在宅脳卒中患者の健康関連QOL—日常生活における行動範囲の影響

Health-related quality of life in stroke patients living in the community : The influence of daily participation on HRQOL

要旨：在宅脳卒中患者のHRQOLを日常の行動範囲の面から検討した．対象は北里大学病院神経内科に急性期で入院し，生存退院した395例である．HRQOLの評価は日本語版EuroQolのQOL効用値を用いた．重回帰分析により，ADLのうち移動能力，更衣，話し言葉，行動範囲の4項目が効用値に影響を及ぼす要因として抽出された．行動範囲を自宅内外の2群に分けて検討すると，ADLの自立度にかかわらず行動範囲が自宅外に拡大している者のQOL効用値は有意に高値を示した．これらの結果から，在宅脳卒中患者にとって社会参加の促進や社会生活の維持は，HRQOLの向上に重要であることが示唆された．

　The purposes of this study were to identify factors influencing health-related quality of life (HRQOL) in home care patients with stroke, and to investigate the influence of participation in HRQOL in daily life. Subjects included 395 patients who responded to questionnaires regarding 10 categories of ADL levels (feeding, toileting, continence, bathing, dressing, mobility, participation, memory, speaking, and understanding) and 5 domains of HRQOL (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). A utility score of the EuroQol was used to assess HRQOL of the patients. Multiple regression analysis revealed that the significant factors influencing HRQOL of stroke patients included mobility, dressing, speaking, and participation (R²=0.70). Further analysis showed that the HRQOL of the patients, whose participating levels were outside of their house, was significantly higher than that of patients whose participating levels were inside the house. The results of our study suggested that the promotion of participation in social life was important in improving HRQOL for home care patients with stroke.