275例早中期帕金森病患者社会参与现状及其相关因素分析

汪虹; 许方蕾; 汤爱玲; 张月; 管强; 龚海燕

doi:10.16766/j.cnki.issn.1674-4152.003255

275例早中期帕金森病患者社会参与现状及其相关因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003255

汪虹^{1, 2},
许方蕾³,
汤爱玲³,
张月²,
管强²,
龚海燕^2, ,

1.
同济大学医学院，上海 200092
2.
同济大学附属同济医院神经内科，上海 200065
3.
同济大学附属同济医院护理部

基金项目:

国家重点研发计划课题 2018YFC1314704

上海市同济医院国自然培育项目 GJPY2148

详细信息

通讯作者:
龚海燕，E-mail: hai_yan_gong@126.com

中图分类号: R742.5
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- 文章访问数: 92
- HTML全文浏览量: 39
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2022-10-09
- 网络出版日期: 2024-01-13

Social participation status and its related factors in patients with mild to moderate Parkinson's disease: a 275-case study

1.
School of Medicine, Tongji University, Shanghai 200092, China

摘要

摘要: 目的了解早中期帕金森病患者社会参与的现状, 并对其相关因素进行分析, 为患者制定个性化、针对性强的干预方案提供可参考的依据。方法采用便利抽样的方法选取2021年1-12月至上海市同济医院神经内科门诊就诊的275例早中期帕金森病患者, 进行一般资料、自主参与问卷(IPA)、自我护理能力量表(ESCA)、统一帕金森病评定量表第Ⅲ部分(UPDRS-Ⅲ)和领悟社会支持量表(PSSS)的问卷调查, 采用多元线性回归分析探讨其影响因素。结果早中期帕金森病患者平均IPA总分为(65.25±28.78)分, 属于中度参与水平; 多元线性回归显示, 文化程度(t=10.562, P < 0.001)、疾病分期(t=10.601, P < 0.001)、自我护理能力(t=3.212, P=0.001)、运动功能障碍程度(t=2.121, P=0.034)和领悟社会支持(t=3.562, P < 0.001)是影响早中期帕金森病患者社会参与的主要因素。结论影响早中期帕金森病患者社会参与水平的因素是多方面的, 医务人员应根据主要影响因素制定针对性的干预措施, 扩大社会对该类患者的关注度, 以促进患者参与社会, 提高其生活质量。
- 帕金森病 /
- 社会参与 /
- 影响因素
Abstract: Objective To investigate the social participation status of people with mild to moderate Parkinson's disease (PD), and to analyze the factors associated with it, in order to provide a reference for intervention. Methods A total of 275 patients with mild to moderate PD who visited the clinic of the Department of Neurology in Shanghai Tongji Hospital from January to December 2021 were selected using convenience sampling.The patients were assessed using a general information questionnaire, the impact on participation and autonomy questionnaire (IPA), the exercise of self-care agency scale (ESCA), the unified Parkinson's disease rating scale part Ⅲ(UPDRS-Ⅲ), and the perceived social support scale (PSSS). Results The mean total score of social participation in mild to moderate PD patients was (65.25±28.78) points.Multivariate regression analysis showed that education level (t=10.562, P < 0.001), disease stage (t=10.601, P < 0.001), self-care ability (t=3.212, P < 0.01), motor dysfunction (t=2.121, P < 0.05) and perceived social support (t=3.562, P < 0.001) were the factors most associated with social participation in mild to moderate PD patients. Conclusion The level of social participation in mild to moderate PD patients was related to many factors.More social attention should be paid to these patients and interventions should be provided based on the factors involved to improve their ability to participate in society and their quality of life.
- Parkinson's disease /
- Social participation /
- Related factors

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表 1 275例早中期PD患者IPA具体得分情况(x±s，分)

Table 1. IPA scores of 275 patients with mild to moderate PD (x±s, points)

