r
Hieu qua cua giao due su-c khoe doi voi su* gioi han hoat dong hSng ngay va han che tham gia cong dong cua benh nhan phong tan tat
Effectiveness of health education in activity limitation and participation restrictions of disability leprosy patients
Le Thi Thanh Truc\ Nguyen Minh Chanh\
Nguygn Tat ThSng^ Tran Hau Khang^
Benh Vien Da Lieu TP.HCM
^Bg mon Da Liiu - Truang DH YDuac TP.HCM
^Bg mon Da Lieu - Trudng DH YHd Ngi
Tom tat
Benh phong gay suy giam chUe nang than kinh (CNTK) va tan tat khien benh nhan gap khd khan trong hoat ddng hang ngay va tham gia cdng ddng. Muc tieu: danh gia hieu qua GDSK ddi vdi gidi han ve cac hoat ddng hang ngay va han che tham gia edng ddng eua benh nhan phong tan tat. Odi tUdng va phUdng phap:
nghien eUu can thiep tren 36 benh nhan phdng mdi va tan tat, dp tudi 15-6, dang ky dieu tri tU 1/1/2009 - 31/3/2010 tai 8 tinh phia Nam. Benh nhan dugc kham, danh gia tan tat thed TCYTTG va diem EHF, lam trac nghiem SALSA va trac nghiem dd dp tham gia (P-seale) trUde va sau GDSK, each tU eham sde va phdng ngUa cho mat, tay va chan bj suy giam CNTK trong 6 thang. Ket qua: nam 69,4%, tudi trung binh 36,5 tudi, 88,9%
the MB, 61,1% tan tat dp 2, 33,3% tan tat thU phat, 80,6% hpc tU cap II trd xudng va hau het la lao ddng chan tay hay that nghiep. Sau GDSK 33,4% benh nhan bj gidi han ve cae hoat ddng hang ngay het bj gidi han va 41,7% bj han che tham gia vao edng ddng het bj han che. 19,4% benh nhan bj han che tham gia vao cdng ddng nghiem trpng giam xudng 2,8% sau GDSK va tUdng tU nhdm han che tham gia eUc ky nghiem trpng tU 11,1% xudng 2,8%. Mat khac trung binh diem SALSA va P scale benh nhan phdng tan tat giam 2 diem va 11,7 diem so vdi trUdc GDSK vdi p=0,002 va p=0,000 theo thU tU. Tdm lai GDSK ed hieu qua ddi vdi gidi han ve cae hoat ddng hang ngay va han che tham gia cdng ddng eua benh nhan phong tan tat.
Tdkhoa: benh nhan phong tan tat, gidi han ve cac hoat ddng hang ngay, han che tham gia edng ddng.
Summary
Leprosy causes nerve function impairment (NFI) and disability that makes patients difficult in conducting daily activities and participation in community. The objective of this study was to investigate the effectiveness of HE in activity limitation and participation restrictions of disability leprosy patients. This before-after study involved 36 new leprosy patients at 8 provinces in the Southern of Vietnam, registered for MDT from 1/1/2009 to 31/3/2010, aged between 16 and 60 years. They were examined, estimated according to WHO disability grading and EHF score, interviewed SALSA scale and Participation scale before and after intervention within six months by health education about how to prevent and self care for eyes, for hands and feet with nen/e function impairments. The study consisted of 69.4% male, age mean: 36,5 years, 88.9% MB, 61.1% disability grade II, 33.3% secondary disability, 80.6% at the second level of high school. They were almost manual
Phan bien khoa hoc: PGS.TS. D A N G V A N EM
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 6 - N°4/2011 labour and jobless. After HE, 33.4% patients with activity limitation become no activity limitation and 41.7%
with participation restriction had no participation restriction. The patients with severe participation restriction reduced from 19.4% to 2.8% after HE and the same in extreme participation restriction group reducing from 11.1% to 2.8%. On other hand, the mean of SALSA score and P-score reduced to 2.1 and 11.7 marks after HE (p= 0.002; p= 0.00, respectively). In summary, health education had positive effect on activity limitation and participation restriction of disability leprosy patients.
