PRIMERJAVA FUNKCIONALNIH TESTOV, KAKOVOSTI ŽIVLJENJA, UTRUJENOSTI IN OCENE NEVROLOŠKE PRIZADETOSTI PO EDSS PRI BOLNIKIH Z MULTIPLO SKLEROZO

Koprivnik, Matej

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Title:	PRIMERJAVA FUNKCIONALNIH TESTOV, KAKOVOSTI ŽIVLJENJA, UTRUJENOSTI IN OCENE NEVROLOŠKE PRIZADETOSTI PO EDSS PRI BOLNIKIH Z MULTIPLO SKLEROZO
Authors:	ID Koprivnik, Matej (Author) ID Hojs-Fabjan, Tanja (Mentor) More about this mentor... ID Novak, Aleš (Comentor) ID Magdič, Jožef (Comentor)
Files:	MAG_Koprivnik_Matej_2016.pdf (2,64 MB) MD5: 9C15CFE75873865EC30D9BC6B8E83FAB
Language:	Slovenian
Work type:	Master's thesis/paper
Typology:	2.09 - Master's Thesis
Organization:	FZV - Faculty of Health Sciences
Abstract:	Multipla skleroza je kronično, vnetno, domnevno avtoimunsko obolenje, z zelo heterogeno simptomatiko, odvisno od velikosti in lokacije lezij v osrednjem živčevju. Simptomi obsegajo motorične, senzorične in kognitivne funkcije in imajo vpliv na funkcioniranje ter kakovost življenja. Za ustrezno izbiro, vrednotenje terapevtskih postopkov in spremljanje bolnika sta ključni objektivna in subjektivna ocena njegovega stanja, ki zagotovita strokovno in stroškovno najprimernejši potek zdravljenja. Namen raziskave je ugotoviti povezavo med stopnjo nevrološke prizadetosti, funkcionalnimi testi, kakovostjo življenja in utrujenostjo, glede na obliko, trajanje bolezni, spol in starost. Metodologija raziskovanja: presečna študija je potekala od aprila do decembra 2015. V raziskavo je bil vključen priložnostno izbrani raziskovalni vzorec 258 bolnikov z multiplo sklerozo (MS), zdravljenih v nevrološki ambulanti ali na Oddelku za nevrološke bolezni Univerzitetnega kliničnega centra Maribor. Od teh je bilo 192 (75 %) žensk in 66 (25 %) moških, s povprečno starostjo 48,5 leta (razpon od 21 do 84 let). Povprečno trajanje bolezni od postavitve diagnoze je bilo 12,52 leta (razpon od 0 do 56 let). Vključeni so bili bolniki z različnimi oblikami bolezni, in sicer 168 (65,1 %) z recidivno-remitentno obliko MS (RRMS), 29 (11,2 %) z benigno MS, 50 (19,4 %) s sekundarno progresivno obliko MS (SPMS) in 11 (4,3 %) s primarno progresivno obliko MS (PPMS). Imunomodulatorno terapijo (IMT) jih je prejemalo 134 (51,9 %). Z uporabo vprašalnikov smo dobili osnovne demografske podatke (spol, starost, oblika, čas trajanja bolezni in IMT). S standardiziranimi merilnimi instrumenti smo ocenili stopnjo nevrološke prizadetosti (angl. Expanded Disability Status Scale – EDSS), funkcionalno prizadetost (angl. Multiple Sclerosis Functional Composite – MSFC), ravnotežje (Bergova lestvica, angl. Berg Balance Scale  BBS), vpliv utrujenosti (angl. Modified Fatigue Impact Scale  MFIS) in z zdravjem povezano kakovost življenja po EQ-VAS. Rezultati raziskave: Med posameznimi oblikami bolezni smo ugotovili statistično značilno razliko na testih: BBS (p < 0,001), 9 HPT (p < 0,001), T25-FW (p < 0,001), PASAT-3 (p = 0,001), EDSS (p < 0,001) in v stopnji zadovoljstva, izraženi v EQ-VAS (p < 0,001). Statistično pomembno povezavo smo ugotovili med EQ-VAS in MFIS (p < 0,001), EDSS (p < 0,01), BBS (p < 0,01), trajanjem bolezni (p < 0,01) ter posameznimi komponentami MSFC ((T25-FW (p < 0,01), 9-HPT (p < 0,01) in PASAT-3 (p < 0,01)). Ugotovili smo statistično pomembno povezavo med EDSS in MFIS (p < 0,01), BBS (p < 0,05) in posameznimi komponentami MSFC ((T25-FW (p < 0,01), 9-HPT (p < 0,01) in PASAT-3 (p < 0,01)). Najvišjo prediktivno moč pri napovedovanju stopnje nevrološke prizadetosti EDSS ima test MSFC. Najboljši napovedniki kakovosti življenja pri bolnikih z MS so dobljeni rezultati na testih EDSS, MFIS in 9-HPT. Sklep: za strokovno in ekonomsko najbolj utemeljen način ocene nevrološke prizadetosti bolnikov z MS se je pokazala kombinirana uporaba instrumentov MSFC in MFIS.
Keywords:	multipla skleroza, nevrološka prizadetost EDSS, funkcionalni testi, ocena kakovosti življenja, ocena utrujenosti.
Place of publishing:	Maribor
Publisher:	[M. Koprivnik]
Year of publishing:	2016
PID:	20.500.12556/DKUM-60533
UDC:	616.832-004
COBISS.SI-ID:	2234788
NUK URN:	URN:SI:UM:DK:G0LF3KRX
Publication date in DKUM:	27.09.2016
Views:	3762
Downloads:	610
Metadata:
Categories:	FZV
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Secondary language

