بررسي ارتباط بين نوع فعاليت بدني با كيفيت زندگي و افسردگي در افراد دچار آسيب نخاعي

Relationship between type of physical activity, quality of life and depression in individuals with spinal cord injury

هدف يكي از عوارض جانبي بسيار رايج آسيب نخاعي، كاهش عملكرد جسمي است كه موجب افسردگي و كاهش كيفيت زندگي در اين افراد مي گردد. با اينكه ارتباط ارتقاي فعاليت بدني در جمعيت عادي و افراد دچار آسيب نخاعي با بهبود كيفيت زندگي و كاهش افسردگي ديده شده است، لازم است بدانيم كه چه نوع از فعاليت بدني مي تواند بر افزايش كيفيت زندگي و كاهش افسردگي موثر باشد. هدف از مطالعه حاضر بررسي ارتباط بين نوع فعاليت بدني با كيفيت زندگي و افسردگي در افراد دچار آسيب نخاعي بود. روش بررسي مطالعه حاضر مطالعه اي توصيفي تحليلي به شيوه مقطعي بود. تعداد 60 نفر با آسيب نخاعي از افراد مراجعه كننده به انجمن ضايعه نخاعي تهران در اين پژوهش شركت كردند. ابزارهاي پژوهش شامل پرسشنامه بين المللي فعاليت بدني (2011)، پرسشنامه كيفيت زندگي (SF-12 (2009، تست افسردگي بك (2002) و پرسشنامه اطلاعات فردي بود. براي تجزيه وتحليل اطلاعات از نرم افزار SPSS استفاده شد و يافته ها در دو بخش توصيفي و استنباطي ارائه گرديد؛ در بخش استنباطي به منظور بررسي روابط بين ميان فعاليت بدني با كيفيت زندگي و افسردگي از ضريب همبستگي پيرسون و رگرسيون خطي چندمتغيره استفاده شد. در تمامي آزمون ها سطح معناداري برابر با 0٫05 در نظر گرفته شد. يافته ها فعاليت بدني مرتبط با كار (0٫045=p و 0٫250=r) فعاليت بدني مرتبط با تردد (0٫048=p و 0٫249=r) و فعاليت بدني مرتبط با تفريح (0٫049=p و 0٫249=r) با كيفيت زندگي جسمي رابطه مستقيم و معناداري داشتند. همچنين رابطه فعاليت بدني كل و انواع فعاليت بدني با كيفيت زندگي رواني معنادار نبود. همچنين بين فعاليت بدني مرتبط با تردد (0٫020=p و 0٫229-=r) و فعاليت بدني مرتبط با تفريح (0٫010=p و 0٫327-=r) و افسردگي رابطه اي معنادار و معكوس ديده شد. نتيجه گيري در مطالعه حاضر فعاليت بدني مرتبط با تفريح، متغيري بودكه بيشترين اثر را هم بر افزايش كيفيت زندگي و هم كاهش افسردگي در افراد دچار آسيب نخاعي داشت. جهت ارتقاي مشاركت اين افراد در فعاليت هاي بدني مرتبط با تفريح نياز است كه حمايت هاي اجتماعي و تطابقات محيطي براي افراد دچار آسيب نخاعي فراهم گردد.

Background & Objective: Spinal cord injuries usually lead to motor impairment and loss of function below the level of the lesion. Rehabilitation interventions improve the quality of life of people with spinal cord injuries using therapeutic techniques and appropriate equipment. There are several medical and psychological consequences for people following a spine injury. One of the familiar repercussions is decreasing physical function, which causes depression and reduces the quality of life of them. Though increasing physical activity after spinal cord injury leads to improving service, level of physical activity in individuals with spinal cord injury is still lower than the normal population. Although there is a positive correlation between physical activity, quality of life, and reduce depression in both healthy population and people with spinal cord injury, there is no clear what type of physical activity can effect on the quality of life and reduce depression of people with spinal cord injury. This study is aimed to find any correlation between the type of physical activity, quality of life, and depression in people with spinal cord injury. Methods: This study was a cross-sectional descriptive study. Sixty people with spinal cord injury participated in this study. Participants recruited from members of the Tehran Spinal Cord Injury Association. Inclusion criteria included: age above 18, presence of spinal cord injury diagnosed by a physician, discharge from hospital and living in the home; spinal cord injury should have occurred at least six months ago completion of the consent form. People depended upon respiratory devices, with progressing infection, with autonomic reflux and/or a condition affecting their movement (e.g. MS, stroke, Rheumatoid Arthritis) excluded from the study. Demographic information (including gender, age, education, and employment) and injury information (including injury level, injury intensity, time passed since trauma) gathered through a questionnaire. The all Persian version of International Physical Activity Questionnaire, 12-Item Short Form Survey and the Beck Depression Inventory were employed to measure physical activity, quality of life, and depression of people with spinal cord injury respectively. All Persian versions of the International Physical Activity Questionnaire, 12-Item Short Form Survey, and Beck Depression Inventory validated in the Iranian community. Also, the correlation between physical activity, quality of life, and depression evaluated using the Pearson correlation and multiple regression. Results: A sample of 60 individuals with average age 38.21 used in the present study, and the meantime passed since the spinal cord injury was 12.41 years. Among them, 31 ones were single, and 29 ones were married. 28.3٪ of sample subjects employed. For the spinal cord injury, it was at the lumbar level in 43.3٪ of the sample, at a thoracic level in 33.3٪, at a cervical level in 18.3٪ and sacral level in 5 percent Mean of physical activity for all participants was 2417.82 Met-min/week (SD=±2060). Most physical activities were associated with household and gardening activities (1665.42 Met-min/week). It respectively followed by a physical activity related to the occupation (1665.42 Met-min/week) and leisure time (316.71 Met-min/week). Minimum physical activity was related to transportation (39. 88 Met-min/week). Considering variance and mean of depression scores (20.93), participants in this study showed some degrees of depression. Mean physical quality of life was 30.26 and mean the mental condition of life was 41.68. Results also showed that the mean score of mental QoL for the sample was higher than that for the physical one. The physical quality of life showed a significantly positive correlation with the work-related (r=0.250), transport-related (r=0.249), leisure-related (r=0.238), and physical activity (p<0.05). However, total physical activity (r=0.006) and type of physical activity were not significantly associated with mental QoL. Transport-related physical activity (r=-0.229) and leisure-related physical activity (r=-0.326) were significantly and negatively associated with depression. Conclusion: In the present study, physical activity related to leisure time had the most impact on the improvement of quality of life and also on decreased depression in individuals with spinal cord injury. This finding may reflect the significant role of the rehabilitation team, particularly occupational therapists, in the improvement of the level of leisure time activities in individuals with spinal cord injuries. Social and financial supports could improve leisure-related physical activity in people with spinal cord injury. Leasre-related physical activity is necessary to enhance the quality of life and depression among people with spinal cord injury.