量表维度	维度均分	条目均分
室内自主参与	14.75±5.77	2.11±0.82
室外自主参与	16.57±7.01	3.04±0.72
社会生活自我参与	18.24±4.34	3.14±0.65
家庭角色自我参与	15.69±3.24	2.37±1.00

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表 2 不同特征早中期PD患者IPA得分比较[M(P₂₅, P₇₅)，分]

Table 2. Comparison of IPA scores in mild to moderate PD patients with different characteristics [M(P₂₅, P₇₅), points]

项目	例数	IPA得分	统计量	P值
性别			-2.352^a	0.019
男性	146	69.00(62.00，80.75)
女性	129	64.00(38.50，79.00)
文化程度			6.594^b	0.037
初中及以下	43	64.00(35.00，72.00)
高中或中专	125	66.00(58.00，79.00)
专科及以上	107	67.00(62.00，84.00)
婚姻状况			-1.701^a	0.089
未婚/离异/丧偶	35	68.00(64.00，88.00)
已婚	240	66.00(54.25，77.75)
居住状态			-0.258^a	0.796
独居	33	65.00(53.50，81.50)
非独居	242	66.00(57.50，80.00)
家庭人均月收入			6.444^b	0.092
1 000~3 000元	9	69.50(53.25，88.00)
3 001~5 000元	94	70.50(52.75，80.00)
>5 000元	172	64.50(58.00，82.00)
医疗保险类型			2.778^b	0.249
城镇职工基本医疗保险	16	64.50(35.50，73.50)
城镇居民基本医疗保险	172	65.00(58.00，79.00)
新型农村合作医疗	87	68.00(62.00，84.00)
疾病分期			12.197^b	＜0.001
1期	90	42.00(35.00，63.00)
2期	86	66.00(64.00，72.00)
3期	99	83.00(71.50，87.00)
是否合并其他慢性病			-0.971^a	0.332
是	268	66.00(58.00，80.00)
否	7	46.00(38.00，70.00)
注：^a为Z值，^b为H值。

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表 3 早中期PD患者ESCA、PSSS、UPDRS-Ⅲ与IPA得分的相关性分析(r值)

Table 3. Correlation analysis between the scores of ESCA, PSSS, UPDRS-Ⅲ and IPA in mild to moderate PD patients (r value)

项目	IPA总分	室内自主参与	家庭角色自我参与	室外自主参与	社会生活自主参与
ESCA总分	-0.537	-0.622	-0.478	-0.385	-0.439
自我概念	-0.521	-0.607	-0.448	-0.370	-0.448
自我护理责任感	-0.462	-0.561	-0.426	-0.285	-0.352
自我护理技能	-0.550	-0.628	-0.498	-0.406	-0.440
健康知识	-0.531	-0.611	-0.470	-0.389	-0.438
PSSS总分	-0.537	-0.628	-0.482	-0.369	-0.432
家庭支持	-0.518	-0.615	-0.456	-0.351	-0.425
朋友支持	-0.540	-0.620	-0.497	-0.375	-0.429
其他支持	-0.514	-0.607	-0.459	-0.354	-0.412
UPDRS-Ⅲ总分	0.602	0.658	0.545	0.460	0.505
注：表中数值为Pearson相关系数，均P＜0.05。

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表 4 自变量赋值情况

Table 4. Independent variables and assignment

自变量	赋值方法
性别	男性=1，女性=2
文化程度	初中及以下=1，高中或中专=2，专科及以上=3
疾病分期	1期=1, 2期=2, 3期=3
自我护理能力总分	以实际值赋值
领悟社会支持总分	以实际值赋值
UPDRSⅢ总分	以实际值赋值

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表 5 早中期PD患者社会参与影响因素的多元线性回归分析

Table 5. Multiple logistic regression analysis of social participation in mild to moderate PD patients

