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English version: THE ESTIMATION OF LIFE QUALITY AND HEALTH STATE IN PATIENTS WITH TUBERCULOSIS DURING THE SANATORIUM PERIOD OF MEDICAL REHABILITATION*
Tsapenko Y.P.
Higher State educational if Ukraine "Ukrainian Medical Dental Academy", Poltava
The Ukrainian version of WHOQOL-IOO has been used to study the dynamics of life quality among 95 patients with tuberculosis of different activity during sanatorium period of medical rehabilitation. It has been established that at the beginning of rehabilitation period all the patients with tuberculosis in the investigated groups have lower general values of life quality compared with the healty persons from the control group and the most expressed reduction of life quality has been marked in spheres "Environment" and "Spiritual sphere". Life quality of patients with firstly diagnosed tuberculosis at the beginning of sanatorium rehabilitation was lower compared with the persons with residual changes after lungs tuberculosis. The dynamics of life quality improvement during the process of rehabilitation was positive in both groups but considerably higher among patients with the firstly diagnosed tuberculosis and corresponded to the life quality indices of healthy persons from the control group on discharge from sanatorium "Hadyach". Thus it is reasonable to apply the questionnaire of life quality and health state WHOQOL- 100 along with the present criteria of treatment efficiency to provide the quality estimation of medical rehabilitation efficiency during sanatorium and other stages of rehabilitation for the patients with tuberculosis.
Key words: tuberculosis, life quality, medical rehabilitation, sanatorium.
WHO experts distinguish adequacy of treatment among the key criteria of initiatives effectiveness estimation concerning population health care and interpret it as the necessity to achieve the quality of life perceived for a patient (WHOQOL Group., 1993). Quality of life is the integrating characteristic of person's physical, mental and social functioning based on subjective perception [5].
The chronic course of tuberculosis, the need of prolonged treatment and isolation from the usual environment as well as the family and eventually the awareness of this disease contageousness cannot but affect the aspects of patient's life [7].
The life quality of patients with tuberculosis has been studied by single authors only [11, 3, 8, 13, 12, 1, 9, 10, 2, 6].
The criteria of treatment efficiency assessment of patients with tuberculosis during hospital and out-patient stages of treatment are to close the cavities of disintegration and stop bacteria producing. There are no similar criteria during sanatorium stage so far and therefore the dynamics of patient's life quality along with the criteria mentioned above as well as the lack of process activity and stable patient's health have become influential [4]. It is these uninvestigated questions that will be the subject of the present work.
The objective of our research is to study the dynamics of life quality of the patients with tuberculosis of different activity on the sanatorium stage of medical rehabilitation.
Materials and methods
To achieve the assigned objective the general quality of life and health state of 95 patients of Hadyach town anti-tubercular sanatorium on admission and discharge have been studied by using the Ukrainian version of life quality and health state estimation methodology WHO-QOL-100 (S.V. Pkhidenko). This methodology investigates 6 spheres of life quality (physical, psychological spheres, level of independence, social relations, environment, spiritual sphere) and 24 specific
subspheres. The rehabilitation period lasted on average for 1,2-1,3 months.
There were 2 groups of patients formed with different tubercular process activity: among them 43 patients (45, 3%) with firstly diagnosed tuberculosis (FDTB) were included into the 1 group; the 2nd group was similarly formed with 52 patients (54,7%) with residual changes after lungs tuberculosis (RCTB). There were 30 healthy people included into the control group with the composition similar to the basic group (age, sex) ( p<0,05). Male-female sex correlation was 3:1 into the first group and average age 42,71±2,17; the 2nd group comprised 5:1 with average age 48,85±1,26 (table 1).