/Ceytvords; disability leprosy patients, activity limitations, participation restrictions.
1. Dat van de ddng cua benh n h l n phong chUa dugc nghien cUu Tdn thUPng than kinh trong benh phong dan ^^l ^iet Nam do dd chung tdi tien h i n h nghien cUu den suy g i l m chUe n i n g than kinh (CNTK) v l t i n ^^ ^^' "^y-
tat. T i n t i t v l bien dang lam cho ngUdi benh ^"^^ ^ieu nghien cUu: Ddnh gid hieu qud GDSK phong bi x l hdi xa l i n h . Sd lieu eua Vien Da Lieu ^oi vdi sUgidi han ve cdc hogt ddng hdng ngdy vd han Viet Nam n l m 2009 cd 77,5% benh n h l n phong '^^^^'''^ ^ia cdng dong cua benh nhdn phong tdn tdt.
mdi the nhieu khuan (MB: iVlultibaeillary) v l 40,9%
the IVIB bj t i n t i t . Ngoli ra 74% benh n h l n dang 2. Doi tuTprng va phifomg phap nghien cuTu quin ly tai cle tinh phia Nam cln chIm sde tin , ^ „.,.^ . . .
^ , , ,, , ,^ ^ ^ 2,l.voi tuang nghien eUu tat. Giao due sue khoe (GDSK) giup benh nhan biet
dau hieu con p h l n Ung de den ble sT sdm va dugc Benh n h l n phong mdi tU 15-60 tudi, bj t i n tat, dieu trj kjp thdi nham han che suy g i l m CNTK, d i n g ky dieu trj tU 1/1/2009-31/3/2010 tai TP.HCM, cung nhu biet elch tU e h i m sde m l t , tay v l c h i n Ddng Nai, T l y Ninh, Ninh T h u l n , Binh T h u l n , Tien bj g i l m CNTK t r i n h t i n tat them, ft bj tan tat thi se Giang, Long An, Kien Giang v l ddng y tham gia it bj gidi han ve hoat ddng do dd benh n h l n tU tin nghien cUu.
hon v l de hda nhap v I o cdng ddng. De d i n h g i l Lpai khdi nghien eUu neu benh n h l n bj cle hieu q u i cua GDSK trong benh phong chung tdi bieu hien sau: benh t l m than, khdng ddng y tham sU dung t r i e nghiem SALSA v l t r i e nghiem do dp gia nghien cUu v l khdng ndi v l hieu tieng Viet, tham gia. Cd mau: benh n h l n phong tan tat dugc lam
Trie nghiem SALSA (Screening of Activity trie nghiem SALSA va do dp tham gia (P-seale) trUde Limitation & Safety Awareness) I I Sang lpc sU han v l sau GDSK. Chi tieu l i m sing d i n h gia hieu q u i che ve hoat ddng v l y thUe ve sU an t o l n ) dupc eua GDSK I I thay ddi diem eua SALSA va P-seale.
p h l t trien bdi nhdm nghien cUu ve SALSA va dugc Dp lech ehuan diem SALSA v l P-seale dugc tfnh cdng bd n l m 2007 [7]. dijng de do ludng sU han dUa vao khIo s i t 7 benh n h l n phong bj tan tat la a che trong cle hoat ddng v l y thUe ve sU an toan d SALSA = 13,93 v l ap-scaie= 7,15.
elc benh n h l n bj benh phong, tieu dudng v l ed Ky vpng sau GDSK, trung blnh diem SALSA va P- van de ve t h i n kinh ngoai bien khIe d c l nUde ed scale cua benh n h l n g i l m 5 diem mdi lpai -^ he sd thu nhap thl'p va dang p h l t trien. Trie nghiem do I n h hudng ES= d /a{d:dg I n h hudng trung blnh;
dp tham gia (Participation Scale = P-seale) [4] de o: dp lech ehuan).