变量	B	SE	β	t值	P值
文化程度	7.378	0.699	0.267	10.562	< 0.001
疾病分期	22.824	2.153	0.422	10.601	< 0.001
ESCA总分	0.357	0.111	0.258	3.212	0.001
PSSS总分	0.168	0.047	0.090	3.562	< 0.001
UPDRS-Ⅲ总分	0.435	0.205	0.232	2.121	0.034
注：整体模型R²=0.436，调整后R²=0.434。

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参考文献(29)

[1]	陈永平, 商慧芳. 2016中国帕金森病诊断标准解读[J]. 中国实用内科杂志, 2017, 37(2): 124-126. CHEN Y P, SHANG H F. Introduction of clinical diagnostic criteria for Parkinson disease in China (2016)[J]. Chinese Journal of Practical Internal Medicine, 2017, 37(2): 124-126.
[2]	周桃峰, 周志明. 帕金森病的诊断与治疗[J]. 中华全科医学, 2019, 17(12): 1982-1983. http://www.zhqkyx.net/article/id/70de6dad-4539-43a9-9096-481d8db02a44 ZHOU T F, ZHOU Z M. Diagnosis and treatment for Parkinson disease[J]. Chinese Journal of General Practice, 2019, 17(12): 1982-1983. http://www.zhqkyx.net/article/id/70de6dad-4539-43a9-9096-481d8db02a44
[3]	甄隽颖, 郑晓丹, 吴军. 人类诱导多能干细胞在帕金森病治疗中的研究进展[J]. 中风与神经疾病杂志, 2020, 37(1): 85-87. ZHEN J Y, ZHENG X D, WU J. Research progress on human induced pluripotent stem cells in the treatment of Parkinson's disease[J]. Journal of Apoplexy and Nervous Diseases, 2020, 37(1): 85-87.
[4]	AHN S, SPRINGER K, GIBSON J S. Social withdrawal in Parkinson's disease: a scoping review[J]. Geriatr Nurs, 2022, 29(48): 251-261.
[5]	何月月, 尹安春, 梁战华, 等. 帕金森病患者病耻感现状及影响因素研究[J]. 中国护理管理, 2020, 20(2): 190-195. doi: 10.3969/j.issn.1672-1756.2020.02.009 HE Y Y, YIN A C, LIANG Z H, et al. Stigma status and its influencing factors among people living with Parkinson's disease[J]. Chinese Nursing Management, 2020, 20(2): 190-195. doi: 10.3969/j.issn.1672-1756.2020.02.009
[6]	HANFF A M, LEIST A K, FRITZ J V, et al. Determinants of self-stigma in people with Parkinson's disease: a mixed methods scoping review[J]. J Parkinsons Dis, 2022, 12(2): 509-522. doi: 10.3233/JPD-212869
[7]	中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍学组. 中国帕金森病治疗指南(第四版)[J]. 中华神经科杂志, 2020, 53(12): 973-986. doi: 10.3760/cma.j.cn113694-20200331-00233 Chinese Society of Parkinson's Disease and Movement Disorders, Parkinson's Disease and Movement Disorder Section of Neurologist Branch of Chinese Medical Doctor Association. Chinese guidelines for the treatment of Parkinson's disease (fourth edition)[J]. Chinese Journal of Neurology, 2020, 53(12): 973-986. doi: 10.3760/cma.j.cn113694-20200331-00233
[8]	中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍专业. 中国帕金森病的诊断标准(2016版)[J]. 中华神经科杂志, 2016, 49(4): 268-271. doi: 10.3760/cma.j.issn.1006-7876.2016.04.002 Chinese Society of Parkinson's Disease and Movement Disorders, Parkinson's Disease and Movement Disorder Section of Neurologist Branch of Chinese Medical Doctor Association. Clinical diagnostic criteria for Parkinson disease in China(2016)[J]. Chinese Journal of Neurology, 2016, 49(4): 268-271. doi: 10.3760/cma.j.issn.1006-7876.2016.04.002