Table 1
Medical and social characteristics of respondents
Respondents characteristic Group 1 n=43 (45,3%) Group II n=52 (54,7%)
a6c. 1 % a6c. 1 %
Sex
Females 7 16,3 13 25
Males 36 83,7 39 75
Habitat
Rural population 21 48,8 39 75
Urban population 22 51,2 13 25
Results and discussion
The indices of life quality and health state (LQ) in the investigated groups were the following at the beginning of the research: 82,38±0,44 points in the 1st group FDTB, 84,64±0,37 points in the 2nd group RCTB and 99,28±0,18 points in the control group. It should be noted that life quality and health state in all spheres among FDTB group patients were 17% down (82,38±0,44 points) (p<0,001) compared with the control group (99,28±0,18 points); in turn LQ in the II group among RCTB patients (84,64±0,37 points) was 15% up compared with the control group (99,28±0,18 points) (p<0,001). While comparing the groups themselves at the beginning of rehabilitation it should be marked that LQ among the patients of RCTB group (84,64±0,37 points)
* To cite this English version: Tsapenko Y.P. The estimation of life quality and health state in patients with tuberculosis during the sanatorium period of medical rehabilitation / / Problemy ekologii ta medytsyny. - 2013. - Vol 17, Ns 1-2. - P. 100 -102.
was 3% up on LQ among the patients of FDTB group (82,38±0,44 points) (p<0,001) (tabl. 2).
The positive dynamics of LQ indices has been marked in both groups after the provided rehabilitation in sanatorium, but more substantial increase of LQ has been revealed among the patients of FDTB group (99,23±0,45 points), accordingly LQ has become 17% up since the beginning of treatment (82,38±0,44) (p<0,001) that did not almost differ from the indices of the control group (99,28±0,18 points); while the LQ among the patients of RCTB group has improved up on 10% (93,82±0,52 points) (p<0,001) since the beginning of treatment (84,64±0,37).
There was the decline of life quality and health state indices in the 1st sphere "Physical sphere" in both investigated groups. It can be noted that the patients of FDTB and RCTB groups suffered from the feeling of physical discomfort, fatigue, reduction of vital activity at the beginning of rehabilitation 10% more often in comparison with the control group (16,31 ±0,21 points) and presented 14,38±0,44 and 14,85±0,46 points (p<0,001) accordingly. Despite this fact the index has improved considerably in a dynamics in both groups: 19% up in FDTB group (17,77±0,39) (p<0,001) and 13% up in RCTB group (p<0,05) (tabl. 2).
Table 2
life and health state in patients with different tuberculosis process activity during sanatorium period of medical rehabilitation, M±m
Sphere and subsphere of life quality Control group (n=30) Group 1 FDTB Group II RCTB
Beginning of rehabilitation (n=43) Discharge (n=43) Beginning of rehabilitation (n=52) Discharge (n=52)
Sphere I. Physical sphere 16,31± 0,21 14,38±0,44 * 17,77±0,39 ** 14,85±0,46 * 17,04±1,04 &
Sphere II. Psychological sphere 15,95± 0,20 13,55±0,41 * 16,27±0,41 ** 14,16±0,35 * 15,24±0,36&
Sphere III. Level of independence 17,63± 0,16 14,41±0,52 * 17,45±0,46 ** 14,42±0,46 * 16,75±0,39&
Sphere IV. Social relations 16,87± 0,17 14,26±0,40 * 16,93±0,51 ** 15,22±0,31 * 15,74±0,44
Sphere V. Environment 16,52± 0,17 13,01±0,42 * 15,60±0,49 ** 13,28±0,36 * 14,74±0,46&
Sphere VI. Spiritual sphere 16,00± 0,17 12,77±0,47 * 15,21±0,46 ** * 12,71±0,27 14,31±0,42&
G. General quality of life and health state 99,28± 0,18 * 82,38±0,44 99,23±0,45 ** 84,64±0,37*,A 93,82±0,52 &
* - indices difference between the group of healthy and afflicted persons(p<0,05- p<0,001);
A - indices difference between the groups at the beginning of treatment (p<0,05-p<0,001);
** - indices difference within the 1st group (FDTB) in dynamics (p<0,05- p<0,001); &- indices difference within the Ilnd group (RCTB) in dynamics (p<0,05- p<0,001)
The analysis of indices in the Ilnd sphere "Psychological sphere" has shown that on the moment of admission to the sanatorium there were the lack of positive and excess of negative emotions, problems with thinking, capacity for learning, memory, decline of self-rating in patients of FDTB group (13,55±0,41) by 15% and in patients of RCTB group (16,27±0,41) by 11% compared with the control group (15,95±0,20) (p<0,001). As a result of the provided rehabilitation the psychological sphere has improved in patients of FDTB group (16,27±0,41) by 17% and in patients of RCTB group (15,24±0,36) (p<0,001; p<0,05).