do ludng mdt elch djnh lupng sU bj gidi han ve ESSALSA= ^.SALSA/GSALSA = 5/13,93 = 0,36 viec tham gia v I o ddi sdng x l hdi m l nhUng ngudi ESp.scaie= d P-scaie/op-scaie = 5/7,15 = 0,7 bj anh hudng bdi benh phong, hole bdi mot tinh C = (Za/2 -F Zp)^\/d\ a= 0,05 va p = 0,1 ta cd:
trang tan tat nao do hay nhUng hoan eInh bj djnh C = 10,51
kien khIc gap p h l i . Theo bao e l o Technical Support Visit 2 - GDSK ed hieu qua the nao ddi vdi gidi han ve Vietnam 2008 cua Dr. Wim H. van Brakel he sd tuang cle hoat dpng hang ngay v l han che tham gia cpng quan r giUa 2 lan phdng van t r i e nghiem SALSA va
P-seale la 0,88 va 0,89 theo thU tU, (benh n h l n dugc phdng van 2 lan, vdi 2 phdng van vien khIe).
-> r nghien eUu nay = 0,8.
2C(1-r)
n. 'P-scale
" S A L S A ~ / C O \
l^^SALSA /
2x10,51x(1-0,8) 0,36^
= 32,4 # 33 ngudi 2C(1-r)
(ESp_scaie )
^2x10,51x(1-0,8) 0,7^
= 8,6 # 9 ngudi Vay cd mau tdi thieu I I 33 ngudi.
2.2. Phuang phap nghiin edu
Nghien eUu can thiep, so sinh trUde sau.
Qui trinh nghien cUu: benh n h l n dugc khIm, trac nghiem co va e l m gilc (VMT/ST), hdi thdng tin (tuoi, gidi, noi sinh sdng, tinh trang hdn n h l n , hpc van, thu nhap...), d i n h g i l tinh trang benh, dp t i n tat theo TCYTTG va tinh tdng diem EHF'^i(mlt, tay va chan), lim trie nghiem SALSA v l do dp tham gia.
Benh nhln phong mdi v l ed tan tat, dugc danh gia trudc GDSK (lan 1) (KhIm, l i m t r i e nghiem VMT/ST, trie nghiem SALSA, trie nghiem do dp tham gia), sau dd can thiep bang:
GDSK 11dn/thdng x 6 thdng tai BVDa Lieu/khoa Da Lieu tinh
Benh nhln dugc d i n h g i l lai sau 6 t h i n g GDSK (lan 2) (KhIm, l i m trie nghiem VMT/ST, t r i e nghiem SALSA, trie nghiem do dp tham gia)
Trie nghiem SALSA: gdm 20 elu hdi v l diem cho mdi clu tUO-4 diem [6, 7].
0 = khdng can phli l i m viec dd
1 = de d i n g khi thUe hien hoat ddng nay 2 = hai khd khi thue hien hoat dpng nay 3 = rl't khd khi thUe hien hoat dpng nay
4 = khdng the lam dugc hoat dpng nay hole tranh bdi vl so nguy ca
Trie nghiem do dp tham gia: gdm 18 c l u hdi, diem mdi clu tUO-5 diem [4].
0 = khdng cd khd khIn gl e l , hole 0 = khdng thich hgp
1 = khdng thdnh vdn de: cd sU gidi han trong tham gia, nhUng khdng phli la v i n de ddi vdi ngUdi dugc phdng v i n e l tren phuong dien thue tien hay elm xue.
2 = van de nhd: cd sU gidi han trong tham gia nhung chi I I mdt van de nhd bdi vl khdng thudng xuyen x i y ra hole khdng phli I I mdt khd khIn Idn.
