Research Of QOL Scales On Post-stroke Patients Treated By TCM

BackgroundStroke dramatically degenerate the life quality of patients because it can cause high possibility of deformity, and severely affect living and working ability, physical action and social and psychological behaviors. Improving the life quality of stroke patients is one of the important goals of rehabilitation therapy. The improvement of prognosis has largely relied on the accurate measurements of life quality of stroke patients and the verification of the factors causing the degeneration of life quality. Most of the previous studies in China on assessing life quality of stroke patients have been done with single scale measurement. Recently the methods of multiple scale measurement for evaluating life quality of stroke patients are under the development and systemization. There is a trend for the transition from single scale measurement to multiple scale measurement including the systematic assessment of psychological condition and physical and participating activity of patients at different clinical stages. In multiple scale measurement, however, the methods for selecting specific suitable scales have remained underdeveloped and controversial. In addition, there are barely studies focusing on the clinical investigation of multiple scale measurement, therefore comprehensive estimation for multiple scale measurement need to be developed. Chinese medicine treatment has been shown to be valuable in treating stroke patients and improving life quality of these patients. However, no research has been done for clinically investigating life quality assessment of stroke patients under Chinese medicine treatment using multiple scale measurement.ObjectivesThe overall goal of this study is to investigate the feasibility of using multiple scale measurement to assess the life quality of ischemic stroke recovering patients before and after Chinese medicine treatment. More specifically, three measurements including the MOS item short from health rurvey (SF-36), stroke-specific quality of life scale (SSQOL) and quality of life instruments for Stroke Patients (QOLISP) are compared for their simplicity, reliability, feasibility, sensitivity on the assessment of the efficacy of clinical Chinese medicine treatment on ischemic stroke recovering patients. Also the relationships among these measurements are investigated so as to better understand the interaction and association of life quality assessment of stroke patients using different measurements.MethodsBased on the analysis of related literatures, three different life quality measurements were selected through expert meeting (i.e., brain storm). They were brief questionnaire of health status, stroke scale for quality of life and quality of life scale in stroke patient. Patients (N=61) that had been clinically considered as suitable for this study were included. General information of these patients including gender, age, job position as well as NIHSS (NIH Stroke Scale) and MMSE (The Mini-Mental State Examination) scores was collected. Using Excel and SPSS 16.0, the statistical analysis of each measurement was performed for the reliability, feasibility and sensitivity. The comparison of three measurements on the assessment of physical and psychological conditions, social behaviors and relative syndromes in Chinese medicine treatment on ischemic stroke patients was also conducted.Results1. Based on the systematic test, three measurements had demonstrated to be relatively high flexible in the clinical operation. These measurements showed the features of being easy to use and operate, less time-consuming (i. e., the average operation time for SF-36, SSQOL, QOLISP were approximately 8 min, 16 min and 12 min, respectively).2. Indicators reflecting reliability had shown high scores both before and after the treatment for SF-36 and SSQOL, indicating strong reliability and stability. For the assessment of QOLISP, before the treatment overall Cronbach's a score was 0.786, but this value decreased to less than 0.7 after excluding two scales of physical and psychological functions. In addition, strong correlation between physical and psychological functions was found for QOLISP. Thus the internal consistency of the reliability of QOLISP needed to be reevaluated. After the treatment Cronbach's a score for QOLISP was larger than 0.8, indicating the increase of internal consistency of the reliability.3. Compared to reliability analysis, due to the lack of direct quantitative indicators for feasibility assessment, we used an indirect method of combining analysis and reasoning to determine the feasibility regarding the content and structure for SF-36, SSQOL and QOLISP. Our method verified the feasibility for all three measurements.4. All three measurements demonstrated relative high sensitivity even for the mild or intermediate stroke patients.