NGHIEN CUtJ KHOA HOC
Gidl HAN
H O A T O O N G H A N G NGAYVA HAN CHATHAM GIA VAO
C O N G D 6 N G COA BENH N H A NPHONG
TAN TATLe Thj Thanh Triic *, TrSn Hau Khang**,
Nguyin Tat Thdng***, Nguyin Minh Chanh****
TOMTAT
Benh phong gay suy giam chctc nang than kinh va tan tat, nhUng anh hudng suy giam nay den cugc song benh nhan (BN) hien nay khong ro, nen nghien cCtu nay nham khao sat t'inh trgng gidi hgn ve cac hogt dqng hang ngay va hgn che tham gia vao cong dong cua BN phong tan tat tgi mot so tinh phia Nam. Day la nghien cCfu cat ngang mota tren 46 BN phong mdi, tCf 15-60 tuoi, bi tan tat, dang ki dieu tri tCf 1/1/2009 den 30/6/2010 tgi mot so tinh phia Nam. BN duac khdm, ddnh gia do tan tat theo TCYTTG va diem EI-iF (mot, tay va chan), lam trac nghiem SALSA (Sang loc suhgn cheve hogt dong vaythCtc ve sUan toan) va trac nghiem do do tham gia. Nghien cCtu cho thdynam gidichiem 71,7%, trong do 84,8% thel\/IB, 69,6% bi tan tat do 2 va 34,8% tan tat thufphat. 47,8% BN khong bi gidi hgn hogt dong, 45,7% bi gidi hgn nhe vecdc hogt dong hang ngay nhUng 13%bi hgn che tham gia vao cong dong vCfa phai, 17,4%i bi hgn che nghiem trong va 8,7%) bi hgn che tham gia cUc ki nghiem trgng. Gidi tinh, the benh, tinh trgng tan tat theo TCYTTG va EHF khac biet c6 y nghia vdi diem SALSA (thu'tLfp^0,04 l;p=0,015; p= 0,023 vap=0,001).
Tan tat thCtphdt anh hUdng den gidi hgn ve cac hogt dong hang ngay (p= 0,007) va hgn che tham gia vao cong dong (p- 0,024). Tom Igi, hgn che tham gia vao cong dong va gidi hgn ve cac hogt dong hang ngay cua BN phong tan tat chUa c6 moi lien he. Gidi tinh, the benh, tinh trgng tan tat anh hUdng den gidi hgn ve cac hogt dong hang ngay cua BN phong tan tat. Tan tat thCfphat cd anh hwdng den gidi hgn ve cac hogt dong hang ngay va hgn che tham gia vao cong dong.
Tii khoa: BN phong tan tat, trac nghiem SALSA (Sang Ipc sU han che ve hoat dong va y thiirc ve si/
an toan), trac nghiem do do tham gia.
* NCS khoa 27 chityen nganh Da Lieu- Truang DH YHa Not
** Bo mon Da Liiii - Tncdng DH YHa Noi
*** Bo mon Da Liiii - Tnr&ngDH Y-Duac TP.HCM
**** Benh Vien Da Liiii TP.HCM
S6 02(Thang11/2010) DA Ll6U HOC I
NGHIEN cull KHOA HOC
I. OAT VAN DE
Benh phong la benh nhiem trung do trac khuan M.Leprae gay nen. Ton thuong than kinh nguyen phat do viem nhiem hoac do phan Cfng dao nghich qua trung gian te bao dan den suy giam chufc nang than kinh va tan tat. Chi'nh SLT tan tat va bien dang nay lam cho ngUdi mac benh phong bi xa hoi xa lanh.
Theo so lieu thong ke cua Benh vien Da lieu Trung uong, nam 2009 c6 77,5% BN phong mdi the nhieu khuan (MB: Multibacillary) trong so d6 CO 40,9% bi tan tat. Ngoai ra, 74% BN dang quan If tai cac tinh phfa Nam can cham soc tan tat. Vi vay, phong chong tan tat dang la van de noi com trong chuong trinh quan If benh phong tai cac tinh phia Nam.