3 = vdn de vda phdi: cd gidi han trong tham gia v l ed I n h hudng den cude sdng eua ngudi dugc phdng v i n .
5 = vdn de Idn: cd gidi han trong tham gia, v l cd the dan den mdt sU thay ddi Idn trong cude sdng cija ngUdi dugc phdng van.
Benh n h l n dugc g i l o due ve benh phong, udng thudc dung elch, dau hieu dj Ung thude, v l con
p h l n Ung phong, elch tU cham sde v l phdng ngUa t i n tat [1,3] cho mat, tay v l chin t r i n h t i n tat them.
Benh n h l n dugc g i l o due b l n g hinh I n h v l v l t dung cu the de benh n h l n hieu, thue h i n h tai chd cung nhu dem hieu biet n i y ve I p dung tai n h i . Benh n h l n dugc kiem tra v l chinh sUa kjp thdi cle ddng t i c sai de viec tap luyen dat hieu q u i .
D i n h g i l hieu q u i GDSK ddi vdi gidi han ve cac hoat ddng hang ngly v l han che tham gia edng ddng eua benh n h l n phong tan tat b l n g so sinh diem SALSA va diem mUc dp tham gia trudc va sau 6 t h i n g GDSK.
Ket q u i chinh I I khIe biet diem trung blnh cija trie nghiep SALSA v l P-scale trUde v l sau GDSK.
Ngdai ra p h l n tich them mdt sd d i e diem cija mau nghien eUu.
De han che sai sd trong do ludng phdng van vien dugc tap huan v l phdng van thU tdi thieu 7 b l n g trie nghiem mdi lpai v l do mdt ngUdi phdng van trude v l sau GDSK.
Sd lieu thu dugc nhap v l xU ly bang phan mem SPSS 15.0. So sinh cle trung blnh Wilcoxon Signed Ranks Test vdi mUc y nghTa p<0,05 vdi 2 dudi.
3. Ket qua va ban luan
Qua khao s i t 36 benh n h l n phong mdi va tan tat tai 8 tinh phfa Nam cho thay nam gidi chien 69,4%,
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol6-N°4/2011 hau het benh n h l n d tudi lao ddng chinh vdi tudi blnh mdi t h i n g 1,7± 0,9 trieu ddng Viet Nam. 63,9%) trung blnh 36,5 ± 11,5 tudi v l cd trinh dp van hda benh n h l n cd gia dinh hay sdng chung khdng hdn thap, 80,6% benh n h l n hpc tU cap II trd xudng nen n h l n , 27,8% ddc t h i n , 5,6% ly hdn v l 2,8% gda va hau het la lao ddng chin tay (72,2%) hay that 61,1% sdng d ndng thdn v l d i n tdc Kinh ehiem nghiep (22,2%) v l thu nhap thap, thu nhap trung 91,7%.
