Status And Correlates Of Body-Image And Quality Of Life Among Patients After Permanent Cystostomy

Backgrounds:Recently years,with the development of aging,the incidence of related diseases(such as prostatitis,urethral neoplasms,etc.)has been increasing.The number of patients who choose cystostomy also increases.It not only greatly damages the patient's health,but also brings a heavy economic burden to our society.Once undergo cystostomy,patients also have several specific problems related to the surgery,such as urine leakage,body image dissatisfaction and low quality of life.The disease itself and its complications usually lead to negative influences on patients'physical and psychological well-being.In this sense,it is necessary to identy the Status and Correlates of Body-image and Quality of Life among Patients after Permanent Cystostomy.Objectives:To evaluate psychometric properties of the Self-rating Body Image Questionnaire(SBIQ-PC)which made by our group earlier,in order to provide a new and scientific instrument to explore the body image of patients after permanent cystostomy in China,ultimately to improve their quality of life,and to promote their physical and mental health.To describe the Status and Correlates of Body-image and Quality of Life among Patients after Permanent Cystostomy,identify the correlates of body image and quality of life and explore the relationship of body image and quality of life.Methods:The study is divided into two stages.The first stage was to evaluate the psychometric properties of SBIQ-PC.In this stage,250 inpatients with BC were recruited and investigated.The SBIQ-PC was used to collect data and these data analyzed to assess psychometric properties of the SBIQ-PC,including feasibility,reliability and validity.Content validity,construct validity,internal consistency,spilt-half reliability and discriminative power were calculated by SPSS software(version 23.0).The second stage was to describe and analyze the results of the cross-sectional study.It aims to identify the status of body image and quality of life in patients with permanent cystostomy,analyze the influencing factors of body image and quality of life,and explore the correlation between body image and quality of life in patients with permanent bladder fistulas.The scores of body image and quality of life were described in the form ofX±SDand values of different dimensions of SF-36 Scale were compared with that of a control sample using t-test.Multiple linear regression(Stepwise)was used to analyse the correlates of body image and quality of life.Spearman correlation analysis was used to explore the relationship between body image and quality of life.Results:1.Psychometric properties of SBIQ-PC:(1)250 BC patients were recruited and administered with the SBIQ-BC.237participants completed the questionnaire among whom 230 provided valid responses.All the investigations were completed within 30 minutes.(2)The validity of the SBIQ-PC.There were statistically significant correlation between the total score of SBIQ-PC and the scores of each of the 6 domains,with the Spearman correlation coefficients ranged from 0.616 to 0.897.Item within each domain was positively correlative(P<0.05),and had no or poor correlation with items in other domains(P>0.05 or r<0.4 P<0.05).The correlation coefficients in each domain ranged from0.470 to 0.695,0.413 to 0.696,0.453 to 0.659,0.716 to 0.762,0.668 to 0.699 and 0.554 to0.651,respectively.The construct validity of the questionnaire was evaluated by exploratory factor analysis(principal component analysis,varimax rotation).7 common factors were extracted,explaining 66.423%of all variances.These common factors basically reflected all the information of the questionnaire.And there was an obvious logical relationship between factors and the inner structure of the questionnaire.(3)The reliability of the SBIQ-PC.The overall Cronbach's?coefficient was 0.88.For each domain,the Cronbach's?coefficients were between 0.50 and 0.75.The overall Spearman-Brown coefficient was 0.860.Each domain's Spearman-Brown coefficients were between 0.34 and 0.80(P<0.05).2.Describe and analyze the results of the cross-sectional study:The score of body image related psychology change(5.76±0.74)is the highest among all the dimensions and sub-dimensions of body imge,followed by score of image image related behavior change(4.08±0.43),body image related social change(3.83±0.49),body image related role change(3.64±0.52),body image related sex life change(3.36±0.85)and self-cognition of body image(2.92±0.96).Univariate analysis showed that gender,occupation,average monthly income,expense payment,understanding of disease and treatment before cystostomy were correlated with body image related self-image cognitive scores of patients with permanent cystostomy.The degree of understanding of the disease and the degree of understanding of the treatment before cystostomy were related to the scores of body image related psychologic changes in the patients with permanent cystostomy.Education level and residence and body image of the patients with permanent cystostomy were correlated with the scores of body image related psychologic changes in the patients with permanent cystostomy.Age,residence place,the degree of understanding of the disease,and the degree of understanding of the treatment before the cystostomy were correlated with the body image related role change among patients with permanent cystostomy.The average monthly income and the level of understanding of the treatment methods before the operation were related to the scores of the body image related social changes in the patients with permanent cystostomy,age,nationality,marital status,type of primary caretaker,living style.The degree of understanding of the disease and the degree of understanding of the treatment before the cystostomy were correlated with the score of body image related sexual life change of the patients with permanent cystostomy.The scores of physical and mental component of SF-36 for PC patients were 170.02±36.91and 196.21±39.80.Compared with scores of the control sample,PC patients had lower score in dimensions of Physical Functioning,Role-Physical,Bodily Pain,General Health,Social Functioning,role emotion and Mental Health and components of physical and mental health(P<0.01).PC patients had a higher score in the dimension of Vitality(P<0.01).No statistical difference was found in the dimension of Role-Emotional(P>0.05).Univariate analysis showed that age,education,type of care and living style were related to the score of PCS among patients with permanent cystostomy,education,understanding of disease and understanding of cystostomy were correlated with MCS among patients with permanent cystostomy.Spearman correlation analysis showed that PC patients body image dimensions of body image related psychology change,body image related role change(3.64±0.52),body image related social change and body image related sex life change positively correlated with Physical Component Score(r_s=-0.17,-0.21,-0.13 and-0.13 respectively;P<0.05)and body image related role change and body iamge related social change with Mental Component Score(r_s=-0.17,-0.19,-0.21?-0.14 respectively;P<0.05)of PC patients quality of life while dimension of self-cognition body image,body image related psycology change,body image related behavior change and body image related sex life change negatively correlated with them(r_s=-0.177 and-0.201,respectively;P<0.01).No correlation was found between the dimension of body image related behavior change,body iamge related sex life change and the score of mental component(P>0.05).Conclusions:The SBIQ-PC is a reliable and valid instrument for the measurement of body image among Chinese PC patients.Levels of body image and quality of life amongPC patients varies between different dimensions.Several dimensions of body image are deteriorated compared to the control samples.Correlates of body image include age,nationality,sex,marital status,occupation,education,residence,living style,average monthly income,method of paying for medical expenses,type of main carer,The degree of understanding of the disease and the treatment before cystostomy.Correlates of quality of life of PC patients include age,education level,the degree of understanding of the disease and the level of understanding of the cystostomy.The body image of patients with cystostomy was related to their quality of life.