SF-6D를 이용한 일개 지역사회의 뇌졸중 장애환자의 건강관련 삶의 질에 미치는 요인 분석
Factors Affecting Health-Related Quality of Life in Persons with Stroke Using SF-6D
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연구배경: 뇌졸중으로 인한 장애인 수가 증가하고 있으나 이들의 건강관련 삶의 질을 살펴본 연구가 없었다. 이연구에서는 일개 시의 뇌졸중 장애인을 대상으로 SF-6D의 타당도를 평가하고, 그에 영향을 미치는 요인들을 살펴보았다. 방법: 2008년 3월 경주시에서 50세 이상의 뇌졸중 장애인 991명을 대상으로 일반 및 임상 특성, Modified Rankin Scale (MRS), 바텔 지표 그리고 SF-36로 건강관련 삶의 질 수준을 조사하였다. 2009년 6-10월에 설문조사자들이 대상자들을 방문하여 조사하였다. SF-36에서 SF-6D 효용값을구하였고, 이에 대한 타당도를 살펴보았다. 그리고 회귀분석을 이용하여 SF-6D에 영향을 미치는 요인들을 살펴보았다결과: 최종적으로 498명의 자료(응답률: 50.3%)를 이용하여 분석하였다. 여성, 고령군에서 SF-6D 지표가 낮았고, MRS와 바텔 지표와의 상관계수도 통계적으로 유의하였다 (각각 -0.533 및 0.555). 다중 선형회귀분석 결과 여성, 고령, 낮은 교육수준, 음주, 흡연, 동반질환의 존재, MRS, 바텔 지표가 나쁠수록 SF-6D가 낮아지는 것으로 나타났다. 결론: SF-6D는 뇌졸중장애인의 건강관련 삶의 질 수준을 평가하는데 타당한 지표라고 할 수 있다. 그리고 기존의 알려진 변수와 함께 기능수준이 뇌졸중 장애인들의 건강 관련 삶의 질에 큰 영향을 주는 것으로 나타났다.
Abstract
Background: The SF-6D, derived from the SF-36, is a preference-based instrument measuring health-related quality of life (HRQOL). Using this tool, we measured the HRQOL of persons disabled by stroke dwelling in Gyeongju city and identified factors affecting the HRQOL. Methods: As of March 2008, 991 persons who had had a stroke and were aged 50 and over were identified on the Gyeongju city disabled registry. Interviewers specifically trained for this face-to-face survey gathered pertinent information including general and clinical characteristics from June to October 2008. In addition, the health status was measured using the Modified Rankin Scale, the Barthel ADL index, and the SF-36. The SF-6D index was derived from the SF-36. We analyzed the known-group construct validity and nvergent validity. Finally, we performed multiple regression analyses to identify factors affecting the HRQOL. Results: Of the 991 potential subjects, 498 persons participated in the interviews (response rate: 50.3%). The SF-6D indices for females and those aged 70 and over were lower than indices for males and those aged 60 and less. Correlation coefficients between the Modified Rankin Scale, the Barthel index, and the SF-6D index were relatively high (-0.533 and 0.555,espectively) and statistically significant (P<0.001). Multiple regression analyses showed that sex, age, smoking, alcohol use, comorbidity, the Modified Rankin Scale, and the Barthel index had an effect on the SF-6D index of persons with stroke, and the Barthel index was the most important factor. Conclusions: Our results indicate that the SF-6D can be a valid tool for evaluating health states of persons disabled by stroke, and functional limitation was the main factor affecting the HRQOL.
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