Phan loai quoc te ve chCfc nang, tan tat va sut khoe (International Classification of Functioning, Disability and Health - ICF) cua To chCrcYte the gidi (TCYTTG) dUa ra khai niem chCfcnang la bao gom tat ca chufc nang cua cothe, cac hoat dong va tham gia, con tan tat la tii bao trijm ca SLT suy giam chiJc nang, siigidi han ve hoat dong va han tham gia'^°l DUa tren co s6 nay trac nghiem SALSA (Screening of Activity Limitation & Safety Awareness: Sang loc su han che ve hoat dong va y thiTc ve sU an toan) da dtfcfc nghien cuU va cong bo nam 2007'^'. No la mot cong cu duoc chuan hoa dung de do ludng sii han che trong cac hoat dong va y thiJc ve sUan toan cua cac BN bi benh phong, tieu dudng va c6 nhQng van de ve than kinh ngoai bien khac d ca nUdc c6 thu nhap thap va nUdc dang phat trien. Ngoai ra, nhom nghien cufu con phat trien trac nghiem do dp tham gia (Participation Scale)'"' de do lUdng sU gidi han trong viec tham gia vao ddi song xa hoi (cac van de tarn If xa hoi va kinh te) cua cac nhom BN noi tren.
Trong benh phong, chung ta biet rat nhieu ve su suy giam CNTK nhUng hieu rat ft ve nhQng suy giam ay anh hudng nhu the nao den sinh hoat hang ngay cung nhU SLT hoa nhap vao xa hoi cua BN. Hien nay, tai cac tinh phia Nam chua c6 de tai nghien cufu ve ITnh vUc nay trong benh phong, do do chung toi tien hanh nghien cu'u nay vdi muc tieu: Khao sat tmh trgng gidi ban ve cac hogt dong hang ngay va hgn che tham gia vao cong dong cua BN phong tan tat tgi mot so tinh phia Nam.
II. DOI TlTCfNG VA PHl/GfNG PHAP NGHIEN CCTU 1. Do! tUtfng nghien cuTu
Tat ca BN phong mdi tCr 15-60 tuoi, bi tan tat, dang kf dieu trj t(i 1/1/2009 den 30/6/2010 tai thanh pho Ho Chf Minh (TP.HCM) va cac tinh Dong Nai, Tay Ninh, Ninh Thuan, Binh Thuan, Tien Giang, Long An va Kien Giang. Chan doan, phan loai nhom benh, do tan tat theo tieu chuan cua TCYTTG. Loai ra khoi nghien cuTu nhQng BN bi benh tam than va nhQng BN khong hieu hoac khong noi dQOc tieng Viet.
2. PhUtfng phap nghien cufu La nghien cQu mo ta cat ngang.
BN tham gia vao nghien cQu dQOc kham, lam trac nghiem ccr va thQ cam giac (Voluntary muscle test/ Sensitivity test = VMT/ST), ghi nhan nhQng thong tin chung nhU: tuoi, gidi, nOi sinh song, dan tpc, tinh trang hon nhan, trinh dp hoc van, nghe nghiep, thu nhap.
Tong diem EHF (eyes, hands and feet = mat, tay va chan) la dQ lieu ve sQ suy giam chQc nang ben canh thang diem toi da danh gia dp suy giam chQc nang cua TCYTTG. Vdi thang diem toi da danh gia
I DA LIEU HOC S6 02 (Thang 11 / 2010)
NGHIEN CLTU KHOA HOC
dp tan tat cua TCYTTG, lay diem tan tat cao nhat 6 bat ki phan nao cua ca the (0,1 hoac 2) de tinh diem cho ngudi do. 6 he thong phan dp tan tat EHF, lay diem toi da cho moi phan trong 6 phan co the (mat, tay va chan) sau do cong 6 gia trj do lai, ta di/oc tong diem EHF^i, do do diem EHF tQ 0-12.
