CC BY
8https://doi.org/10.32921/2225-9929-2019-4-33-29-34 Original article
Results of measuring the QOL of patients with pathology of the retina and optic nerve in Nur-Sultan city
Zeinet Akhmedyanova 1, Luca G Brusati 2, Raushangul Magzumova3, Zhanna Bayanbayeva 4, Saltanat Beisenova 5
1 Acting Head of the Chair of Ophthalmology, Astana Medical University, Nur-Sultan, Kazakhstan
2 Scientific Coordinator of the Laboratory for Research in Economics and Management Department of
Economics and Statistics Udine University, Italy
3 Associate Professor of the Chair of Public Health, Astana Medical University, Nur-Sultan, Kazakhstan
4 Assistant of the Chair Ophthalmology, Astana Medical University, Nur-Sultan, Kazakhstan 5 Senior Lecturer of the Chair of Public Health, Astana Medical University, Nur-Sultan, Kazakhstan
Abstract
The purpose of the study. Measurement of the quality of life (QOL) of patients with pathology of the retina and optic nerve.
Methods. In this study the main components of QOL were evaluated using a standardized questionnaire SF -36 of 60 patients with pathology of the retina and optic nerve in Nur-Sultan city during 2018-2019.
Results. According to our results, patients aged between 68-77, 78-87 felt stronger impact on the part of the organ of vision compared with other groups, as it was evidenced from a decreased QOL indicators in all parameters of the questionnaire.
Conclusion. The QOL of patients in the age group between 68-87, 78-87 years had lower rates in all the studying categories of quality of life in comparison with patients of other age groups. This circumstance is possibly a result of a deterioration in general somatic and psychological health due to age-related characteristics.
Key words: quality of life, universal questionnaire SF- 36, pathology of the retina and optic nerve.
Нур-Султан каласында кездщ торлы кабыгы мен керу жуйкесшщ патологиясы бар наукастардыц емiршщ сапасын зерттеу нэтижелерi
Ахмедьянова З.У.1, Luca G Во^ай 2, Магзумова Р.З.3, Баянбаева Ж.С.4, Бейсенова С.С.5
1 Кез аурулары кафедрасынын мензерушiсiнiн м.а., Астана медициналыц университетi,
Нур-Султан, Казацстан 2 Экономика жэне статистика факультетiнiн экономика мен басцару саласындагы зерттеу
жумыстары зертханасынын Yйлестiрушiсi, Удине университетi, Италия 3 Когамдыц денсаулыц сацтау кафедрасынын доцентi, Астана медициналыц университетi,
Нур-Султан, Казацстан 4 Кез аурулары кафедрасынын ассистентi, Астана медициналыц университетi, Нур-Султан,
Казацстан
5 Когамдыц денсаулыц кафедрасынын ага оцытушысы, Астана медициналыц университетi,
Нур-Султан, Казацстан
Тушндеме
Зерттеудщ максаты. Квзд/'ц торлы цабыгы мен квружYйкесiнiн патологиясы бар науцастардын вм/'р/'н'ц сапасын зерттеу.
Эдютерк Бер1лген зерттеу жумысынын аясында 2018-2019 жылдар аралыгында Нур-Султан цаласы бойынша квзд/'н торлы цабыцшасы мен квру жYйкесiнiн патологиясы бар 60 науцасынын вм/'р/'н/'н сапасынын нег/'згi компонеттер1 SF-36 сауалнамасы арцылы аныцталды.
Нэтижеск Зерттеу нэтижелер1 бойынша басца топтармен салыстырганда 68-77 жэне 78-87 жас аралыгындагы науцастар вздер/'н/'н квру мYшесiнiн цызмет1н1н бузылуынын вм1р сапасына едэу/'р эсер еткенд1г1н белгледi. Осы науцастар толтырган сауалнаманын барлыц кврсетюштер1 бойынша вм1р сапасынын твмендеу.i квр/'н/'с тапцаны белглi болды.
Корытынды. Басца жас топтармен салыстырганда 68-77жэне 78-87жас аралыгындагы науцастардын вмiр сапасы зерттелiп отырган барлыц кврсетюштер бойынша твмендегенi аныцталды. Бул нэтиже осы категориядагы науцастардын жас ерекшел/'ктер/'не сэйкес олардын жалпы соматикалыц жэне психикалыц денсаулыгынын твмендеуне байланысты болса керек.
Тушн сездер: вмiр сапасы, SF-36 эмбебап сауалнамасы, квзд/'н торлы цабыгы пен квру жYйкесiнiн патологиясы.
