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系統識別號 U0026-2208201911385400
論文名稱(中文) 巴金森氏病患者生活品質之決定因素-縱貫式研究
論文名稱(英文) A Longitudinal Examination of Determinants of Quality of Life in Patients with Parkinson’s Disease
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 107
學期 2
出版年 108
研究生(中文) 凃筱菁
研究生(英文) Xiao-Jing Tu
學號 TA8001083
學位類別 博士
語文別 英文
論文頁數 84頁
口試委員 指導教授-馬慧英
口試委員-黃文柱
口試委員-趙善如
口試委員-黃松林
口試委員-邱靜如
中文關鍵字 健康相關生活品質  巴金森氏病  決定因素  反應性 
英文關鍵字 Health-related quality of life  Parkinson’s disease  Determinants  Responsiveness 
學科別分類
中文摘要 巴金森氏病(Parkinson’s disease, PD)是一常見與年齡相關的退化性神經疾病之一。它的臨床症狀可能導致了患者日常生活活動限制,且也降低其健康相關生活品質(health-related quality of life, HRQoL)。健康相關生活品質對於巴金森氏病患者而言,它呈現了臨床上的照顧品質和治療效果。其測量工具可分為一般性和特定疾病性等兩類。在巴金森氏病患者健康相關生活品質測量中,自覺健康量表(the 36-item Short-Form Health Survey, SF-36)是最常被使用的一般性健康相關生活品質問卷、巴金森氏病生活品質量表(the 39-item Parkinson's disease Questionnaire, PDQ-39) 則是最常被使用的特定疾病性健康相關生活品質問卷。這兩種測量工具使用可能會反映出巴金森氏病患者生活中的不同面向和不同決定因素。除此,測量工具的反應性(responsiveness)是重要的,因為它可以檢測出疾病過程中的變化程度和呈現測量工具的縱貫性效度(longitudinal validity)。本論文是運用二個研究來探討巴金森氏病患者健康相關生活品質決定因素和透過一年追蹤來了解SF-36及PDQ-39這兩測量工具的反應性。
研究一是採用了同一組預測因子來了解SF-36和PDQ-39的決定因素。92位巴金森氏病患者參與了此研究。此研究結果顯示憂鬱症狀和日常生活中動作障礙是這兩個測量工具前兩項重要的決定因素。研究二則是使用了動作症狀和心理測量來做為健康相關生活品質測量工具之外在反應性和內在反應性檢測的參考評估工具。74位巴金森氏病患者在基準線和一年後追蹤都使用了SF-36和PDQ-39來評估其生活品質。研究結果顯示,這兩個評估工具皆具有部分性改變且能區分出動作症狀改善和惡化的巴金森氏病患者。除此,這兩個評估工具一年後的改變與日常生活動作障礙變化是有一樣的關聯性,另SF-36改變與憂鬱症狀的變化則是比PDQ-39改變更為敏感。
綜合上述,本論文對於巴金森氏病患者健康相關生活品質決定因素和測量工具反應性呈現了一些重要資訊。未來對於巴金森氏病患者之健康相關生活品質研究應可使用多重測量時間點、包含其他非動作症狀預測因子和使用混合研究方法來做進一步的探討。
英文摘要 Parkinson’s disease (PD) is one of the most common age-related neurodegenerative disorders. Its clinical symptoms may lead to the limitation of activities of daily living and reduce health-related quality of life (HRQoL). HRQoL is important in that it reflects the quality of care and treatment effectiveness of the clinical medicine administered to patients with PD. HRQoL measures can be categorized into two types: generic and disease-specific instruments. For patients with PD, the 36-item Short-Form Health Survey (SF-36) is the most frequently used generic HRQoL instrument, and the 39-item Parkinson’s Disease Questionnaire (PDQ-39) is the most frequently used disease-specific HRQoL instrument. They may reflect different aspects of the lives of patients with PD and thus may be associated with different determinants. In addition, the responsiveness of a measurement is important, because it reflects the extent to which the instrument can detect changes in the progression of a disease and to which it shows longitudinal validity. This dissertation includes two studies in patients with PD that were aimed at investigating these issues: the determinants of the HRQoL of patients with PD, and the longitudinal validity of the SF-36 and the PDQ-39 over a one-year follow-up period.
The Study I identified the determinants of HRQoL based on the same set of predictors for the SF-36 and the PDQ-39. A total of 92 patients with PD were recruited. The results showed that depressive symptoms and motor difficulties of daily living were the first two significant determinants for both instruments. The study II used evaluations by clinicians of motor signs and a psychological measure as external criteria to evaluate the internal and external responsiveness of HRQoL measures. Seventy-four patients with PD were evaluated using both the SF-36 and PDQ-39 at baseline and again after one year. The results showed that both instruments were partially sensitive to change over a one-year follow-up period, and that they discriminated between patients with improved and deteriorated motor signs. In addition, they were similarly responsive to changes in motor difficulties affecting daily living, and the SF-36 was more sensitive than the PDQ-39 to changes in depressive symptoms.
In summary, this dissertation provides important information regarding the determinants of the HRQoL of patients with PD and the longitudinal validity of the SF-36 and PDQ-39 for these patients. Additional studies are needed to measure HRQoL at multiple time points, include other predictors of non-motor symptoms, and use a mixed-methods design for HRQoL research in patients with PD.
論文目次 TABLE OF CONTENTS

中文摘要 I
ABSTRACT III
誌謝 V
TABLE OF CONTENTS VI
LIST OF TABLES VIII
CHAPTER 1 INTRODUCTION 1
1.1 Background 1
1.2 Parkinson’s disease 3
1.3 Health-related quality of life 5
1.4 Determinants of health-related quality of life in patients with Parkinson’s disease 11
1.5 Research purposes of the studies 12
1.6 Significance of the studies 12
CHAPTER 2 DETERMINANTS OF GENERIC AND SPECIFIC HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH PARKINSON’S DISEASE 14
2.1 Introduction 14
2.2 Methods 18
2.3 Results 21
2.4 Discussion 23
2.5 Conclusions 28
CHAPTER 3 RESPONSIVENESS OF THE SHORT-FORM HEALTH SURVEY AND THE PARKINSON’S DISEASE QUESTIONNAIRE IN PATIENTS WITH PARKINSON’S DISEASE 29
3.1 Introduction 29
3.2 Methods 31
3.3 Results 36
3.4 Discussion 38
3.5 Conclusions 42
CHAPTER 4 SUMMARY 44
4.1 Conclusion 44
4.2 Recommendations for future research and practices 46
REFERENCES 50
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