Physical activity and health related quality of life in patients with end stage renal disease

Končna ledvična odpoved poseže na različna področja delovanja – telesno, duševno in psihosocialno. Pridružene bolezni in naporno nadomestno zdravljenje bolnikom s končno ledvično boleznijo spremenijo način življenja. Bolniki na nadomestnem zdravljenju s hemodializo v primerjavi s splošno populacijo poročajo o nižji stopnji gibalne aktivnosti in o slabši subjektivni oceni z zdravjem povezane kakovosti življenja. Eno izmed področij, ki lahko pozitivno vpliva na njihovo telesno in psihično počutje ter socialno vključenost, je gibalna aktivnost. Namen raziskave je bil ugotoviti, ali med bolniki s končno ledvično odpovedjo in ledvično zdravimi kontrolnimi preiskovanci obstajajo statistično pomembne razlike v gibalni aktivnosti ter v z zdravjem povezani kakovosti življenja tako na telesni kot na psihični komponenti. Zanimalo nas je tudi, ali v skupini bolnikov s končno ledvično odpovedjo obstajajo razlike v z zdravjem povezani kakovosti življenja na telesni in na psihični komponenti glede na stopnjo njihove gibalne aktivnosti. Rezultate o z zdravjem povezani kakovosti življenja smo pridobili z vprašalnikom SF-36v2, rezultate o gibalni aktivnosti pa z vprašalnikom HAP. V raziskavi je sodelovalo 233 odraslih oseb, od tega 92 bolnikov s končno ledvično odpovedjo na nadomestnem zdravljenju s hemodializo in 141 ledvično zdravih kontrolnih preiskovancev. Bolnike s končno ledvično odpovedjo smo glede na rezultat lestvice AAS (običajni nivo gibalne aktivnosti) vprašalnika HAP enakomerno razdelili v tri skupine glede na stopnjo gibalne aktivnostimed gibalno neaktivne (n1 = 32), zmerno gibalno aktivne (n2 = 30) in gibalno aktivne (n3 = 30). Rezultati so pokazali, da so bolniki s končno ledvično odpovedjo v primerjavi z ledvično zdravimi kontrolnimi preiskovanci manj gibalno aktivni in imajo slabšo z zdravjem povezano kakovost življenja na telesni komponenti. Rezultati srednjih vrednosti so pokazali, da bolniki s končno ledvično odpovedjo nižje ocenjujejo tudi psihično komponento z zdravjem povezane kakovosti življenja, vendar razlike med preiskovanci niso statistično pomembne. Ugotovili smo, da med različno gibalno aktivnimi bolniki s končno ledvično odpovedjo obstajajo statistično pomembne razlike na telesni komponenti z zdravjem povezane kakovosti življenjain sicer med skupino gibalno neaktivnih in skupino zmerno gibalno aktivnih ter med skupino gibalno neaktivnih in gibalno aktivnih. Glede na stopnjo gibalne aktivnosti med bolniki s končno ledvično odpovedjo na psihični komponenti z zdravjem povezane kakovosti življenja ni prišlo do statistično pomembnih razlik. Ugotovitve empiričnega dela smo s pomočjo strokovne literature in opravljenega intervjuja prenesli na specialno pedagoško področje. Specialni in rehabilitacijski pedagog se v okviru obravnave dolgotrajno bolnih otrok srečuje z otroki in mladostniki s končno ledvično odpovedjo, zato smo zapisali praktične smernice za delo specialnega in rehabilitacijskega pedagoga.End stage renal disease can effect different areas of a human life - physical, mental and psychosocial. Associated illnesses and strenuous renal replacement therapy can alter patient’s quality of life. In comparison to general population, patients on renal replacement therapy report a lower level of movement and give a lower subjective assessment of the health-related quality of life. One of the areas that can have a positive effect on their physical and psychological well-being as well as social inclusion is the physical activity. The purpose of the study was to determine whether there are any statistically significant differences in physical activity and health-related quality of life between patients with end-stage renal disease and healthy study participants, in terms of physical and mental components. We were also interested whether there are differences in the quality of life of patients with end-stage renal disease in physical and mental components based on the level of their physical activity. The results on the health-related quality of life were obtained with the SF-36v2 questionnaire and the results of the physical activity with the HAP questionnaire. The study involved 233 adults, including 92 patients with end-stage renal disease that are receiving renal replacement therapy with hemodialysis and 141 renal healthy control subjects. Patients with end-stage renal disease were evenly divided into 3 groups according to the AAS scale (normal level of physical movement) of the HAP questionnaire in terms of the level of physical activity into physically inactive (n1 = 32), moderately physically active (n2 = 30) and physically active (n3 = 30). The results show that patients with end-stage renal disease have a lower health-related quality of life on mental component and are less physically active compared to renal healthy participants. Results related to the group of moderately active show that patients with end stage renal disease assessed their mental component of health-related quality of life as lower, but the differences between the subjects are not statistically significant. We found that there are statistically significant differences among physically active patients with end-stage renal disease on the physical component of the health-related quality of life – among physically inactive patients and moderately physically active group of patients and among the physically inactive and physically active group. Depending on the level of the physical activity among patients with end-stage renal disease, there are no statistically significant differences in the mental component of the health-related quality of life. The results of the survey were conveyed into the area of special education via reference literature and the interview conducted. As a special education and rehabilitation teacher deals with children with long-term illnesses, s/he may also work with children and teenagers with end-stage renal disease, therefore we compiled practical guidelines for special education teacher