Bang 1 . Tinh hinh benh tat, gidi han ve elc hoat ddng h i n g n g l y
v l han che tham gia cdng ddng cua benh n h l n phong t i n tat trUdc v l sau GDSK Tinh trang
The benh: PB MB
0 6 tan tat TCYTTG O d i Op 2 Tdng diem EHF 1 diem
2 diem 3 - 4 diem
> 5 diem Tan tat Nguyen phat
ThU phat
Phan Ung phong : Khdng phan Ung Phan Ung dao nghjeh Hdng ban nut
Viem than kinh
Gidi han hoat ddng hang ngay: Khdng cd (10-24 diem) Nhe (25-39 diem) VUa phai (40-49 diem) Han che tham gia edng ddng: Khdng cd (0-12 diem)
Nhe (13-22 diem) VUa phai (23-32 diem)
Nghiem trpng (33-52 diem) Cue ky nghiem trpng > 53 diem
Trudc GDSK n
4 32 14 22 9 13
9 5 24 12 28 5 1 2 18 17 1 12
7 6 7 4
% 11,1 88,9 39,9 61,1 25 36.1
25 13,9 66,7 33,3 77,8 13,9 2,8 5,6 50 47,2
2,8 33,3 19,4 16,7 19,4 11,1
Sau GDSK n
4 32 15 21 9 13
8 6 23
13 28 5 1 2 24 11 1 22
7 5 1 1
% 11,1 88,9 41,7 58,3 25 36,1 22,2 16,7 63,9 36,1 77,8 13,9 2,8 5,6 66,7 30,6 2,8 61,1 19,4 13,9 2,8 2,8
Blng 1 cho thl'y, 88,9% benh n h l n the MB, 1/3 bi tan tat thU p h l t , 50% bj gidi han ve cle hoat ddng h i n g ngay va 66,7% bj han che tham gia v I o cpng ddng. Tan tat eua benh n h l n trude va sau GDSK rl't it thay ddi nhUng gidi han ve cle hoat dpng hang ngay g i l m nhieu, benh n h l n bj gidi han nhe ve elc hoat ddng hang ngay sau GDSK 30,6%
so vdi trudc GDSK 47,2% (khoing 16,7%/50% = 33,4% benh n h l n bj gidi han ve cle hoat ddng
h i n g n g l y het bj gidi han). Han che tham gia vao edng ddng eua benh n h l n phong tan tat g i l m d i n g ke, nhdm benh n h l n han che tham gia nghiem trpng tU 19,4% trUde GDSK g i l m xudng 2,8% sau GDSK v l tuang tU nhdm han che tham gia cue ky nghiem trpng ll,l%o xudng 2,8%). Khoing 27,8%/66,7% = 41,7% benh n h l n bj han che tham gia v I o cpng ddng het bj han che.
Diem trung blnh han che tham gia v I o cdng ddng sau GDSK eiJa benh n h l n phong t i n tat g i l m nhieu so vdi trUde GDSK (12,1 diem so vdi 23,8 diem), vdi p=0,000.
Phan Idn benh n h l n gidi han ve elc hoat ddng hang ngay d mUc dp nhe nen sU thay ddi khdng nhieu nhU trong han che tham gia vao edng ddng.
19,4% benh n h l n bj han che tham gia v I o edng ddng nghiem trpng g i l m xudng 2,8% sau GDSK v l tuong tu nhdm han che tham gia cue ky nghiem trong tU 11,1% xudng 2,8%. Mat khIc sau GDSK trung blnh diem SALSA v l P scale benh n h l n phong tan tat gilm 2 diem v l 11,7 diem so vdi trUde GDSK vdi p=0,002 v l p=0,000 theo thU tU (blng 2).
Bang 2. Hieu q u i GDSK ddi vdi gidi han ve cac hoat ddng hang ngly v l han che tham gia v I o
cdng ddng eua benh n h l n phong t i n tat Tinh trang
Gidi han ve cae hoat dpng hang ngay:
Trudc GDSK Sau GDSK Han che tham gia vao cong ddng:
Trudc GDSK Sau GDSK
n
36
36
Mean
25,3 ± 6,8 23,2 ± 6,1
23,8 ±18,6 12,1 ±12,8
P
0,002*
0,000*
* Wilcoxon Signed Ranks Test
Nhd GDSK ngUdi benh biet ve benh phong va tinh trang benh tat ma b i n t h i n hp p h l i ddi mat tU 66 hp bdt lo sp v l ed t h i i dp tich cue han trong viec cham sde va phdng trinh tan tat. Vdi cle bai tap dan giln cho mlt, tay va chin bj suy g i l m CNTK, ngUdi benh cd the tap bat cU luc n i o va bl't eU d l u nen hp de tuin thu. Benh nhln dugc hudng dan thay ddi mot sd thdi quen, each di lai/lam viec de tranh tan tat them hay cae tieu x l o de giup ban tay bi khuyet tatthuc hien cac hoat dpng neu hp chUa biet. Ngdai ra benh nhln dUgc gilo due d l u hieu p h l n Ung phong de p h l t hien va dieu trj kjp thdi nham han che suy g i l m CNTK. Theo nghien cufu Richard gan
2/3 benh n h l n MB t i n tat cd nguy co suy g i l m CNTK trong vdng hai n l m tU khi d i n g ky dieu trj [5] nen GDSK cung giup 88,9% benh n h l n MB t i n tat cua nghien cUu n i y han che tan tat them.
