КАЧЕСТВО ЖИЗНИ БОЛЬНЫХ ОСТЕОХОНДРОЗОМ
ORCID: 0000-0001-6692-4968, Кандидат медицинских наук, доцент, Национальный Исследовательский Мордовский Государственный Университет им. Н.П. Огарева, Медицинский институт г. Саранск
КАЧЕСТВО ЖИЗНИ БОЛЬНЫХ ОСТЕОХОНДРОЗОМ
Остеохондроз – это дегенеративно-деструктивное поражение позвоночника, которое включает в себя поражение тел позвонков, суставного аппарата, связочного аппарата и межпозвоночных дисков. В статье представлены результаты исследования, цель которого – оценка качества жизни, выраженности тревожности и наличия депрессивных расстройств у пациентов с остеохондрозом позвоночника. Под наблюдением находилось 80 пациентов с достоверным диагнозом остеохондроз позвоночника. Качество жизни изучали с помощью опросника «SF-36 Health Status Survey». Критериями качества жизни при этом являлись: физическая и социальная активность, роль физических и эмоциональных проблем в ограничении жизнедеятельности, общее и психическое здоровье. Установлено, что качество жизни больных остеохондрозом позвоночника достоверно ниже по сравнению с практически здоровыми лицами, что обусловлено наличием хронического заболевания.
Ключевые слова: качество жизни, остеохондроз, физическая и социальная активность.
ORCID: 0000-0001-6692-4968, MD, Associate Professor, Mordovia N. P. Ogarev National Research State University, Institute of Medicine
LIFE QUALITY OF PATIENTS WITH OSTEOCHONDROSIS
Osteochondrosis is degenerative and destructive lesions of a spine which includes vertebral bodies, articular apparatus and ligaments apparatus affection as well as intervertebral discs affection. The article presents the results of a study and its purpose is assessment of life quality, anxiety severity and presence of depressive disorders in patients with spinal osteochondrosis. We observed 80 patients with a documented diagnosis of osteochondrosis. Their quality of life was studied using a questionnaire called «SF-36 Health Status Survey». The criteria for quality of life in this case are physical and social activity, the role of physical and emotional problems in activity limitation, general and mental health. It was found that life quality of patients with spinal osteochondros is significantly lower compared to healthy individuals, due to presence of chronic diseases.
Keywords: quality of life, osteochondrosis, physical and social activity.
In recent decades, the society has been paying more and more attention to subjective well-being and quality of person’s life. Assessment of life quality is a complex integral characteristic of physical, psychological, emotional and social functioning of a patient, based on his subjective feelings. In accordance with the principles of evidence-based medicine, the main criteria for evaluating treatment effectiveness should be clinically important results and treatment outcomes, one of which is an indicator of life quality that can determine a condition of patients with chronic diseases only in an informative way [2, P. 48].
Nowadays a level of vertebral pathology in most countries reaches epidemic proportions [1, P. 42]. Osteochondrosis is the underlying disease in neurology affecting more than 30% of people. Osteochondrosis is one of the leading causes of going to the doctor and receiving a disability status for people of different ages [4, P. 11].
The World Health Organization recommends defining the quality of life as a correlation between human health indicators and socio-economic factors that evaluate a complex of physical, emotional, mental and intellectual human characteristics. All these characteristics determine people’s individual ability to function in a society. However, a medical concept of life quality includes, above all, those indicators that are associated with human health state [3, P. 61]. The term “medical aspects of life quality” refers to impact of the disease itself (its signs and symptoms), functional capacity constraints caused by it, as well as treatment impact on patient’s daily life activity. Quality of life today is a reliable, informative and cost-effective method for assessing patient’s health on an individual and group level.
The purpose of the study is assessment of life quality, anxiety severity and depressive disorders presence in patients with spinal osteochondrosis of various localizations.