Результаты измерения качества жизни пациентов с патологией сетчатки и зрительного
нерва в г.Нур-Султан
Ахмедьянова З.У.1, Luca G Brusati 2, Магзумова Р.З.3, Баянбаева Ж.С.4, Бейсенова С.С.5
1 И.о. заведующего кафедрой глазных болезней, Медицинский университет Астана, Нур-Султан,
Казахстан
2 Научный координатор лаборатории исследований в области экономики и управления Факультета экономики и статистики, Университет Удине, Италия 3 Доцент кафедры общественного здравоохранения, Медицинский университет Астана,
Нур-Султан, Казахстан
4 Ассистент кафедры глазных болезней, Медицинский университет Астана, Нур-Султан, Казахстан 5 Старший преподаватель кафедры общественного здоровья, Медицинский университет Астана,
Нур-Султан, Казахстан
Резюме
Цель исследования. Измерение качества жизни пациентов с патологией сетчатки и зрительного
нерва.
Методы. В рамках данного исследования проведена оценка основных компонентов качества жизни, с использованием стандартизированного опросника SF-36 у 60 пациентов с патологией сетчатки и зрительного нерва в г. Нур-Султан в 2018-2019 гг.
Результаты. Согласно нашим результатам, пациенты в возрастных категориях 68-77 и 78-87 лет оценивали более сильное воздействие со стороны органа зрения по сравнению с другими группами, о чем свидетельствует уменьшение показателей качества жизни во всех параметрах опросника.
Выводы. Качество жизни в возрастной группе пациентов 68-87, 78-87 лет имело сниженные показатели по всем изучающим категориям качества жизни в сравнении с остальными пациентами в других возрастных группах. Данное обстоятельство возможно обусловлено ухудшением общего соматического и психологического здоровья в виду возрастных особенностей.
Ключевые слова: качество жизни, универсальный опросник SF-36, патологии сетчатки и зрительного
нерва.
Corresponding author: Zhanna Bayanbayeva, Assistant of the Chair Ophthalmology, Astana Medical University, Nur-Sultan,
Kazakhstan
Postal code: 010000
Address: 010000, Nur-Sultan city, Beybitshilik str., 49 а Phone:+77015662864, E-mail: zsb2377@gmail.com
J Health Dev 2019; 4 (33): 29-34 UDC 617.7); 614; 614.2 Recieved: 08-09-2019 Accepted: 12-11-2019 This work is licensed under a Creative Commons Attribution 4.0 International License
Introduction
Visual impairment adversely affects social, physical and mental well-being. The global prevalence of eye diseases is estimated at 300 million people, with 85% of people with low vision and 15% being blind [1]. About 90% of people with low vision live in low-income countries, for 28% of people the problem with visual impairment arises during the working age period [2-3].At this age people face number of issues: the level of demand for their profession, unemployment, financial security, loss of independence [3-4]. This is largely due to the fact that any type of activity that creates the conditions for productive development and independence of existence highly depends on good vision [5]. The result of a study by American colleagues showed that a complete loss of vision by 100% adversely affects the physical, psychological and social well-being of a person, the negative impact spreads to relatives, house sitters and society [6-7].
In order to assess the scale of the impact of disease on a person, taking into account all the factors that form it: biological, psychological, social is possible in the context of the concept of quality
Materials and methods
The study was conducted on 60 of the retina and optic nerve disease diagnosed cases, which were under the ophthalmologist's supervision at the PHC (primary health care) level in NurSultan city, aged 18 and older. The diagnosis was established in accordance with the International Statistical Classification of Diseases 10. The permission to conduct the study was approved by the local bioethical committee of the NJC "Astana Medical University" in compliance with all principles of the Helsinki Declaration of the World Medical Association. Patient participation was voluntary with the receipt of informed consent to conduct the survey; patient confidentiality was respected.
According to the principles of international practice of studying the parameters of quality of life, a comparative assessment of data on quality of life using the SF-36 questionnaire was conducted formed by the Medical Outcomes Study Short
Results
The study included 60 patients; the average age was between 49.1±2.4, where 31 (51.7%) were women with an average age of 51.1±3.3 and 29 (48.7%) men, whose average age corresponded to 46.1±3.5 (p>0.05). The overwhelming majority of the examined patients were retired people (40%), unemployed (28.3%), workers (11.7%), employees (15%) and entrepreneurs (5%).
