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Abstract
Purpose
This study aimed to investigate the influencing factors on self care, respiratory difficulty, sleep impediment, anxiety and depression among patients with neuromuscular disease who are dependent on Home Mechanical Ventilator (HMV).
Methods
157 patients were recruited through hospital based home nursing care departments and HMV rental centers. Data were collected by questionnaires. The analytic methods were n (%) / M±SD, x2 / t-test or ANOVA and multiple linear regression.
Results
Patients with Amyotrophic lateral sclerosis were more likely to utilize HMV, had shorter periods of morbidity and the most extended daily use of HMV. As for medical equipment, they had ambu-bag (87.2%) and oxygenator (15.4%). Reports of respiratory difficulty and sleep impediment were low. There were no significant difference. In contrast, reported anxiety and depression were high and showed significant difference between non invasive HMV and invasive HMV. Anxiety contributes to respiratory difficulty (t=3.62, p=.002), sleep impediment (t=2.06, p=.042), and depression (t=7.24, p<.001). However, home nursing care exerts a positive influence in reducing anxiety (t=-2.73, p=.008).
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Table 1.
Comparisons of General Characteristics by Applied Method of HMV (N=157)
| Variables | Categories | Total (N=157) | Non IHMV (n=55) | IHMV (n=102) | x2 or t | p |
|---|---|---|---|---|---|---|
| n (%) or M±SD | n (%) or M±SD | n (%) or M±SD | ||||
| Gender | Male | 101 (64.3) | 42 (76.4) | 59 (57.8) | 5.34 | .021 |
| Female | 56 (35.7) | 13 (23.6) | 43 (42.2) | |||
| Age (year) | ＜45 | 68 (43.6) | 41 (75.9) | 27 (26.5) | ＜.001† | |
| 45~＜65 | 61 (39.1) | 10 (18.5) | 51 (50.0) | |||
| ≥65 | 27 (17.3) | 3 (5.6) | 24 (23.5) | |||
| 43.46±21.71 | 30.87±17.46 | 51.12±20.82 | -5.80 | ＜.001 | ||
| Religion | No | 50 (31.8) | 18 (32.7) | 32 (31.4) | 0.03 | .862 |
| Yes | 107 (68.2) | 37 (67.3) | 70 (68.6) | |||
| Family member | Couple | 24 (15.4) | 5 (9.1) | 19 (18.8) | 3.10 | .212 |
| Couple & offspring | 97 (62.2) | 35 (63.6) | 62 (61.4) | |||
| Parent & others | 35 (22.4) | 15 (28.3) | 20 (19.8) | |||
| Number of caring person | 1.75±0.80 | 1.63±0.77 | 1.81±0.82 | -1.25 | .215 | |
Table 2.
Comparisons of Disease related Characteristics by Applied Method of HMV (N=157)
| Variables | Categories | Total (N=157) | Non IHMV (n=55) | IHMV (n=102) | x2 or t | p |
|---|---|---|---|---|---|---|
| n (%)/M±SD | n (%)/M±SD | n (%)/M±SD | ||||
| Physical functional status | 0.82±.087 | 1.75±0.61 | 0.32±0.51 | 14.88 | ＜.001 | |
| Diagnosis | ALS | 87 (55.1) | 13 (23.6) | 74 (75.2) | 35.22 | ＜.001 |
| SMA & PMD | 51 (32.9) | 32 (58.2) | 19 (18.6) | |||
| Others | 19 (12.0) | 10 (6.4) | 9 (8.8) | |||
| Morbidity duration of disease (month) | 100.53±73.82 | 128.75±77.31 | 85.38±67.55 | 3.51 | .001 | |
| Diagnosis | ALSa | 75.41±63.24 | 62.08±58.32 | 73.28±52.87 | ||
| SMA & PMDb | 141.26±69.69 | 151.93±66.60 | 125.00±75.01 | |||
| Othersc | 109.00±82.65 | 141.50±86.11 | 72.89±65.12 | |||
| F (p) | 13.92 (＜.001) | 7.42 (.002) | 5.23 (.007) | |||