The research is based on the data of 80 patients with spinal osteochondrosis of various localizations who had in-patient treatment in a neurology department of Federal State Budgetary Institution of Public Health in the Republic of Mordovia «Mordovian Republican Clinical Hospital» in 2015-2016. The exclusion criteria were malignancy presence, other clinically significant chronic somatic diseases with poor short-term prognosis, refusals to participate in the study. The age of examined patients ranged from 33 to 76 years old, the average age was 45,8 ± 8,4 years. There were 35 males and 45 females. The range of disease duration ranged from 2 months to 35 years, an average of 9,37 ± 2,17 years. Half of the examined respondents had permanent disability (52.7%). The highest proportion of people with a disability status is among those aged 36-45 years old, that is, in the most active working age. Nearly half of them (48.4%) have the third group of disability, 37.2% — the second one, and 9.1% — the first one. Family members of the respondents are ambivalent about their disease: only half of the respondents feel support, approval of their family members (52.5%); 41.7% of the respondents are helped by their family members with everything; only one-third of the patients (34.7%) believe that their relatives are upset because of the disease.
Pre-clinical, laboratory, neuroorthopedic and radiographic examinations have been carried out carefully. Criteria for inclusion into the study were the presence of osteochondrosis of various localizations and patients’ consent to participate in the study. The control group consisted of 30 healthy people, who were the same age and sex as the patients in the main group.
As for the level of education among patients with spinal osteochondrosis, people with specialized secondary education (54.3%) dominated, the respondents with higher education -30.2% were in the second place, then there were the patients with secondary education — 12.4% and people with incomplete higher education — 3.1% were in the last place. Classification of patients with spine osteochondrosis according to their social position showed that about half of the respondents (47,2%) are employed workers, 1.6% — entrepreneurs, 12.6% — people who do not study or work (mainly, retirement pensioners), 33.2% were disabiled, and 5.4% were representatives of other social groups. More than half of the respondents (56.4%) estimated their financial situation to be satisfactory or good.
On admission to the hospital assessment of all patients’ life quality was carried out with the help of «SF-36 health status survey» questionnaire developed by Evidence Company [4, P. 35]. «SF-36 Health Status Survey» is a non-specific questionnaire aimed at assessing quality of life; it is widely used in the USA and European countries when carrying out quality of life researches. Translation into Russian and methodology testing were conducted by “The Institute of Clinical and Pharmacological Research» (St. Petersburg). “SF-36 Health Survey» questionnaire consists of 11 sections; results are presented in the form of points on 8 scales showed in such a way that a higher score indicates a better quality of life. Indicators of each scale range between 0 and 100, where 100 represents full health. All scales form two indicators: physical and mental well-being.
Dynamics of 8 main indicators were taken into account: FF — physical functioning, RPF — role-physical functioning, P — pain, GH — general health, V — vitality, SF — social functioning, REF — role emotional functioning, MH — mental health and assessment of two total measurements : physical (PCS) and mental health (MCS), which were compared with population control of the same sex and age. Statistic processing was performed using Statistica 8.0 program. For each feature in two groups the arithmetic mean value (M) and the error of the mean (m) were determined. For all types of analysis differences were considered accurate at p <0.05.
The results of the comparative analysis of life quality parameters of the patients with spinal osteochondrosis and the group of population control of the same sex and age, assessed with the help of «SF-36 Health Status Survey» questionnaire, show that all the indicators of patients’ life quality were significantly lower compared with those of the population control.
Patient testing with the help of «SF-36 Health Status Survey» questionnaire showed deterioration in life quality of the patients with spinal osteochondrosis. To the greatest extent it concerned PCS, which was > 21 points below the average figures of the population control, indicating substantial limitations for the patients with spinal osteochondrosis when taking care of themselves and when doing physical activity. Physical health indicators changed the most (FF, RPF, P, GH). FF was reduced by 46.3%, RPF — by 39.7%, B — by 38.6% compared with the average figures of the population control. Among the indicators of life quality that characterize psychological health (V, SF, REF, MH), V and SF were significantly reduced: V — by 37.2% and SF — by 33.4%.
Life quality assessment makes it possible to more precisely detect disorders in patients’ health, to get a clearer idea of the essence of a clinical problem, to determine the most rational method of treatment and to assess its expected results according to the parameters that are located at the junction of specialists’ scientific approach and patients’ subjective point of view. The results of life quality evaluation allow more accurate assessment of cost-effectiveness of different treatments and, therefore, make it possible to rationally plan the health care budget.
Список литературы / References
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Список литературы на английском языке / References in English
- Naumov A. V. Bol’ v Rossii: fakty i umozakluchenija (Pain in Russia: facts and conclusions) / A. V. Naumov, P. A. Semenov // Consilium medicum. Neurology and Rheumatology. — 2010. – Volume 12. — №2. — P. 42-48. [In Russian]
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