The analysis of general indicators for each parameter of the questionnaire revealed an increased level of a generalized indicator
of life [8]. This concept makes it possible to take a broader look at the effect of the disease and its symptoms, medical interventions, and compare maximum damage in all spheres of human life, which reduce the degree of perception of its well-being and integrity [9].
According to the WHO report 2018, the causes of visual impairment and blindness include diseases of the retina and optic nerve: age - related macular degeneration, glaucoma and diabetic retinopathy [1].
The opportunity to understand and estimate the complexity of influence of ophthalmic pathology caused by damage to the optic nerve and retina, on patient's quality of life is realized by the standardized survey [10]. In the proposed study the universal questionnaire SF-36 was used, which is widely applied in studying the quality of life associated with health in various fields of medicine.
The purpose of the study. Measurement of QOL of patients with retinal and optic nerve pathology using standardized universal questionnaire SF-36 in the Nur-Sultan city.
Form. The widely used in Europe and the USA survey based on SF-36 refers to a non-specific general study of quality of life and has an approved methodology in the Russian-language version, which was developed at the Institute of Clinical and Pharmacological Research in St. Petersburg [11]. The questionnaire allows to assess general health and basic parameters of quality of life as a physical condition (PF), role-related functioning associated with physical condition (RP), severity of pain (BP), general health (GH), vitality (VT), social functioning (SF), role-based functioning caused by emotional status (RE), mental health (MH). In order to analyze the obtained results of life quality assessments we focused on a range of data reflecting the impact of pathology on quality of life, where 81-100% refers to a high quality of life index, 61-80% to an increased indicator, 41-60% to an average indicator, 21-40% -reduced rate, 0-20% - the lowest rate of QOL.
(77.1±2.4) compared with the physical (50.2±0.2) and mental components (47.9±1.1) (p<0,01). There is a high level of QOL associated with the manifestation of physical pain (86.1±1.7) in comparison with the general indicator (p<0.05), which explains the absence or insignificant effect of pain sensations stipulated by eye pathology during daily activities. Increased indicator can be observed in the results that correspond to the parameters of role functioning (67.7±2.1), general health (69.8±1.8), vitality (69.1±1.6), emotional
functioning (69.3 ± 3.0), mental health (70.6±1.3), meanwhile results related to the general indicator of QOL were decreased (p<0.05). The aforementioned decrease in indicators by parameters is due to the insignificant effect of retinal and optic nerve diseases on these aspects of the patient's life,
leading to a limitation in accomplishment of simple everyday tasks and responsibilities due to physical problems, dissatisfaction with the general state of health, decreased vital energy, potential, emotional experiences, psychological discomfort (Table 1).
Table 1 - General parameters of the SF-36 questionnaire of patients with pathology of the retina and optic nerve
Questionnaire Options Parameter Rating
PF - Physical Functioning 77.7±2.1
RP - Role-Playing 67.7±2.1
BP - Physical Pain 86.1±1.7
GH - General Health 69.8±1.8
VT - Vitality 69.1±1.6
SF - Social Performance 83.2±2.1
RE - Emotional Functioning 69.3±3.0
MH - Mental Health 70.6±1.3
General Indicator 77.1±2.4
Physical Component 50.2±0.2
Mental Component 47.9±1.1
Further the quality of life was studied differences between the indicators of women and according to the proposed parameters of the men were revealed (Table 2). examined questionnaire among men and women. For each aspect of the questionnaire, no statistical
Table 2 - Comparative assessment of life quality according to the parameters of the SF-36 questionnaire for men and women
QuestionnaireOptions Men Women P
PF - Physical Functioning 77.5±3.3 75.3±3.2 p>0.05
RP - Role-Playing 61.5±3.2 59.8±3.3
BP - Physical Pain 85.9±2.5 84.9±2.5
GH - General Health 69.5±2.6 67.3±2.7
VT - Life Force 68.8±2.2 67.1±2.1
SF - Social Performance 82.9±3.0 81.1±3.1
RE - Emotional Functioning 68.8±4.4 63.6±4.5
MH - Mental Health 70.5±1.9 69.1±2.1
Patients with pathology of the retina and optic nerve did not notice any decrease or limitation of activity in the social sphere in the form of communication with friends, family members, and also did not note any effect as physical discomfort in the form of eye pain on the performance of usual daily activities. High level of life quality was observed in these parameters among both men and women.