Regarding the sphere "Level of independence" it can be noted that at the beginning of research in the investigated groups patients' possibility to exist independently as well as to provide and serve themselves was 18% down compared with the control group (17,63±0,16): 14,41±0,52 points for the patients of FDTB group and 14,42±0,46 points for the patients of the Ilnd group (p<0,001). During the process of the provided medical rehabilitation patients' ability to move and possibility to cope with day-to-day activity has improved and the dependence on medicines taking and other kinds of therapy has diminished by17% among the pa-
tients of FDTB group (17,45±0,46) and by 14% among the patients of RCTB group (16,75±0,39 ) (p<0,001).
Regarding the sphere "Social relations" there was a reduction in the investigated groups of patient's personal close relations, possibility to support other people and derive encouragement from them as well as possibility to satisfy sexual necessities: by15% among patients of FDTB group (14,26±0,40); and by 10 % in patients of RCTB group (15,22±0,31) compared with the control group (16,87±0,17) (p<0,001). After the provided rehabilitation the indices of this sphere among patients of FDTB group have increased by 16% (16,93±0,51) that even insignificantly but exceeded the index of the control group (16,87±0,17) (p<0,001); while the improvement concerning this sphere among the patients of RCTB group was only by 3% (15,74±0,44) (p>0,1).
Analyzing the results of questionnaire within the sphere "Environment" on admission the considerable worsening of external (economic etc.) conditions of patient's life compared with the control group (15,70±0,16) can be noted : by 21% among patients of FDTB group (01±0,42) and by 20% among the patients of RCTB group (13,28±0,36) (p<0,001). In a dynamics this index has improved in both groups: by 17% among patients of
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FDTB group (15,60±0,49) and only by 10% in patients of RCTB group (14,74±0,46) (p<0,001).
Analyzing the indices of all spheres of LQ questionnaire concerning the health state it can be noted that the VI sphere "Spiritual sphere" of the responders at the beginning of sanatorium rehabilitation has been affected particularly, i.e the personal persuasions that give the person the contents, value, prospect and their influence on quality of life. The indices of this sphere were 1,3 times down compared with the control group (16,00±0,17): 12,77±0,47 and 12,71±0,27 among patients of FDTB and RCTB groups accordingly (p<0,001). In a dynamics this index has improved by 16% among patients of FDTB group (15,21±0,46) and by 11% in patients of FDTB group (14,31±0,42) (p<0,001).
Conclusions
1. At the beginning of rehabilitation period the patients with tuberculosis in the investigated groups have lower general values of life quality and health state: 82,38±0,44 in patients of FDTB group and 84,64±0,52 in patients of RCTB group compared with the healthy persons of the control group (99,28±0,18) (p<0,001).
2. At the beginning of treatment LQ among patients with firstly diagnosed tuberculosis group refered to the medical rehabilitation in sanatorium of Hadyach town was lower (82,38±0,44) compared with the indices of LQ among the responders of RCTB group (84,64±0,37) (p<0,001).
3. The dynamics of LQ improvement during the process of medical rehabilitation on the sanatorium stage was satisfactory in both groups, but considerably higher for patients with the firstly diagnosed tuberculosis from 82,38±0,4 to 99,23±0,45 (p<0,001) and almost corresponded to the indices of LQ of healthy persons from the control group (99,28± 0,18); this index was from 84,64± 0,37 to 93,82±0,52 for the patients of RCTB group (p<0,001).