| b＞c＞a | b, c＞a | b＞a, c | ||||
| Utility duration of HMV (month) | 43.42±35.37 | 44.43±35.09 | 42.87±35.68 | 0.26 | .795 | |
| Diagnosis | ALS | 39.20±31.50 | 34.69±24.16 | 40.18±32.91 | ||
| SMA & PMD | 52.00±38.53 | 47.97±36.70 | 57.29±42.31 | |||
| Others | 40.37±42.11 | 45.10±42.45 | 34.00±41.11 | |||
| F (p) | 1.78 (.154) | 0.66 (.521) | 1.90 (.155) | |||
| Applied hours of HMV (day) | 18.77±7.17 | 11.79±6.08 | 22.46±4.47 | -11.41 | ＜.001 | |
| Diagnosis | ALSa | 21.99±5.35 | 14.67±8.52 | 23.16±3.51 | ||
| SMA & PMDb | 14.40±6.95 | 10.77±4.67 | 20.33±5.88 | |||
| Othersc | 15.89±7.78 | 11.60±6.22 | 20.67±6.63 | |||
| F (p) | 26.04 (＜.001) | 1.86 (.165) | 3.89 (.024) | |||
| a＞b, c | a＞b, c | |||||
| Type of HMV | Volume | 102 (65.0) | 41 (74.5) | 61 (59.8) | 3.41 | .065 |
| Pressure | 55 (35.0) | 14 (25.5) | 41 (40.2) | |||
| Parameter of HMV | In case of TV | 636.76±273.88 | 840.24±209.77 | 561±209.77 | 7.22 | ＜.001 |
| In case of PIP | 13.41±4.38 | 11.82±5.09 | 13.97±4.02 | -1.60 | .116 | |
| Respiratory rate | 15.43±4.41 | 14.69±3.13 | 15.85±4.94 | -1.56 | .120 | |
| Change of parameter (6 months) | No | 103 (65.6) | 35 (63.6) | 68 (66.7) | 0.14 | .764 |
| Yes | 54 (34.4) | 20 (36.4) | 34 (33.3) | |||
| Reason† (yes only) | RD | 23 (33.3) | 5 (19.2) | 18 (11.4) | 1.67 | .232 |
| Headache | 23 (33.3) | 10 (38.5) | 13 (12.8) | |||
| Problem of HMV | 4 (5.8) | 1 (3.8) | 3 (2.0) | |||
| After check up | 6 (8.7) | 0 (0.0) | 6 (3.9) | |||
| Others | 13 (18.8) | 10 (38.5) | 3 (7.0) | |||
| Changer of parameter | Physician | 74 (67.9) | 35 (83.3) | 39 (58.2) | .014 | |
| Home care nurse | 13 (11.9) | 4 (9.5) | 9 (13.4) | |||
| Employer of equipment | 22 (20.2) | 3 (7.1) | 19 (28.4) | |||
| Home nursing care | No | 60 (38.2) | 48 (87.3) | 12 (11.8) | 86.28 | ＜.001 |
| Yes | 97 (61.8) | 7 (12.7) | 90 (88.2) | |||
Table 3.
Comparisons of Self Care by Applied Method of HMV (N=157)
| Variables | Categories | Total (N=157) | Non IHMV (n=55) | IHMV (n=102) | x2 | p | |
|---|---|---|---|---|---|---|---|
| n (%) | n (%) | n (%) | |||||
| HMV related | Holding equipment† (yes only) | Equipment for suction | 109 (69.9) | 14 (12.8) | 95 (87.2) | 75.77 | ＜.001 |
| Equipment for oxygen | 24 (15.4) | 4 (16.7) | 20 (83.3) | .061 | |||
| Ambu bag | 136 (87.2) | 44 (32.4) | 92 (67.6) | 2.40 | .121 | ||
| Pulse oxymetry | 80 (51.3) | 26 (32.5) | 54 (67.5) | 0.33 | .569 | ||
| Assisted cough | 84 (53.8) | 49 (58.3) | 35 (41.7) | 4.00 | .046 | ||
| Changing cycle of circuit | q 2 weeks | 29 (23.4) | 18 (37.5) | 11 (14.3) | 9.72 | .008 | |
| q≥1 month | 95 (76.6) | 30 (62.5) | 65 (85.7) | ||||
| Changer of circuit | Family caregiver | 44 (29.7) | 18 (33.4) | 26 (27.7) | 4.45 | .218 | |
| Employer of company | 80 (54.1) | 24 (44.4) | 56 (59.6) | ||||
| Home care nurse | 24 (16.2) | 12 (22.2) | 12 (12.8) | ||||
| Changing cycle of filter | q 2 weeks | 11 (15.1) | 1 (4.8) | 10 (19.2) | .272 | ||
| q 1 month and above | 62 (74.9) | 20 (95.5) | 39 (75.0) | ||||
| Changer of filter | Family caregiver | 103 (76.5) | 33 (58.9) | 68 (69.4) | .073 | ||
| Employer of company | 45 (29.0) | 17 (30.4) | 28 (28.6) | ||||
