目的:探讨社会人口统计学,临床,幻肢痛患者的神经生理变量和与健康相关的生活质量(HR-QOL)。
方法:这是对先前临床试验的横断面分析。使用单变量和多变量线性和逻辑回归分析对HR-QOL的预测因子进行建模。我们使用了一种增加调整水平的顺序建模方法,控制年龄和性别,和其他相关临床变量(截肢后的时间,水平的截肢,和痛苦)。通过SF-36健康调查及其八个子领域评估了HR-QOL。
结果:我们分析了92例下肢截肢患者的基线数据。他们大多是男性(63%)。45.2±15.6年,截肢以来的平均时间为82.7±122.4个月,SF-36总评分为55.9±21.5。我们发现受影响半球的皮质内促进(ICF),加巴喷丁的用法,HR-QOLICF是更好的HRQOL的预测因子,而加巴喷丁的使用与较差的HR-QOL相关,主模型解释了13.4%的结果方差。对于SF-36子域,ICF也是社会功能的积极预测因子,身体疼痛,和活力,虽然药物使用与心理健康得分较低有关,一般健康感知,身体疼痛,和活力。
结论:我们在PLP患者中发现了两个新的HR-QOL独立预测因子,即,神经生理学指标ICF和加巴喷丁的使用。这些结果突出了运动皮质兴奋性在HR-QOL中的作用,并强调需要在截肢后进行有利于神经可塑性适应的治疗。ICF可以用作可能的标记。
OBJECTIVE: To explore the relationship between sociodemographic, clinical, and neurophysiological variables and health-related quality of life (HR-QOL) of patients with phantom limb pain.
METHODS: This is a cross-sectional analysis of a previous clinical trial. Univariate and multivariate linear and logistic regression analyses were used to model the predictors of HR-QOL. We utilized a sequential modeling approach with increasing adjustment levels, controlling for age and sex, and other relevant clinical variables (time since amputation, level of amputation, and pain). HR-QOL was assessed by the SF-36 Health Survey and its eight subdomains.
RESULTS: We analyzed baseline data from 92 patients with lower-limb amputations. They were mostly male (63%), 45.2 ± 15.6 years, with a mean time since amputation of 82.7 ± 122.4 months, and an overall SF-36 score of 55.9 ± 21.5. We found an association between intracortical facilitation in the affected hemisphere (ICF), gabapentin usage, and HR-QOL. ICF is a predictor of better HRQOL, whereas gabapentin usage was associated with a poorer HR-QOL, with the main model explaining 13.4% of the variance in the outcome. For the SF-36 subdomains, ICF was also a positive predictor for social functioning, bodily pain, and vitality, while medication usage was associated with lower scores in mental health, general health perception, bodily pain, and vitality.
CONCLUSIONS: We found firsthand two new independent predictors of HR-QOL in individuals with PLP, namely, the neurophysiological metric ICF and gabapentin usage. These results highlight the role of the motor cortex excitability in the HR-QOL and stress the need for treatments that favor the neuroplastic adaptation after amputation, for which ICF may be used as a possible marker.