4. The most expressed reduction of life quality and health state of the responders at the beginning of rehabilitation has been marked in the V sphere "Environment" and in the VI sphere "Spiritual sphere" (p<0,001); it testifies that the personal freedom, physical safety, the feelings of security provided by patients habitat as well as impossibility to satisfy the necessities in the absence of the sufficient financial provision and personal persuasions that give the person the contents, value, prospect have been affected particularly.
5. Thus it is reasonable to apply the questionnaire of life quality and health state WHOQOL- 100 along with the
present criteria of treatment efficiency to provide the quality estimation of medical rehabilitation efficiency during sanatorium and other stages of rehabilitation for the patients with tuberculosis.
References
1. Bobro M. G. Korekziya psichichnich rozladiv chvorich z vpershe viyavlenim tuberkul'ozom legeniv / M. G. Bobro // Medichni perspektivi. - 2005. - № 3. - S. 62-65.
2. Valez'kiy Yu. M. Osoblivosti psichiki ta TT rozladi u chvorich na tuberkul'oz legeniv / Yu. M. Valez'kiy // Vrachebnaya praktika. - 2006. - № 1. - S. 43-46.
3. Gorbach L. A. Kachestvo zhizni bol'nych tuberkulyeza organov dychaniya / L. A. Gorbach // Belorusskiy medizinskiy zhurnal. - 2002. - № 1. - S. 45-51.
4. Gurylyeva M. E. Charakteristika kachestva zhizni bol'nych tuberkulyezom organov dychaniya pri ambulatornom rezhime lecheniya / M. E. Gurylyeva, O. I. Gerasimova // Problemy tuberkulyeza. - 2002. - № 8. - S. 10-12.
5. Lechan V. M. Yakist' zhittya yak kriteriy yakosti medichnoi dopomogi / V. M. Lechan, 0. L. Zyukov, A. V. Ipatov // Visnik sozial'noi gigieni ta organizazii ochoroni zdorov?ya Ukraini. - 2006. - № 3. - S. 95-99.
6. Motrich I. V. charakteristika yakosti zhittya studentiv chvorich na vpershe viyavleniy tuberkul'oz legeniv / I. V. Motrich // Aktual'ni pitannya ftiziatrii. - 2008. - № 2. - S. 68-70.
7. Savula M. M. Ozinka chvorich na tuberkul'oz legen' sozial'nich i psichologichnich aspektiv yakosti zhittya / M. M. Savula, N. I. Zinchuk // Infekziyni chvorobi. - 2008. --№ 1. - S. 52-54.
8. Suchov V. M. Nekotorye osobennosti kachestva zhizni bol'nych tuberkulyezom lyegkich / V. M. Suchov, E. V. Suchova // Problemy tuberkuleza i bolezney organov dychaniya. - 2003. - № 4. - S. 29-30.
9. Suchova E. V. Osobennosti otnosheniya k bolezni bol'nych tuberkulyezom lyegkich / E. V. Suchova, V. M. Suchov, A. V. Kornev // Problemy tuberkuleza i bolezney organov dychaniya. - 2006. - № 5. - S. 20-23.
10. Shalaeva O. E. Sravnitel'nyy analiz pokazateley kachestva zhizni u bol'nych tuberkulyezom lyegkich posle konservativnogo i chirurgicheskogo lecheniya : avtoref. dis. na soiskanie uchen. stepeni kand. med. nauk : spez. 14.00.26 «Ftiziatriya» / O. E. Shalaeva. - M., 2007. - 24 s.
11. Shmelev E. I. Izuchenie kachestva zhizni bol'nych tuberkul'ozom lyegkich / E. I. Shmelev, G. M. Kulina // Problemy tuberkuleza. - 2001. - № 8. - S. 34-37.
12. Chang B. Quality of Life in Tuberculosis: A Review of the English Language Literature / B. Chang // Quality of Life in Research. - 2004. - Vol. 13, № 10. - P. 1633-1642.
13. Yong D. V. Ten years of research progress and what 's to come / D. B. Yong // Tuberculosis. - 2003. - Vol. 83, № 13. - P. 77-81.
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