| ObjectiveBased on the Wilson-Cleary health-related quality of life model,the study aimed to investigate the current situation of gout patients’health-related quality of life and analyze the influencing factors of gout patients’health-related quality of life through cross-sectional survey.A structural equation model of influencing factors of health-related quality of life in gout patients was established,through which the mechanisms of these factors were explored,so as to provide scientific basis for clinical staff to formulate individualized intervention measures and improve the health-related quality of life in gout patients.MethodsCross sectional investigation was conducted on 380 patients who suffer from gout in Shandong Gout Clinical Medical Center between November 2019 and August 2020.We used a general information questionnaire,together with Visual Analogue Scale,Health Assessment Questionnaire Disability Index,General Self-Efficacy Scale,Perceived Social Support Scale,and Gout Impact Scale.Except for the disease-related information,which is filled in by the researcher according to the patients’outpatient medical record,the rest of the questionnaire is filled in by the patients or their family members,so the researcher completes the charts based on patients’real thought.The data are analyzed by SPSS 26.0software package.The health-related quality of life level of gout patients with different characteristics is compared by independent sample t test or one-way ANOVA.Pearson correlation or Spearman correlation was used to analyze the correlation between each variable and health-related quality of life.And multivariate stepwise regression analysis is used to analyze the factors affecting health-related quality of life.AMOS 26.0 software was used to construct the structural equation model.Results1.The total score of Gout Impact Scale was(60.56±17.66),and the scores for each dimension were as follows:gout concern overall(79.72±21.67),gout medication side effects(71.32±22.58),unmet gout treatment need(33.79±18.52),well-being during attack(67.88±24.58)and gout concern during attack(56.27±26.07).2.Univariate analysis showed that factors affecting health-related quality of life in gout patients were residence,marriage status,educational level,gout attacks in the past year,body mass index,comorbidities,tophi and course of disease(P<0.05).Pearson correlation analysis showed that the pain was positively correlated with gout impact scale(r=0.476,P<0.01),self-efficacy was negatively correlated with gout impact scale(r=-0.433,P<0.01);Spearman correlation analysis showed that functional disability was positively related to gout impact scale(r_s=0.394,P<0.01),social support was negatively related to gout impact scale(r_s=-0.328,P<0.01).3.Hierarchical regression analysis showed that factors affecting health-related quality of life in gout patients were residence,comorbidities,pain,functional disability and self-efficacy.The above factors explained 70.7%of the total variation in health-related quality of life with gout patients.4.Structural equation model showed that there were three paths of pain to health-related quality of life:pain to health-related quality of life,pain to functional disability to health-related quality of life.There was one path of functional disability to health-related quality of life:functional disability to health-related quality of life.There were four paths of self-efficacy to health-related quality of life:self-efficacy to health-related quality of life,self-efficacy to pain to health-related quality of life,self-efficacy to functional disability to health-related quality of life,self-efficacy to pain to functional disability to health-related quality of life.There were six paths of social support to health-related quality of life:social support to pain to health-related quality of life,social support to self-efficacy to health-related quality of life,social support to self-efficacy to pain to health-related quality of life,social support to self-efficacy to functional disability to health-related quality of life,social support to pain to functional disability to health-related quality of life,social support to self-efficacy to pain to functional disability to health-related quality of life.Pain(β=0.296,P<0.001),functional disability(β=0.227,P<0.001),self-efficacy(β=-0.181,P<0.001)had a direct effect on health-related quality of life;social support(β=0.294,P<0.001)had an indirect effect on health-related quality of life.The mediating functional disability in pain to health-related quality of life path was 0.044.The mediating effect of pain in self-efficacy to health-related quality of life path was 0.118.The mediating effect of functional disability in self-efficacy to health-related quality of life path was 0.060.The chain intermediary effect of pain and functional disability in self-efficacy to health-related quality of life path was 0.018.The mediating effect of pain in social support to health-related quality of life path was 0.109.The mediating effect of self-efficacy in social support to health-related quality of life path was 0.080.The chain intermediary effect of self-efficacy and pain in social support to health-related quality of life path was 0.053.The chain intermediary effect of self-efficacy and functional disability in social support to health-related quality of life path was 0.027.The chain intermediary effect of pain and functional disability in social support to health-related quality of life path was 0.016.The chain intermediary effect of self-efficacy,pain and functional disability in social support to health-related quality of life path was 0.008.Conclusions1.The status of health-related quality of life in gout patients was at a lower middle level and needs to be improved.2.The factors affecting health-related quality of life in gout patients were residence,comorbidities,pain,functional disability,and self-efficacy.3.The higher the score of pain and functional disability,the higher the score of gout impact and the lower the health-related quality of life of in gout patients.The higher the score of self-efficacy and social support,the lower the score of gout impact and the higher the health-related quality of life of in gout patients.4.Based on the Wilson-Cleary model,structural equation model shows that pain and functional disability can directly and negatively affect health-related quality of life,while self-efficacy can directly and positively affect health-related quality of life.Social support cannot directly influence health-related quality of life but can play an indirect effect by self-efficacy and pain to predict patients’health-related quality of life.Targeted interventions should be strengthened to relieve pain,prevent or slow down the progress of physical disability,enhance self-efficacy and social support to improve health-related quality of life in gout patients. |
PDF Full Text Request