TU chIm sde v l tap luyen h i n g ngly giup ngudi benh it bj t i n tat them v l gidi han hoat ddng tU dd hp t u tin hon de hda nhap v I o x l hdi. Qua g i l o due ngudi benh thiet lap mdt kenh lien lac mdi tU dd hp dugc tham van, hudng dan de tiep can vdi cle djch vu san cd nhu elc trung t l m phau thuat chinh hinh tinh hay tuyen khu vUc, dao tao hudng nghiep, giup hp hda nhap vao cdng ddng de hon. De benh n h l n phong t i n tat hda nhap vIo x l hdi khdng ehi cd g i l o due eho benh nhln m l c l n g i l o due eho tdan x l hdi, d i e biet I I nhUng ngudi tan tat khdng p h l i do benh phong va nhUng ngudi cung cap elc djch vu phue hdi chUe ning v l kinh te sin cd trong cdng ddng. Cd nhU vay thi ngudi benh phong mdi cd ca hdi tiep can v l hudng Ipi tU cle djch vu niy.
Han che nghien cUu: Trie nghiem SALSA va do dp tham gia mdi dugc p h l t trien v l trien khai tren the gidi mdt v i i n l m nay, nen b i i b i o nghien cUu ve ITnh vUe n i y cdn it vl vay chung tdi chUa so sinh hieu q u i GDSK ddi vdi gidi han ve cle hoat ddng hang ngay va han che tham gia cdng ddng cua benh n h l n phong t i n tat trong nghien cUu niy vdi cle nghien eUu khIc. Nghien cUu nay chung tdi khdng chpn nhdm ehUng la nhdm khdng dugc gilo due vl nhu vay se pham y dUc vl khdng g i l o due eho benh nhan ed the I n h hUdng den ket q u i dieu trj.
4. Ket luan
Gilo due sUe khde da chUng td cd hieu q u i , d l eli thien tinh trang gidi han ve cle hoat ddng hang ngay va han che tham gia edng ddng eua benh nhln phong tan tat.
De benh n h l n phong tan tat hda nhap vao x l hpi khdng ehi ed giao due cho benh nhln m l can g i l o due cho toan x l hdi, d i e biet la nhUng ngUdi tan tat khdng p h l i do benh phong va ngUdi cung cap elc djch vu phuc hdi chufc nang va kinh te san CO trong cpng ddng.
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY V O I 6 - N ° 4 / 2 0 1 1
Tai lieu t h a m khao
1. Bp Y te - Vien Da Lieu Viet Nam (2000), Phdng chdng tan tat trong benh phong.
2. Brandsma, J. W, Van Brakel, W. H. (2003), "WHO disability grading: operational definitions", Lepr Rev 74, 366-373.
3. ILEP (2006), "How to Prevent Disability in Leprosy", Learning Guide Four.
4. Participation Scale Users Manual (2008), Version 5.2.
7.
Richard P Croft, Peter G Nieholls (2000), "A clinical prediction rule for nerve function impairment in leprosy patients". The Lancet, 355,1003-06.
SALSA Scale (Screening Activity Limitation and Safety Awareness) Users Manual (2010), Version 1.1.
The SALSA Collaborative Study Group (2007), 'The development of a shdrt questidnnaire for screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes" Disabil Rehabil 29(9) 689-700.