The increased rates among male and female in our study are found in role-based functioning, general health, vitality, emotional functioning and mental health. Attention is drawn to the presence of the same problems in males and females with these pathologies regarding self-realization,
discomfort due to a decrease in vital energy, general well-being, emotional experiences, and mental tension (Figure 1)
Figure 1 - Quality of life indicators for patients with pathology of the retina and optic nerve according to the SF-
36 questionnaire among men and women
During the investigation of life quality of patients with pathology of the retina and optic nerve in the age intervals calculated according
to Sturgess, the following results were obtained (Table 3).
Table 3 - Indicators of quality of life parameters at different age intervals
Parameters SF 36 Age intervals
18-27 28-37 38-47 48-57 58-67 68-77 78-87
Pf 92 ±2.0 94.0±0.7 89.6 ±1.8 81.9±2.1 68.6±2.7 50.0±1.5 46.7±4.4
RF 70,0±5.0 75.0±3.7 75.0±3.1 59.4±4.6 56.8±3.6 39.3±5.0 37.5±5.6
BP 94.6±1.9 93.4±1.4 93.3±2.3 88.0±4.4 84.5±4.3 74.3±4.8 62.2±1.8
Gh 79.1±4.5 85.0±2.0 75.8±3.0 65.0±3.2 63.8±3.6 57.8±2.1 48.3±3.6
VT 80.5±3.3 79.5±2.0 72.9±3.4 66.9±2.1 63.6±2.9 57.1±1.8 52.5±1.7
SF 95.0±3.2 90.0±3.1 89.8±5.1 85.9±5.0 78.4±3.8 71.4±5.2 56.2±4.3
RE 86.7±5.4 83.3±5.5 75.0±7.3 70.8±5.5 61.9±8.7 75.0±7.3 75.0±7.3
Mh 78.4±3.1 77.6±2.2 74.7±2.5 71.0±2.7 66,9±1.5 64.0±2.5 52.0±2.1
According to our results, patients in age groups 68-77, 78-87 felt a stronger impact from the organ of vision compared with other groups, as it was evidenced from a decreased QOL indicators in all parameters of the questionnaire. This circumstance is possibly the result of a deteriorating general somatic and psychological health due to age peculiarities. It was noted that there is a significant effect of the disease that limits the execution of daily housework, movement in public places, ordinary work activities, communication with friends, relatives; also decreases the feeling of fullness of vital energy, motivation, and rises the tendency to experience negative emotions, expressed in feelings of uselessness, emptiness, unreasonable annoyance and anger against others and themselves.
The specific feature of all other age groups (18-27, 28-37, 38-47, 48-57, 58-67) is the absence or slight effect of the symptoms of the disease on physical activity, social life, on the emotional sphere (mood, feelings, experiences, motivations). The negative impact of the pain syndrome is not evaluated by patients, as witnessed by the high and increased threshold of quality of life indicators in the parameters of the questionnaire. However, patients of the corresponding age groups also have a limitation in the implementation of role functions: a decrease in vital activity, the presence of dissatisfaction with the general state of health and psychological discomfort, which are estimated by lower scores in the corresponding components of the quality of life.
Discussion
The QOL which was assessed using the nonspecific questionnaire SF-36 revealed that patients an of an age group of 68-87 years has lower rates in all studying categories of quality of life compared to patients of other age groups.
Possibly, according to the authors [12], older people who experience visual impairment are more prone to mental health problems related to treatment tolerance, visual function, adaptation in everyday life due to low vision, which can lead to
an increase in disability and mortality due to vision, as well as to the formation of an economic burden associated with raised health care costs. In the current study, the revealed psychological aspect of patients aged 68-87 years requires extensive study as one of the possible predictors of the development of complications in order to implement optimized effective treatment tactics [13, 14].
A differentiated analysis of QOL by measuring parameters carried out using the universal questionnaire SF-36 among patients with pathology of the retina and optic nerve noted a high indicator of the integral quality of life, but the physical and
mental components amounted to an average level of assessment. During the study, patients did not reveal any physical activity restrictions due to eye pain. Patients with these pathologies had problems only due to eye disorders that slightly limited their daily activities and duties, influenced the degree of satisfaction with health in general and psychological condition, and experienced reduction in vitality. Such picture was common either for men and women and was observed in all age groups. High rates were observed in the parameters that characterize the peculiarity of social activity, tolerance to physical activities and intensity of pain, which was observed in all age groups among men and women.
Conclusion
The QOL of patients aged between 68-87, 78-87 лет years had lower rates in all the studying categories of QOL in comparison with other patients of other age groups. It can be assumed that the universal questionnaire SF-36 is focused
on measuring general indicators but requires deeper study of the impact of visual disturbances on quality of life, which is feasible within specialized questionnaires.
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