BN dQdc phong van theo:
* Bang trac nghiem SALSA de do iQdng ve cac gidi han hoat dong hang ngay cua moi ca nhan d tinh diem SALSA cua BN va
* Bang trac nghiem do dp tham gia de do iQdng sQ bj han che trong viec tham gia vao ddi song xa hoi cua moi ca nhan d tinh diem dp tham gia cua BN.
Trac nghiem SALSA: gom 20 cau hoi va diem cho moi cau tQ 0-4 diem '*-^'
0 = khong can phai lam viec do
1 = de dang khi thQc hien hoat dong nay 2 = hoi khd khi thQc hien hoat dong nay 3 = rat khd khi thQc hien hoat dong nay 4 = khong the lam dQpc hoat dong nay hoac tranh bdi vi sP nguy ccJ
Trac nghiem do dp tham gia: gom 18 cau hoi, diem moi cau tQO-5 diem'"'.
0 = khong cd khd khan gi ca, hoac 0 = khong thfch hap
1 = khong thanh van de: cd sQ gidi han trong tham gia, nhQng khong phai la van de doi vdi ngQdi dQpc phong van ca tren phQpng dien thQc tien hay cam xuc
2 - van de nho: cd sQ gidi han trong tham gia nhQng chi la mot van de nhd bdi vi khong thQdng xuyen xay ra hoac khong phai la mot khd khan Idn
3 = van de viia phai: cd gidi han trong tham gia va cd anh hQdng den cupc song cua ngQdi dQOc phong van
5 - van deldn: cd gidi han trong tham gia va cd the dan den mot sQ thay doi Idn trong cupc song cua ngQdi dQpc phong van
3. Dao dufc trong nghien cuTu
BN tQ nguyen va kf nhan vao giay tham gia nghien cQu. Thong tin ca nhan dQpc bao mat va ten BN dQdc ma hda. BN dQOc chi tra tien xe khi di lai tham gia nghien cQu, dQpc tham van, hQdng dan va dieu trj mien phi.
III. KET QUA
Qua khao sat 46 BN phong mdi, tQ 15 - 60 tuoi, bj tan tat, dang ki dieu trj tQ 1 / I /2009 den 30/6/2010 tai mot so tinh phia Nam cd ket qua sau:
Bang 1. Mot so dgc diem cua BN nghien citu
Gidi: NQ Nam Tuoi trung binh
NPi sinh song: Thanh thi Ndngthdn Dan tdc: Kinh
Trinh dp hpcvan:
MuchQ
Biet chQ-cap 1 Cap II
Cap III Dai hoc Nghe nghiep:
That nghiep Lao dong chan tay Tri thQc
Tinh trang hon nhan:
Doc than
Cd gia dinh/song chung Ly hdn/lythan
Gda
Thu nhap trung binh (x 1000 dong)*
N 13 33
% 28,3 71,7 37,5 ±11,6 18 . 28 41 1 27 10 6 2 11 33 2 12 30 2 2
39,1 60,9 89,1 2,2 58,7 21,7 13 4,3 23,9 71,7 4,3 26,1 65,2 4,3 4,3 1718,2 ±888,2 ''n = 33, ngUdi cd cong viec
So 02 (Thang 11 / 2010) DA L I § U HOC
N G H I I N cufu KHOA HOC
r
Nghien cQu cho thay nam gidi chiem hon 2/3 va hon 60% BN song d vung ndng thdn. Da so BN co hoc van thap, 82,6% hpc tQ cap II trd xuong va hau het la lao dong chan tay hay that nghiep (95,7%).
