should go and in which way existing instruments in prosthetic rehabilitation should be revised for people with lower limb amputations. This study also proposed specific guidelines for improvement of prosthetic rehabilitation program in patients with lower limb amputation. |
