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

Abstract

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. The 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.

Σκοπός: H ποσοτική εκτίμηση του βαθμού κοινωνικής επανένταξης και ποιότητας ζωής των ατόμων με κάκωση νωτιαίου μυελού (KNM) και η συσχέτιση των ευρημάτων με δημογραφικά χαρακτηριστικά και κλινικές παραμέτρους. Μέθοδοι: Μελετήθηκαν 164 άτομα με KNM. Για την εκτίμηση της ποιότητας ζωής χρησιμοποιήθηκε η κλίμακα WHOQOL-BREF και για την κοινωνική επανένταξη η κλίμακα CHART. Αποτελέσματα: Η απασχόληση έχει συσχέτιση με το πεδίο WHOQOL BREF-φυσική κατάσταση (p=0,025). Επίσης με τα πεδία CΗΑRΤ-κινητικότητα (p<0,0005), επάγγελμα (p<0,0005) και κοινωνική ενσωμάτωση (p=0,008). Ειδικότερα άτομα που εργάζονται ή σπουδάζουν εμφανίζουν καλύτερη ποιότητα ζωής και επανένταξη σε σχέση με όσα συνταξιοδοτούνται ή αναζητούν εργασία. Η ηλικία είχε συσχέτιση με τα πεδία της WHOQOL-BREF και της CΗΑRΤ. Συγκεκριμένα η αύξηση της ηλικίας επιδρά αρνητικά στους αντίστοιχους τομείς επανένταξης και ποιότητας ζωής. Ο τύπος της ΚΝΜ (παραπληγία ή τετραπληγία) έχει συσχέτιση με τα πεδία WHOQOL BREF-φυσική κατάσταση (p=0,002), ψυχολογική κατάσταση (p=0,038), καθώς και με τα πεδία της CΗΑRΤ που αφορούν στη φυσική (p<0,0005) και γνωσιακή ανεξαρτησία (p<0,0005) και το επάγγελμα (p=0,002), πάντοτε με επιβάρυνση των τετραπληγικών σε σχέση με τα παραπληγικά άτομα. Ο πόνος βρέθηκε να έχει συσχέτιση με τα πεδία της WHOQOL-BREF και της CΗΑRΤ-φυσική ανεξαρτησία (p=0,075 τάση) και κοινωνική ενσωμάτωση (p=0,049). Αυτό που είχε συσχέτιση δεν ήταν το είδος του πόνου αλλά η έντασή του, η οποία αυξανόμενη επηρεάζει δυσμενώς την ποιότητα ζωής και την επανένταξη.Συμπεράσματα: Το επίπεδο της βλάβης, η σοβαρότητα του πόνου, η ηλικία και η απασχόληση αποτελούν τους σημαντικότερους παράγοντες που επηρεάζουν την κοινωνική επανένταξη και την ποιότητα ζωής των ατόμων με ΚΝΜ.