| Home care nurse | 7 (4.5) | 6 (10.7) | 2 (2.0) | ||||
| Life habit related | Respiratory exercise (yes only)‡ | Cough assisted coughing | 90 (59.2) | 35 (66.0) | 55 (55.6) | .210 | |
| Postural drainage | 18 (11.3) | 3 (6.8) | 15 (18.3) | .109 | |||
| Chest vibration | 10 (7.2) | 3 (6.5) | 7 (7.5) | 1.000 | |||
| Exercise of accumulated air | 55 (41.0) | 25 (55.6) | 30 (33.7) | 5.90 | .015 | ||
| Respiratory muscle exercise | 29 (21.0) | 15 (33.3) | 14 (15.1) | .040 | |||
| Suction of airway | 104 (74.3) | 9 (21.4) | 95 (96.9) | ＜.001 | |||
| General exercise | No | 61 (39.1) | 23 (42.6) | 38 (37.3) | 0.42 | .516 | |
| Yes | 95 (60.9) | 31 (57.4) | 64 (62.7) | ||||
| Major type of meal | Oral diet | 74 (47.1) | 48 (87.3.) | 26 (25.5) | 54.74 | ＜.001 | |
| Tube feeding | 83 (52.9) | 7 (12.7) | 76 (74.5) | ||||
| Elevated upper body during meal | No | 32 (20.8) | 20 (38.5) | 12 (11.8) | 14.91 | ＜.001 | |
| Yes | 122 (79.2) | 32 (61.5) | 90 (88.2) | ||||
| Oral care | No | 18 (11.7) | 10 (18.9) | 8 (7.9) | 4.05 | .045 | |
| Yes | 136 (88.3) | 43 (81.1) | 93 (92.1) | ||||
Table 4.
Comparisons by Applied Method and Influencing Factors on Respiratory Difficulty, Sleep Impediment, Anxiety, and Depression (N=157)
| Variables | Total (n=157) | Non IHMV (n=55) | IHMV (n=102) | t (p) | Variables (Constant) | B | β | t | p | R2 | Adj. R2 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| M±SD | M±SD | M±SD | |||||||||
| Respiratory difficulty | 0.88±1.10 | 0.76±1.07 | 0.95±1.18 | -0.94 | (Constant) | 3.55 | 3.61 | ＜.001 | .16 | .14 | |
| (.347) | Anxiety | 0.97 | 0.30 | 3.62 | .002 | ||||||
| Utility duration of HMV | -0.02 | -0.24 | -2.57 | .012 | |||||||
| Gender (male) | -1.31 | -0.22 | -2.31 | .023 | |||||||
| Sleep impediment | 0.44±0.29 | 0.43±0.31 | 0.45±0.28 | -0.41 | (Constant) | 1.30 | 5.88 | ＜.001 | .32 | .28 | |
| (.681) | SMA & PMD(yes) | 0.50 | 0.32 | 2.91 | .004 | ||||||
| Duration of morbidity | -0.01 | -0.20 | -2.05 | .043 | |||||||
| Applied method(IHMV) | -0.48 | -0.31 | -3.08 | .003 | |||||||
| Changing cycle of circuit | 0.31 | 0.19 | 2.13 | .035 | |||||||
| Anxiety | 0.18 | 0.21 | 2.06 | .042 | |||||||
| Anxiety | 1.41±0.85 | 0.96±0.77 | 1.69±0.83 | -5.27 | (Constant) | 0.23 | 1.30 | .198 | |||
| (＜.001) | Depression | 0.62 | 0.62 | 8.42 | ＜.001 | ||||||
| Sleep impediment | 0.22 | 0.19 | 2.83 | .006 | .62 | .60 | |||||
| Physical functional status | -0.35 | -0.33 | -3.57 | .001 | |||||||
| HNC(yes) | -0.43 | -0.24 | -2.73 | .008 | |||||||
| Depression | 1.68±0.84 | 1.13±0.79 | 2.1±12 | -6.60 | (Constant) | 0.53 | 3.02 | .003 | .66 | .65 | |
| (＜.001) | Anxiety | 0.51 | 0.51 | 7.24 | ＜.001 | ||||||
| Age | 0.02 | 0.46 | 5.30 | ＜.001 | |||||||
| Duration of morbidity | -0.01 | -0.21 | -2.70 | .008 |
Missing data be excluded; Gender: Male (1) vs Female (0); Diagnosis: ALS (no) 0 vs SMA & PMD (yes)1; Applied method: non Invasive (0) vs Invasive (1); HNC (Home nursing care): No (0) vs Yes (1); IHMV=invasive home mechanical ventilator, SMA=spinal muscular atrophy; PMD=primary muscular disease; Adj. R
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