Bang 2. Tmh hinh benh tat, tinh trgng gidi hgn ve cac hogt dong hang ngay va hgn che tham gia vao cong dong cua BN phong tan tat
Tinh trang The benh: PB
MB
Dp tan tat theo TCYTTG: Dp 1 Dp 2
Tong diem EHF (mat, tay va chan): 1 diem 2 diem 3 - 4 diem
> 5 diem Tan tat Nguyen phat
ThQ phat
Phan Qng phong luctham gia nghien cQu:
Khong phan Qng Phan Qng dao nghjch Hong ban nut Viem than kinh
Gidi han ve cac hoat dong hang ngay (Trac nghiem SALSA):
Khong cd (10-24 diem) Nhe (25-39 diem) VQa phai (40-49 diem) Nghiem trong (50-59 diem)
Han che tham gia vao cong dong (Trac nghiem tham gia):
Khong cd (0-12 diem) Nhe (13-22 diem) VQa phai (23-32 diem) Nghiem trpng (33-52 diem) CQC ki nghiem trpng (> 53 diem)
n 7 39 14 32 9 18 12 7 30 16
35 5 2 4
22 21 2 1
17 11 6 8 4
% 15,2 84,8 30,4 69,6 19,6 39,1 26,1 15,2 65,2 34,8
76,1 10,9 4,3 8,7
47,8 45,7 4,3 2,2
37 23,9
13 17,4
8,7 Khong cd sQ khac nhau cd y nghla glQa han che tham gia vao cong dong vdi cac mQc gidi han ve hoat dong hang ngay cua BN phong tan tat (p=0,495). Ngoai ra, nghien cQu cho thay noi song, tuoi, dan tpc, trinh dp hpc van, tinh trang hon nhan, thu nhap va phan Qng phong cung khong cd moi lien he vdi gidi han ve cac hoat dong hang ngay va han che tham gia vao cong dong cua BN phong tan tat (p> 0,05).
8 I DA LIEU HOC s6
02 (Thang 11 /2010)4-4-4
NGHIEN CirU KHOA HOCBang 3. Moi lien hi giOTa tinh trgng gidi hgn ve cac hogt dong hang ngay va hgn che tham gia vao cong dong vdimptsoyeu to tren BN phong tan tgt
Yeuto
Gidi: NQ Nam The benh: PB MB Tan tat WHO: D p i
Dp 2 EHF: 1 diem
2 diem 3-4 diem
> 5 diem Tan tat thQ phat: Khong
CO
n
13 33 7 39 14 32 9 18 12 7 30 16
SALSA Mean 22,4 ± 4,4 27,7 + 9,3 20,4 ±2,7 27,3 ± 8,8 22,4 ± 4,4 27,9 ± 9,3 21.8 ±4,8 22,7 ± 4,4 30,4 ±8,1 33.9 ±12,9
24,3 ± 7,3 29,8 ± 9,7
P 0,041*
0,015*
0,023*
0.00 T
0,007*
Op tham gia Mean
26,6 ±19,7 20 ±17,1
12 ±9,8 23,7 ±18,5
19±16,1 23,2 ±18,7 16,8 ±14,9 16,5 ±14,2 33 ± 20,7 23,3 ±19,3 17,5 ±15,6 30,1 ±19,4
P 0,25*
0,14*
0,54*
0,13^
0,024*
*; Mann-Whitney Test; £: Kruskal-Wallis Test IV. BAN LUAN
Qua khao sat 46 BN phong mdi, tQ 15 - 60 tuoi, bj tan tat, dang ki dieu tri tQ 1/1/2009 den 30/6/2010 tai mot so tinh phfa Nam, cho thay 71,7% la nam, da so cd hpc van thap, 82,6% BN hpc tQcap II trd xudng nen hau het la lao dong chan tay hay that nghiep (95,7%) vi vay ma thu nhap thap {bang 1). Mat khac 84,8% BN the nhieu khuan (MB), hon 2/3 BN bi tan tat dp 2 va 1/3 BN cd tan tat thQ phat. 47,8% BN phong tan tat khong bj gidi han va 45,7% bj gidi han nhe ve cac hoat dong hang ngay nhQng 13%
BN bj han che tham gia vao cong dong vQa phai, 17,4% bj han che nghiem trpng va 8,7%
bi han che tham gia cQc ki nghiem trpng. Dieu
nay cho thay khong phai BN phong tan tat it bj gidi han ve cac hoat dong hang ngay se ft bj han che tham gia vao cong dong [bang 2). Ngoai ra, nghien cQu cho thay chQa khac nhau cd y nghla giQa han che tham gia vao cong dong vdi cac mQc gidi han ve hoat dong hang ngay cua BN phong tan tat (p=0,495).
