基于ICF-RS探索影响住院糖尿病患者功能的因素

Evaluation of Hospitalized Patients with Diabetes Mellitus with the International Classification of Functioning,Disability and Health Rehabilitation Set

目目的的:应用《国际功能、残疾和健康分类康复组合》(ICF-RS)评估住院糖尿病患者的功能,探索影响糖尿病患者功能的因素。方法:邀请2021年8月—2022年2月在广东省中医院住院的419例糖尿病患者参加调查,以面对面访谈的方式获得患者社会人口学和生活方式方面的资料,使用ICF-RS评估患者的功能,通过查阅病历获取患者入院后首次检查的相关生理生化指标。对ICF-RS评估结果进行标准化处理,所有类目限定值结果求和,再除以类目总和与4的乘积,然后乘以100,即ICF-RS标准化评分=[所有类目限定值结果之和/(类目总和×4)]×100,标准化评分越高,功能障碍越严重。单变量分析采用t检验、秩和检验或简单线性回归,多变量分析构建多重线性回归模型,分析影响糖尿病患者功能的因素。结果:共376例完成《国际功能、残疾和健康分类康复组合》评估,全部患者的ICF-RS标准化评分范围是0.83~75.83分,平均值为(17.23±10.83)分。单因素分析发现年龄、共患疾病数量、文化水平、工作情况、家庭人均月收入、是否饮酒、步行时间、是否运动、糖化血红蛋白、肌酐、总胆固醇、低密度脂蛋白胆固醇是糖尿病患者功能状态的影响因素(P<0.05)。以ICF-RS标准化评分为因变量,以单变量分析中对糖尿病患者功能状态有影响的因素作为自变量建立多重线性回归方程,回归模型有统计学意义(F=22.558,P<0.001),肌酐(β=0.010,t=7.272,P<0.001)、年龄(β=0.183,t=4.454,P<0.001)、每周步行时间(β=-0.336,t=-3.538,P=0.001)、每周运动时间(β=-0.378,t=-2.566,P=0.011)和文化水平(β=-1.338,t=-2.426,P=0.016)是住院糖尿病患者功能状态的独立影响因素。结论:糖尿病患者身体功能、活动、参与3个维度均受到影响,肌酐、年龄、每周步行时间、每周运动时间和文化水平是住院糖尿病患者功能状态的独立影响因素,肌酐值越高、年龄越大的糖尿病患者功能状态越差,每周步行时间越长、每周运动时间越长、文化水平越高的患者功能状态越好。

Objective:To evaluate the function of hospitalized patients with diabetes mellitus with the ICF-RS(International Classification of Functioning,Disability and Health Rehabilitation Set)and to explore factors that affect patients’functions.Methods:A total of 419 patients who were hospitalized in Guangdong Provincial Hospital of Traditional Chinese Medicine from August 2021 to February 2022 were recruited.The patients’socio-demographic and lifestyle data were obtained by the face-to-face interviews.Each patient’s function was evaluated with the ICF-RS.The initial clinical examination results and laboratory findings after admission were obtained by consulting the medical record.The results of ICF-RS evaluation were standardized.The sum of all categories’qualifiers was divided by the product of the sum of categories and 4,and then multiplied by 100,that is,ICF-RS standardized scores=[Sum of all categories’qualifiers/(sum of categories×4)]×100.The higher the standardization results,the worse the functions were.Univariate analysis was performed by t-test,Wilcoxon rank sum test,or linear regression.Multivariate analysis was performed by multiple linear regression models to investigate factors that affect diabetic patients’functional status.Results:A total of 376 patients completed the ICF-RS assessment,and the range of ICF-RS standardized results of these patients was 0.83-75.83 with an average score of(17.23±10.83).Univariate analysis showed that age,comorbidities,education level,employment,monthly household income,alcohol consumption,walking time,exercise,glycosylated hemoglobin,creatinine,total cholesterol and low density lipoprotein cholesterol were the factors influencing functions of patients with diabetes mellitus(P<0.05).With ICF-RS standardization results as dependent variable and factors affecting patients’function in univariate analysis as independent variables,a multiple linear regression model(F=22.558,P<0.001)was established.The model showed that creatinine(β=0.010,t=7.272,P<0.001),age(β=0.183,t=4.454,P<0.001),weekly walking time(β=-0.336,t=-3.538,P=0.001),weekly exercise time(β=-0.378,t=-2.566,P=0.011)and education level(β=-1.338,t=-2.426,P=0.016)were independent factors that affected functions of patients with diabetes mellitus.Conclusion:Three dimensions(body function,activity and participation)are all affected,and creatinine,age,weekly walking time,weekly exercise and education level are independent factors that affect functions of patients with diabetes mellitus.Patients with higher creatinine value and older age had worse functions,and patients with longer weekly walking time,longer weekly exercise time and higher education level had better functions.