Effects Of Different Methords On Psychosocial State,Quality Of Life And Curative Effect In Hospitalized Patients With Hepatic Cirrhosis

Objectives To investigate the quality of life (QOL) and its influencing factors in hospitalized patients with hepatic cirrhosis; to explore the effects of different methods to the socio-psychological factors such as the anxiety and depression, self-efficacy and coping style; to compare the effects of different methods to the quality of life and the curative effect in hospitalized patients with hepatic cirrhosis.Methods This study was a Clinical randomized controlled trial. Form July to December in 2010,144 patients with hepatic cirrhosis who were hospitalized in digestive system department of Xiang-Ya hospital, the Second and the Third Xiang-Ya hospital of Central South University were selected to be samples. Then the samples were assorted randomly into four groups:a control group, a Cognitive Behavior Therapy (CBT) group, a Progressive Muscle Relaxation Training (PMRT) group and a synthetical group, every group had 36 patients. Subjects in the control group were given routine cure and care only, but Subjects in the intervention groups were given relevant psychological intervening measures based on the control group. While in hospital CBT group was given cognitive behavior therapy, PMRT group was given progressive muscle relaxation training, and synthetical group was given cognitive behavior therapy and regressive muscle relaxation training meanwhile. The outcome of general information, anxiety, depression, quality of life, self-efficacy, performance state and coping style were evaluated before and after the intervention by patients, self applying Sociodemographic Data Recording Form(SDDRF), Hospital Anxiety and Depression Scale(HAD). Chronic Liver Disease Questionnaire (CLDQ), Karnofsky Performance Status (KPS), General Self-Efficacy Scale (GSES) and Medical Coping Modes Questionnaire(MCMQ). In the meantime Child-Pugh score was evaluated before and after the intervention by patients, doctors to estimate the state of hepatic illness. Then the effects of different methods given to different groups were compared.Results 1. The baseline results showed that the incidence rate of anxiety and depression in hospitalized patients with hepatic cirrhosis was 69.4% and 79.2%.The average scores of Confrontation, Avoidance and Resignation of MCMQ were 19.22±3.28,17.64±1.57,12.26±2.37, comparing clinical norm the difference of Confrontation scores was not significant(p>0.05),but the differences of Avoidance and Resignation scores were significant(p<0.01)and the scores were higher.2. The average total score of QOL were 15.84±4.06, in QOL the scores of Fatigue and systemic symptoms were lower relatively, the scores of Abdominal Symptoms and Activity were higher relatively and the scores of Emotional Function and Worry were medial. After Multiple Linear Regression KPS, the period of hepatic illness, self-efficacy, Resignation, the state of social support, the total score of anxiety and depression, the score of Child-Pugh entered into regression equation as the independent influencing factors. The best fitting equation was: Y=19.565+0.386X6+1.291X7-0.532X13-2.257X15+1.118X19-0.053X18-3.351 X20(F=18.707,P=0.000), R2=0.526。3. Repeated measures analysis of covariance to total score of QOL among the four groups showed that the main effects of intervention and time were both significant (P<0.001); meanwhile there were significant interactions (P<0.001) between time and intervention. Then mult-sample s analysis of covariance in paired-date and LSD-t test showed that the differences among the four groups were significant as a while(F=29.814,P<0.001)and though multiple comparison the differences between the control group and any intervention group(P<0.001), between the CBT group and the PMRT group(P<0.01), between the PMRT group and the synthetical group(P<0.05)were all significant, but there was not the difference between the PMRT group and the synthetical group(P>0.05).4. Comparing the dimensionalities of QOL between pre and post interventions in every group, Paired T test showed that except Fatigue of the CBT group and Emotional Function of PMRT group the differences of all dimensionalities in all intervention groups were significant(P<0.05), and the scores post intervention were higher than pre. in other words, after intervention most of QOL dimensionalities were improved; but in control group the differences only in the dimensionalities of Abdominal Symptoms, Systemic Symptoms and Activity were significant(P<0.05).Completely random mult-samples analysis of covariance showed that pre intervention the differences of all QOL dimensionalities in every group were not significant (P>0.05), but post intervention except Abdominal Symptoms, Systemic Symptoms and Activity the differences in other dimensionalities of QOL were significant(P<0.05).5. Repeated measures analysis of covariance to the scores of anxiety and depression among the four groups showed that the main effects of intervention and time were both significant (P<0.001); meanwhile there were significant interactions(P<0.001)between time and intervention.Among the slopes of the lines in the interaction diagram about anxiety, the ones of the synthetical group and the PMRT group were maximum, the one of the CBT group was medium, the one of the control group was minimum. But among the slopes of the lines in the interaction diagram about depression, the ones of the synthetical group and the CBT group were maximum, the one of the PMRT group was medium, the one of the control group was minimum.6. Comparing the scores of self-efficacy between pre and post interventions in every group, Paired T test showed that the differences of the synthetical group and the CBT group were significant(P<0.05), and the scores post intervention increased; but the differences of the PMRT group and the control group were not significant(P>0.05).Completely random mult-samples analysis of covariance showed that pre intervention the differences of self-efficacy among four groups were not significant(P>0.05), but post intervention the differences among four groups were significant(P<0.05).7. Comparing the scores of the three kinds of copying style between pre and post interventions in every group, Paired T test showed that about the synthetical group the score of Confrontation post intervention increased, the scores of Avoidance and Resignation post intervention decreased, and the differences were all significant(P<0.05); about the CBT group the score of Confrontation post intervention increased, the scores of Resignation post intervention decreased, and the differences were both significant(P<0.05),but the difference of Avoidance was not significant(P>0.05); about the PMRT group and the control group the differences of all copying style between pre and post interventions were not significant(P>0.05).Completely random mult-samples analysis of covariance showed that pre interventions the differences of Confrontation, Avoidance and Resignation among four groups were not significant (P>0.05), but post intervention the differences of Confrontation, Avoidance and Resignation among four groups were significant (P<0.05).8. Comparing the scores of Child-Pugh between pre and post interventions in every group,Paired-sample Wilconox sign-rank test showed that the difference in every group was significant(P<0.05). But Kruskal-Wallis H test showed that pre interventions the differences of the scores of Child-Pugh among four groups were not significant(P>0.05), post intervention the differences of the scores of Child-Pugh among four groups were not significant still(P<0.05).Conclusions 1. The anxiety and depression of hospitalized patients with hepatic cirrhosis were outstanding. About copying style, applying Avoidance and Resignation were higher than the general lever of hospitalized patients.2. The general QOL of hospitalized patients with hepatic cirrhosis related to KPS, the period of hepatic illness, self-efficacy, Resignation, the state of social support, the total score of anxiety and depression and the score of Child-Pugh.3. The three methods could all improve the general QOL of hospitalized patients with hepatic cirrhosis; the effects of the synthetical group and the CBT group were better than the PMRT group. Concerning the dimensionalities of QOL, most of all could be improved by the three methods. Cognitive Behavior Therapy was mainly useful to Emotional Function and Anxiety; Progressive Muscle Relaxation Training was mainly useful to Fatigue and Anxiety; the synthetical method of the two interventions had universal effects to all dimensionalities, but the effects was not outstanding than single intervention.4. The three methods could all decrease the anxiety and depression of hospitalized patients with hepatic cirrhosis.5. The synthetical method and CBT could improve self-efficacy of hospitalized patients with hepatic cirrhosis, increase positive copying style and decrease negative copying style.6. The effects to cure of the three methods were not obvious.