[9]	HYDE E, MURPHY B. Computerized clinical pathways(care plans): piloting a strategy to enhance quality patient care[J]. Clin Nurse Spec, 2012, 26(5): 277-282.
[10]	贺亚楠, 万霞, 李红, 等. 中文版自主参与问卷在脑卒中患者中应用的信度和效度评价[J]. 中国护理管理, 2013, 13(6): 22-24. HE Y N, WAN X, LI H, et al. The validity and reliability of the Chinese version of the Impact on Participation and Autonomy Questionnaire among stroke patients[J]. Chinese Nursing Management, 2013, 13(6): 22-24.
[11]	WANG H H, LAFFREY S C. Preliminary development and testing of instruments to measure self-care agency and social support of women in Taiwan[J]. Kaohsiung J Med Sci, 2000, 16(9): 459-467.
[12]	陈海波. 统一帕金森病评定量表[J]. 中华老年医学杂志, 1999, 18(1): 61-62. CHEN H B. Unified Parkinson's disease rating scale[J]. Chin J Geriatr, 1999, 18(1): 61-62.
[13]	姜乾金. 领悟社会支持量表[J]. 中国心理卫生杂志, 1999(增刊): 131-133. JIANG Q J. Perceived social support scale[J]. Chinese Mental Health Journal, 1999(supplement): 131-133.
[14]	孙振球. 医学统计学[M]. 4版. 北京: 人民卫生出版社, 2014: 524-527. SUN Z Q. Medical statistics[M]. 4th edition. Beijing: People's Medical Publishing House, 2014: 524-527.
[15]	宋伟霞, 吕雨梅. 脑卒中病人社会参与影响因素的研究进展[J]. 全科护理, 2022, 20(15): 2056-2059. doi: 10.12104/j.issn.1674-4748.2022.15.011 SONG W X, LYU Y M. Research progress on social participation and its influencing factors of stroke patients[J]. Chinese General Practice Nursing, 2022, 20(15): 2056-2059. doi: 10.12104/j.issn.1674-4748.2022.15.011
[16]	倪四峰, 代选慧. 基于六西格玛理论的健康教育对冠心病患者自护能力、疾病知识认知及生存质量的影响[J]. 海南医学, 2019, 30(15): 2031-2034. doi: 10.3969/j.issn.1003-6350.2019.15.039 NI S F, DAI X H. Effect of health education based on six Sigma theory on self-care ability, disease-related knowledge, and quality of life in patients with coronary heart disease[J]. Hainan Med J, 2019, 30(15): 2031-2034. doi: 10.3969/j.issn.1003-6350.2019.15.039
[17]	马思慧, 沙丽艳. 膀胱癌尿流改道腹壁造口患者社会参与现状及影响因素分析[J]. 中国医学创新, 2022, 19(3): 114-119. doi: 10.3969/j.issn.1674-4985.2022.03.026 MA S H, SHA L Y. Analysis of social participation status and influencing factors in patients with bladder cancer undergoing urinary diversion and abdominal stoma[J]. Medical Innovation of China, 2022, 19(3): 114-119. doi: 10.3969/j.issn.1674-4985.2022.03.026
[18]	MELE B, VAN S, HOLROYD-LEDUC J, et al. Diagnosis, treatment and management of apathy in Parkinson's disease: a scoping review[J]. BMJ Open, 2020, 10(9): 110-121.
[19]	赵煜华, 王俊霞, 吴田瑞. 老年肠造口病人社会参与水平现状及影响因素分析[J]. 护理研究, 2021, 35(13): 2419-2424. doi: 10.12102/j.issn.1009-6493.2021.13.031 ZHAO Y H, WANG J X, WU T R. Status quo of level of social participation in elderly patients with enterostomy and its influencing factors analysis[J]. Chinese Nursing Research, 2021, 35(13): 2419-2424. doi: 10.12102/j.issn.1009-6493.2021.13.031