Language:	English
Title:	A COMPARISON OF FUNCTIONAL TESTS, QUALITY OF LIFE, FATIGUE AND NEUROLOGICAL DISABILITY ON EDSS IN PATIENTS WITH MULTIPLE SCLEROSIS
Abstract:	Multiple sclerosis (MS) is a chronic, inflammatory, presumably autoimmune disease, with very heterogeneous symptoms, depending on the size and location of lesions in the central nervous system (CNS). Symptoms include motor, sensory and cognitive functions, and have an impact on the functioning and quality of life. For proper selection, evaluation of therapeutic procedures and patient follow-up, appropriate patient assessment is crucial (“objective and subjective”), providing professional and cost-effective treatment. The purpose of our research is to explore relation between the degree of neurological impairment, functional tests, quality of life and fatigue, compared to disease type and duration, patient gender and age. Research methodology: a cross-sectional study was conducted from April to December 2015. We have used selected research sample of 258 multiple sclerosis (MS) patients treated at the Department of Neurological Diseases at UMC Maribor. Of these 192 (75 %) were women and 66 (25 %) men, with a mean age of 48.5 years (range 21 to 84 years). The mean disease duration was 12.52 years (range 0 to 56 years). Patients with different disease types were included, 168 (65.1 %) with relapsing-remitting MS (RRMS), 29 (11.2 %) with benign MS, 50 (19.4 %) with secondary progressive MS (SPMS), and 11 (4.3 %) with primary progressive MS (PPMS). Immunomodulatory therapy (IMT) was present in 134 (51.9 %) patients. Basic demographic data were collected by questionnaire from patients: gender, age, type and duration of the disease and IMT. With standardized measurement instruments, we assessed the degree of neurological impairment (Expanded Disability Status Scale, EDSS), functional disability (Multiple Sclerosis Functional Composite, MSFC), balance (Berg Balance Scale, BBS), impact of fatigue (Modified Fatigue Impact Scale, MFIS) and health-related quality of life according to EQ-VAS. Results: differences between the various types of MS reached the level of statistical significance for the performance on the following tests: BBS (p < 0.001), 9-HPT (p < 0.001), T25-FW (p < 0.001), PASAT-3 (p = 0.001), EDSS (p < 0.001) and the level of satisfaction expressed in EQ-VAS (p < 0.001). A statistically significant correlation was found between the EQ-VAS and MFIS (p < 0.001), EDSS (p < 0.01), BBS (p < 0.01), disease duration (p < 0.01) and the individual components of the MSFC ((T25-FW (p < 0.01), 9-HPT (p < 0.01) and PASAT-3 (p < 0.01)). EDSS showed a statistically significant correlation with the MFIS (p < 0.01), BBS (p < 0.05) and the individual components of the MSFC ((T25-FW (p < 0.01), 9-HPT (p < 0.01) and PASAT-3 (p < 0.01)). The score in MSFC is the most predictive functional test for neurological disability on EDSS. Quality of life in patients with MS is related to scores on EDSS, MFIS and 9-HPT. Conclusion: from professional and economical point of view the combined use of instruments MSFC and MFIS is the most reasonable way of rating neurological impairment in MS patients.
Keywords:	multiple sclerosis, neurological disability, EDSS, functional tests, assessing quality of life, assessing fatigue.

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