(1) SF-36:average scores of eight indicators except mental health (MH) and vitality (VT) showed significant increase after the treatment. Within the eight indicators, physiological function (PF), physical function (RP), emotional function (RE), social function (SF), bodily pain (BP) and general health (GH) had statistically shown significant difference (P<0.01), indicating the strong sensitivity of each indicators.(2) SSQOL:after the treatment, average scores of twelve areas except visual acuity had shown considerable increase than those before the treatment. Physical fitness, family activities, language, movement, emotions, personality, self-care ability, social activities, thinking ability, upper limb function and working ability demonstrated significant difference (P< 0.05) after the treatment, indicating good sensitivity for these eleven areas.(3)QOLISP:average scores of four indicators including physical function, psychological function, social relations and relative syndromes in Chinese medicine treatment had shown significant difference (P<0.05) after the treatment, indicating good sensitivity for each indicator.5. In the correlation analysis of overall scores of the three measurements, SSQOL and QOLISP demonstrated the significant correlation (P<0.01) with the correlation coefficient of 0.813 and 0.868 before and after the treatment, respectively. However, SF-36 had been found to be weakly correlated with both SSQOL and QOLISP. For the correlation analysis of similar indicators across different measurements, self-care ability in SSQOL and physiological function in QOLISP, as well as emotional health in SSQOL and Psychology in QOLISP both showed strong positive correlation (P<0.01). No significant correlation was found for other pairs.6. SSQOL and QOLISP demonstrated the significant difference (Z=-2.764, P<0.05) in terms of the decreasing ratio. By analyzing the median value, SSQOL showed a tendency of providing high scores. After the treatment, SSQOL showed larger decreasing ratio of scores than QOLISP in the same group of patients, indicating higher sensitivity and higher possibility of the occurrence of false-positive assessment.Conclusion1. Compared to SF-36, SSQOL and QOLSP are more advantageous for their comprehensive contents and flexibility that allows to be applied to broader range of conditions on the assessment of life quality of stroke patients. In addition to assessing physical function, SSQOL also takes into account languages, vision, communication, memory, thinking and social role function, which makes SSQOL much suitable for assessing life quality of stroke patients. QOLISP, however, are better reflecting the characteristic syndromes within Chinese medicine treatment, including the ones such as paraplegia language disadvantage, numbness, dizziness, limb rigidity, limb pain, dysphasia, irritability, constipation, stool incontinence and weak waist, etc. Therefore, QOLISP is much suitable for assessing life quality of stroke patients who are undergoing Chinese medicine treatment.2. For analyzing ischemic stroke patients, specific measurements including SSQOL and QOLISP demonstrate strong correlation in terms of overall scores and scores of certain similar indictors, further indicating the importance of their application on assessment of life quality of stroke patients. Our study also shows the good performance of SSQOL which is consistent with the fact that SSQOL has been widely accepted and employed in life quality assessment of stoke patients. However, higher sensitivity is found for SSQOL than for QOLISP. For assessing stroke patients under Chinese medicine treatment, measurements including QOLISP that have better descriptions of Chinese medicine treatment syndromes become promising. However, due to the lack of large sample, further steps should be taken for evaluating their reliability, feasibility and sensitivity. 3. Based on the results of this study, stroke patients treated by Chinese medicine, we can use with Chinese characteristics, the QOLISP scale, so that Chinese medicine in terms of quality of life scale evaluation of the efficacy of a more perfect; or use specialized stroke scale SS-QOL and QOLISP comprehensive measurement scale portfolio quality of life of stroke patients, the efficacy evaluation more comprehensive. As little as possible to use a universal scale SF-36, thereby reducing the stroke patients in the more important aspects of quality of life of neurological deficit measured ignored.4. the region, severity of the disease, ease of access to health services, rehabilitation and other aspects of measurement point in time of the study sample there are some limitations, some conclusions have yet to be to continue to explore, but at the same time three different scales measured in the same patient comparison, the corresponding conclusions and discussions are still worth learning. Comparison in a variety of scales can be selected or developed more suitable for specialized medical treatment for stroke patients quality of life scale for Chinese medicine, the efficacy of treatment for stroke patients to provide more basis for evaluation.