[20]	赵海蓉, 张连香, 张志琴. 结直肠癌术后患者社会参与水平现状及其影响因素研究[J]. 中华现代护理杂志, 2018, 24(32): 3927-3930. ZHAO H R, ZHANG L X, ZHANG Z Q. Status quo of social participation and its influencing factors in patients with colorectal cancer after operation[J]. Journal of Modern Nursing, 2018, 24(32): 3927-3930.
[21]	周沛萱, 李双庆. 帕金森病患者直立性低血压的研究进展[J]. 中华全科医学, 2018, 16(1): 113-117. doi: 10.16766/j.cnki.issn.1674-4152.000033 ZHOU P X, LI S Q. Research progress on orthostatic hypotension of Parkinson's disease[J]. Chinese Journal of General Practice, 2018, 16(1): 113-117. doi: 10.16766/j.cnki.issn.1674-4152.000033
[22]	陈文秀, 王含, 薄琳, 等. 轻中度帕金森病患者自我管理现状及影响因素分析[J]. 护理学杂志, 2021, 36(15): 23-26. CHEN W X, WANG H, BO L, et al. Self-management level of patients with mild to moderate Parkinson's disease: the influencing factors[J]. Journal of Nursing Science, 2021, 36(15): 23-26.
[23]	HOU M, MAO X, HOU X, et al. Stigma and associated correlates of elderly patients with Parkinson's disease[J]. Front Psychiatry, 2021, 12(7): 89-95.
[24]	SALAZAR R D, WEIZENBAUM E, ELLIS T D, et al. Predictors of self-perceived stigma in Parkinson's disease[J]. Parkinsonism Relat Disord, 2019, 3(60): 76-80.
[25]	中华医学会神经病学分会神经康复学组, 中国微循环学会神经变性病专业委员会康复学组, 中国康复医学会帕金森病与运动障碍康复专业委员会. 帕金森病康复中国专家共识[J]. 中国康复理论与实践, 2018, 24(7): 745-752. Neurologic Rehabilitation Studies Group of Neurology Branch of Chinese Medical Association, Rehabilitation Group of Neurodegenerative Diseases Professional Committee of Chinese Microcirculation Society, Rehabilitation Committee of Chinese Medical Association Rehabilitation of Parkinson's Disease and Movement Disorders, Chinese Society of Rehabilitation Medicine. Rehabilitation for Parkinson's disease: Chinese expert consensus[J]. Chin J Rehabil Theory Pract, 2018, 24(7): 745-752.
[26]	沈琪, 张秀文. 多学科领域协作下帕金森病照护护理工作室在帕金森病患者中的应用效果[J]. 中国医药导报, 2021, 18(23): 169-172. SHEN Q, ZHANG X W. Application effect of Parkinson disease nursing care studio on Parkinson disease patients under multidisciplinary collaboration[J]. China Medical Herald, 2021, 18(23): 169-172.
[27]	TUIJT R, TAN A, ARMSTRONG M, et al. Self-Management components as experienced by people with Parkinson's disease and their carers: a systematic review and synthesis of the qualitative literature[J]. Parkinsons Dis, 2020, 12(15): 88-98.
[28]	KESSLER D, HAUTECLOCQUE J, GRIMES D, et al. Development of the Integrated Parkinson's Care Network (IPCN): using co-design to plan collaborative care for people with Parkinson's disease[J]. Qual Life Res, 2019, 28(5): 1355-1364.
[29]	庞芳芳, 赵佳, 苏英, 等. 老年人共情能力与抑郁: 领悟社会支持和心理弹性的多重中介作用[J]. 中国临床心理学杂志, 2019, 27(2): 330-333. PANG F F, ZHAO J, SU Y, et al. Empathy and geriatric depression: mediating of perceived social support and resilience[J]. Chinese Journal of Clinical Psychology, 2019, 27(2): 330-333.