| Sažetak | U lijecenju boli je tijekom posljednjih dvadesetak godina postignut veliki napredak.
Unatoc tome, pacijenti nerijetko i dalje trpe jaku, pa i neizdrživu bol. Uslijed produljenja
životnoga vijeka današnja populacija sve je starija, što logicno dovodi do povecanog broja
hospitalizacija osoba starije životne dobi. U ovoj je populaciji cesta pojava senzornih
oštecenja (osobito oštecenja sluha i vida), a takoer i kognitivnih oštecenja, ponajprije
demencije te Alzheimerove bolesti kao njena najtežeg oblika. Sve ovo komunikaciju s
navedenom grupom pacijenata cini otežanom, zbog cega i procjena boli u njihovom slucaju
zahtijeva posebnu pažnju, educiranost te alat(e) koji ce je najbolje procijeniti. Procjena boli
temelj je kvalitetne kontrole boli te preduvjet adekvatnog lijecenja usmjerenog ka smanjenju
komplikacija, što bržem oporavku, a time i financijskoj uštedi.
Cilj ovog istraživanja jest utvrditi metrijske karakteristike (pouzdanost i valjanost)
Abbey-skale za procjenu boli na hrvatskoj populaciji bolesnika starije životne dobi s
otežanom komunikacijom, odnosno ispitati povezanost tako procijenjenog doživljaja akutne
boli i ucinkovitosti analgezije u istih.
Uzorak je cinio 31 bolesnik stariji od 65 godina hospitaliziran u Klinici za traumatologiju
KBC-a„Sestre milosrdnice“ u Zagrebu. Za procjenu boli korištena je Abbey-skala koju je sa
suradnicima razvilaprof. Jennifer Abbey sa australskog sveucilišta Queensland (Abbey i dr.,
2004). Dobiveni rezultati usporeivani su sa samoizvješcima bolesnika o intenzitetu boli
prema VAS-skali. Mentalni status bolesnika procjenjivao se MMSE-skalom.
Pouzdanost skale u ovom istraživanju potvrena je Chrombachovim koeficijentom
unutarnje konzistencije. Njegova je vrijednost iznosila 0,561, što se smatra prihvatljivim.
Štoviše, kad bi se pri izracunu koeficijenta unutarnje konzistencije iz upitnika izbacila cestica
„Fizicke promjene“, pouzdanost Abbey-skale porasla bi na 0,7, tj. na zadovoljavajuce
pouzdanu i homogeniju razinu
Marica Jerlekovic: Primjena Abbey-skale za procjenu akutne perioperativne boli (diplomski rad)
6
Kako je u istraživanju sudjelovao mali broj ispitanika, u svrhu utvrivanja valjanosti
Abbey-skale, procjena prema istoj korelirana je sa samoprocjenom bolesnika. Koeficijent
korelacije od 0,612 pokazuje da je vjerojatnost da je ova korelacija uzrokovana slucajnošcu
manja od 1%. Korelacija izmeu procjene Abbey-skale nakon analgezije te VAS-skale nakon
analgezije (r 0,739; sig. 0.00) visoka je i znacajna.
Da je Abbey-skala prikladan alat za procjenu boli kod predmetne populacije, pokazuju i
rezultati intenziteta boli mjereni prije i nakon analgezije. Intenzitet prije analgezije iznosio je
13 ± 3, a nakon nje 9 ± 2. T-test je pokazao da postoji statisticki znacajna redukcija
(P<0,000). Rezultati istraživanja ukazuju na to da Abbey-skala ima dobre metrijske
karakteristike valjanosti i pouzdanosti,odnosno da se radi o adekvatnom alatu za procjenu boli
u bolesnika starije životne dobi sa otežanom komunikacijom. Njena je upotreba povezana sa
zadovoljavajucom analgezijom kod istih. |
| Sažetak (engleski) | During thelast twenty years, a great progress has been achieved in pain treatment.
However, patients still often suffer from strong, and even unbearable pain. Population
nowadays is getting older, due to a prolonged lifespan. Naturally, number of hospitalizations
of elderly people increases. This population is commonly associated with sensory
impairments (e. g. hearing and vision impairment), as well as with cognitive, demential
impairments of which Alzheimer's disease is the most severe one. Therefore, it is evident that
communication with these patients is more difficult, which means that the pain assessment is
more difficult as well. It requires special attention, education, and tools able to achieve most
precise evaluation. The process is of a great importance, because pain assessment represents
the basis of a quality pain control, and is a prerequisite for adequate treatment directed
towards reduction of complications, faster recovery, and financial savings.
The aim of this study was to determine metric characteristics (reliability and validity) of
the Abbey pain scale in the assessment of pain among Croatian population of elderly patients
with hampered communication. Also, study examined a correlation between an estimated
acute pain experience and the effectiveness of analgesia in the same. The sample consisted of
31 patients aged 65 and more, hospitalized at University Hospital Center „Sestre milosrdnice“
Clinic for Traumatology.
Pain was evaluated by using the Abbey pain scale, which had been developed by prof.
Jennifer Abbey and her associates from Queensland University, Australia (Abbey et al.,
2004). The results were compared with the self-report of the pain intensity according to VAS
scale. Mental status of patients was evaluated by MMSE. Reliability of the scale in this
research was confirmed by the Chrombach coefficient of internal consistency. Its value
(0,561) is considered acceptable. Moreover, if the „physical changes“ particle of the
questionnaire was omitted, the reliability of the Abbey pain scale would increase to 0,7, which
would qualify it as satisfactorily reliable and more homogenous.
Because of the small number of participants, validity of the Abbey pain scale was
correlated with patient's self-assessment. The correlation coefficient of 0,612 means that there
Marica Jerlekovic: Primjena Abbey-skale za procjenu akutne perioperativne boli (diplomski rad)
8
is less than 1% probability that this correlation was caused by coincidence. The correlation
between the estimation of Abbey pain scale after analgesia and VAS scales after analgesia (r
0.739; sig 0.00) is high and significant. The results of pain intensity measured before and after
analgesia also show that Abbey pain scale in older age patients with hampered
communication is a useful tool. Intensity prior to analgesia was 13 ± 3, and after it 9 ± 2. The
t-test showed that the reduction was statistically significant (P<0,000).
The overall results show that the Abbey pain scale has good metric characteristics of
validity and reliability, and therefore is a good tool for assessing pain in older age patients
with hampered communication. Its use is associated with satisfactory analgesia among the
investigated population. |