Nghien cQu cua Singh, S. va cong sQ tai An Dp cho thay 54,3% BN khong bj han che tham gia vao cong dong va chi 3,7% bj han che tham gia cQc ki nghiem trpng'^. Ket qua nay khac vdi nghien cQu cua chung toi do chung toi chi danh gia tren BN tan tat nen tl le khong bj han che thap hon (37%) va bj han che tham gia vao cong dong cQc ki nghiem trpng cao hon (8,7%). Mac khac.
So 02 (Thang 11/2010) DA Ll£U HOC I
NGHIEN CUtJ KHOA HOC
nghien cQu cua Singh, S. cho thay cd sQ khac nhau cd y nghia giQa tinh trang tan tat va dp han che tham gia, dieu nay If giai phan nao vi sao ti le han che tham gia vao cong dong cQc ki nghiem trpng trong nghien cQu cua chung toi cao hon.
Gidi tinh va dp tan tat chQa thay cd moi lien he (p>0,05), nhQng gidi tinh cd anh hQdng den gidi han ve cac hoat dong hang ngay cua BN phong tan tat.Trung binh diem SALSA cua nam (27,7 diem) cao hon nQ (22,4 diem) vdi p= 0,041 (bang 3). Diem SALSA cang cao cho thay cang tang gidi han ve cac hoat dong hang ngay. The benh, tinh trang tan tat theo TCYTTG va theo EHF khac biet cd y nghla vdi diem gidi han ve cac hoat dong hang ngay cua BN phong tan tat (theo thQtQ p= 0,015; p= 0,023 va p= 0,001), the benh hay tinh trang tan tat cang nang thi diem gidi han ve cac hoat dong hang ngay se cao hon. Dieu nay phu hop vi cac hoat dong hang ngay cua BN dQpc danh gia tren cac ITnh vQc thj giac, van dong cua tay, chan, tQ cham sdc ban than va sQ kheo leo™. Phat hien va dieu tri sdm benh phong lam giam tinh trang tan tat cho BN dan den giam di gidi han ve cac hoat dong hang ngay cho nen can phai giao due ve benh phong cho cong dong de giup phat hien benh sdm.Theo nghien cQu cua Le'^' chan doan cham
>12thang thi tan tat trong BN mdi 45,9% so vdi 20,4% d nhom cham <6 thang. Mat khac, the benh, dp tan tat theo TCYTTG hay tong diem EHF chQa thay khac biet cd y nghia vdi han che tham gia vao cong dong cua nhQng BN nay.
Tan tat thQ phat anh hQdng den gidi han ve cac hoat dong hang ngay (p= 0,007) va han che tham gia vao cong dong (p= 0,024) cua BN phong tan tat [bang 3). Trung binh diem SALSA
va diem do dp tham gia cua nhdm bj tan tat thQ phat ludn cao hon nhdm khong bj.Tan tat thQ phat do BN bi chan doan va dieu tri tre hay do tQ cham sdc va phong ngQa tan tat cua BN chQa thQc hien tot vdi nhieu li do khac nhau, cd the tQ nganh y te, tQ BN hay ca hai'^'. Do do can phai giao due cho BN each tQ cham sdc va phong ngQa tan tat de tranh tan tat them.
Han che nghien cQu: Trac nghiem SALSA va do dp tham gia mdi dQpc phat trien va trien khai tren the gidi mot vai nam nay, nen bai bao nghien cQu ve ITnh vQc nay con it vi vay chung toi mdi so sanh vdi nghien cQu cua tac gia Singh, S. Mat khac, mau nghien cQu cua chung toi nho, khong phan phoi chuan nen chung toi dung test phi tham so de kiem chQng sQ khac biet. De han che sal so trong do iQdng, phong van vien dQpc tap huan va phong van thQ toi thieu 7 bang trac nghiem moi loai va do mot ngQdi phong van.
