臂神經叢損傷病人上肢功能、生活品質及憂鬱相關性探討

The Association between Physical Function in Upper Extremity, Quality of Life, and Depression in Patients with Brachial Plexus Injury

陳淑雯(Shu-Wen Chen)

指導教授 ： 呂筑韻

義守大學/管理學院/管理碩博士班/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00301

摘要

背景：臂神經叢損傷在生理層面會造成上肢功能障礙，使日常生活與工作能力受到影響，造成生活品質降低，在心理層面則因疾病導致焦慮、悲觀及自信心低落…等，嚴重者可能有憂鬱的傾向。本研究主要的目的有：(1)了解臂神經叢損傷病人的基本特性、社經狀況、疾病特性、上肢功能、生活品質與憂鬱情形；(2)探討臂神經叢損傷病人上肢功能的相關因素，包含病人基本特性、社經狀況、疾病特性等；(3)探討臂神經叢損傷病人生活品質的相關因素，包含病人基本特性、社經狀況、疾病特性；(4)探討臂神經叢損傷病人憂鬱的預測因子。
方法：本研究採橫斷式相關性研究設計，從2014年11月1日至2015年10月31日，在南台灣某區域教學醫院骨科病房共收案43位臂神經叢損傷病人。以結構性問卷進行資料收集，內容包含病人基本資料、臺灣中文版上肢功能評估問卷(DASH)、台灣簡明版世界衛生組織生活品質問卷及簡式健康量表，使用Excel 2013進行資料建檔，以SPSS 19.0套裝軟體進行統計分析。
結果：本研究樣本大部分為男性27位(62.8%)、單身27位(62.8%)、平均年齡36.58歲(標準差為15.24)、教育程度以高中職以上35位(81.4%)、只有16位(37.2%)目前有工作、28位(66.7%)患病時間未滿一年。上肢功能「失能層面」及「症狀層面」的嚴重度皆在中等程度以上(DASH上肢功能得分超過50)，整體生活品質約在中等程度，有27位(62.8%)的病人呈現憂鬱狀態。樣本基本特性、社經狀況、疾病特性在上肢功能「失能層面」無顯著差異，但在上肢功能「症狀層面」，單身的分數較已婚者低(52.78 vs. 69.42, p = 0.03)，患病時間一年以下者得分較患病時間一年以上者高(65.43 vs. 48.72, p = 0.01)。在生活品質方面，疾病特性在生活品質各範疇分數並無顯著差別；但單身者的「心理範疇」分數較已婚者高(12.49 vs. 9.75, p < 0.01)；男性的「社會關係範疇」分數較女性高(13.15 vs. 11.19, p = 0.02)；有工作者的「社會關係範疇」及「環境範疇」分數較無工作者高(13.56 vs. 11.74, p = 0.04; 13.69 vs. 12.12, p = 0.02)。除了生活品質之「社會關係範疇」，上肢功能各層面及生活品質各範疇皆呈現顯著負相關（r = 0.34 - 0.68）。邏輯斯回歸分析結果顯示，上肢功能「症狀層面」為憂鬱的危險因子，生活品質「生理範疇」、「心理範疇」、「社會關係範疇」則為憂鬱的保護因子。
結論：本研究顯示臂神經叢損傷病人上肢功能得分愈高，生活品質得分愈低，對於社會關係範疇則無顯著影響，除此之外，本族群憂鬱盛行率較高，且上肢功能症狀愈嚴重，罹患憂鬱的危險性愈高，但上肢功能失能的嚴重度對憂鬱則無顯著影響，意指能緩解臂神經叢損傷病人的生理不適，可改善此族群憂鬱的情形。

關鍵字

臂神經叢損傷病人 ； 臺灣中文版上肢功能評估問卷 ； 台灣簡明版世界衛生組織生活品質問卷 ； 簡式健康量表

並列摘要

The purpose of this study was to examine the association among physical function in upper extremity, quality of life, and depression in patients with brachial plexus injury.
Method: The study was a cross-sectional research design. Subjects who were diagnosed as brachial plexus injury were invited to participate in the study, and forty-three patients were recruited from a teaching hospital in southern Taiwan during November 2014 and October 2015. Study instruments including Disability of the Arm, Shoulder and Hand questionnaire (DASH), World Health Organization Quality of Life-abbreviated version (WHOQOL-BEEF), and Brief Symptom Rating Scale (BSRS-5) were used to collect information. Statistical software SPSS 19.0 was used and descriptive statistics, bivariate statistics, and logistic regression were employed to analyze the data.
Result: The study group was mainly male 27 (62.8%), single 27 (62.8%), and had an average age of 36.58 years (standard deviation 15.24). Many of them (n=35, 81.4%) had a senior high school or higher degree ; only 16 (37.2%) had a job, and 28 (66.7%) were injured less than a year. Subjects reported to have a higher DASH score than average (the average DASH upper limb function score = 50) in both dimensions: disability and symptom. The overall average score of quality of life was in moderate level, and 27 subjects (62.8%) reported to have depressive symptoms. There was no difference of DASH disability scores in terms of demographic, social-economical, and disease-related variables. In DASH symptom subscale, subjects who were unmarried reported to have a lower scores than those who were married (52.78 vs. 69.42, p = 0.03); and those with brachial plexus injury within one year reported to have higher scores than those with injury more than one year (65.43 vs. 48.72, p = 0.01). Results showed that there was no association between disease-related variables and QOL scores, but not subject demographic and social-economical variables. For instance, unmarried reported to have higher scores of WHOQOL in the psychological domain than those who were married (12.49 vs. 9.75, p < 0.01), male reported to have higher scores of WHOQOL in the social relationship domain than female (13.15 vs. 11.19, p = 0.02). Furthermore, subject who were currently working reported to have higher scores of WHOQOL in the both social relationship and environment domains (13.56 vs. 11.74, p = 0.04; 13.69 vs. 12.12, p = 0.02). Correlation analyses results revealed that the score of DASH was negatively associated with scores of WHOOQOL in physical, psychological, and environment domains (r = 0.34- 0.68), not social relationship domain. Based on the result of logistic regression analysis, upper limb symptoms as measured by DASH was considered as a risk factor to depressive symptoms, and different dimensions of QOL, including physical, psychological, and social relationship, were considered as protective factors to depressive symptoms.
Conclusion: This study demonstrated a negative correlation between DASH Score and all aspects of WHOQOL except for social relation in patients with brachial plexus injury, suggesting that physical impairment did not significantly affect social function and that symptom alleviation was an important factor for other aspects of WHOQOL improvement. Besides, there was a high prevalence of depressive symptoms in this patient population. The frequency of depressive symptoms was negatively associated with the symptom aspect instead of the disability aspect of DASH Score, implying that symptomatic relief may be relatively more important than disability improvement in depression prevention.

並列關鍵字

Brachial Plexus Injury ； physical function in upper extremity ； Quality of life ； Depressive symptoms

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