V. KET LUAN
1 .Tan tat thQ phat cd anh hQdng den gidi han ve cac hoat dong hang ngay va han che tham gia vao cong dong cua BN phong tan tat.
2. Gidi tinh, the benh, tinh trang tan tat anh hQdng den gidi han ve cac hoat dong hang ngay cua BN phong tan tat.
3. Khong cd moi lien quan giQa han che tham gia vao cong dong va gidi han ve cac hoat dong hang ngay cua BN phong tan tat.
Giao due ve benh phong cho cong dong nham phat hien va dieu trj sdm se giam tinh trang tan tat va se giam di gidi han ve cac hoat dong hang ngay. Rieng BN phong bj tan tat can giao due ho each tQ cham sdc va phong ngQa tan tat de tranh tan tat them.
1 0 I DA L l i U HOC So 02 (Thang 11/2010)
NGHIEN cCrU KHOA HOC
TAI LIEU T H A M KHAO
1. Bao cao tong ket hogt dong cua Benh vien Da lieu nam 2007vaphuang hudng hogt dong nam 2008.
2. Brandsma, J. W, Van Brake!, W. H. WHO disability grading: operational definitions. Leprosy review, 2003; 74:366-373.
3. Le.T.T.Truc, Vu.H.Thdi va cs: Cham tre trong chan doan benh phong tgi cac tinh phfa Nam, 2005. Yhocthgchanh2008;S65tr 143-145.
4. Participation Scale Users ManuaL 9 July 2008; Version 5.2.
5. Phong chong tan tat trong benh phong. Bo Y te- Vien Da Lieu Viet Nam, 2000.
6. SALSA Scale (Screening Activity Limitation and Safety Awareness) Users Manual, 21st July 2010; Version 1.1.
7. Singh, S, Sinha, A. K, Banerjee, B. G, Jaswal, N.
Participation level of the leprosy patients in society.
Indian journal of leprosy 2009; 81 (4): 181-7.
8. The SALSA Collaborative Study Group. SALSA Beta Testing backage. May 2004; Version 1.0.
9. The SALSA Collaborative Study Group. The developmentofashortguestionnairefor screening of activity limitation and safety awareness (SALSA) in clients affected by leprosy or diabetes. Disability and rehabilitation 2007; 29(9):689-700.
10. To wards a common language for Functioning, Disability and Health ICF World Health Organization 2002.
SUMMARY
ACTIVITY LIMITATION AND PARTICIPATION RESTRICTIONS OF LEPROSY PATIENTS WITH DEFORMITY
Leprosy causes nerve function impairment (NFI) and deformity. However, it it is not clear to know how these impacts of nerve function impairment have affected patient lives. The objective of this study was to survey activity limitation and participation restrictions of leprosy patients with deformity at 8 provinces in the Southern of Vietnam. This cross-sectional study involved 46 new leprosy patients registered for MDT from 1/1/2009 to 30/6/2010, aged between 16 and 60, had deformity. They were examined clinically, and mesured deformity according to the WHO grading and EHF score, interviewed SALSA scale and Participation scale. The results of the study consisted of 71.7%) male, 84.8%) MB, 69.6%) disability grade II and 34.8%) secondary disability. 47.8%) patients have no significant limitation, 45.7%) mild activity limitation, but only 13%) of the patients had moderate participation restriction, 17.4% severe restriction and 8.7%) extreme retriction. Sex, type disease, disability status followed WHO disability grading and EHF score of patients reflected significant differences with the mark of SALSA score, (p-0.041; p= 0.015; p=
0.023 vd p= 0.001, respectively). Secondary disability showed significant differences with the mark of SALSA scale (p=0.007) and the mark of Participation score (p= 0.024). In sum, there was no relationship between activity limitation and participation restriction in disability leprosy patients. Sex, type disease, disability status affected the activity limitation of disability leprosy patients. Secondary disability affected both the activity limitation and participation restriction.
Key words: Leprosy patients with deformity, interviewed SALSA scale and participaties scale
So 02 (Thang 11/2010) D A L l E U H O C I 1 1
