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Quality of Life Assessment After Severe Hand Injury

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Quality of Life Assessment After Severe Hand Injury Klinikum rechts der Isar der Technischen Universität München Abteilung für Plastische & Wiederherstellungschirurgie (Chefarzt: Univ. - Prof. Dr. E. Biemer) Quality of Life Assessment after Severe Hand Injury Marion Grob Vollständiger Abdruck der von der Fakultät für Medizin der Technischen Universität München zur Erlangung des akademischen Grades eines Doktors der Medizin genehmigten Dissertation. Vorsitzender: Univ.-Prof. Dr. D. Neumeier Prüfer der Dissertation: 1. Univ.- Prof. Dr. E. Biemer 2. Univ.- Prof. Dr. H. Bartels Die Dissertation wurde am 18.09.2006 bei der Technischen Universität München eingereicht und durch die Fakultät für Medizin am 13.12.2006 angenommen. Für meine Großeltern, deren Güte und Liebe mich für immer begleiten wird I Introduction.......................................................................................................1 I.1 Quality of Life......................................................................................................... 1 I.1.1 Historical Overview..........................................................................................................1 I.1.2 Definition and Concept of Quality of Life........................................................................3 I.1.3 Importance of Assessment of Quality of Life...................................................................5 I.1.4 Accuracy of Assessment of Quality of Life......................................................................7 I.2 Severe Hand Injury................................................................................................ 9 I.2.1 Overview ..........................................................................................................................9 I.2.2 Classification of Severe Hand Injuries ...........................................................................11 I.2.3 Outcome after Hand Injury.............................................................................................12 I.2.4 Psychological Impact of Severe Hand Injury .................................................................14 I.3 Aim of Study......................................................................................................... 20 II Patients and Methods......................................................................................22 II.1 Patient Group ....................................................................................................... 22 II.2 Inclusion Criteria ................................................................................................. 24 II.3 Hand Injury Severity Scoring System................................................................ 24 II.4 18 - Page Questionnaire....................................................................................... 26 II.4.1 General Part ....................................................................................................................26 II.4.2 Specific Questionnaires ..................................................................................................26 II.4.2.1 Disability of the Arm, Shoulder, and Hand (DASH)...........................................27 II.4.2.2 Body Dysmorphic Disorder Examination - Self Report (BDDE - SR), (Munich Version) ..............................................................................................................29 II.4.2.3 HADS (Hospital Anxiety and Depression Score)................................................31 II.4.2.4 FLZ (Fragen zur Lebenszufriedenheit)...............................................................33 II.4.2.5 FBeK (Fragebogen zur Beurteilung des eigenen Körpers) ...............................35 II.5 Statistical Analysis ............................................................................................... 36 III Results..............................................................................................................39 III.1 Demographic Data ............................................................................................... 39 III.2 Hand Injury.......................................................................................................... 40 III.3 Treatment ............................................................................................................. 43 III.3.1 Patient Group - Subdivision.......................................................................................43 III.3.2 Treatment Methods ....................................................................................................43 III.3.3 HISS across Treatment Groups..................................................................................45 III.3.4 Hospital Data .............................................................................................................46 III.3.5 Rehabilitation.............................................................................................................49 III.3.6 Completion of treatment ............................................................................................49 III.4 Outcome ................................................................................................................ 50 III.4.1 Hand Function............................................................................................................50 III.4.2 Sensory Disturbances, Cold Intolerance and Pain .....................................................54 III.4.3 Satisfaction with Operation - Result ..........................................................................59 III.4.4 Work related Aspects.................................................................................................60 III.4.5 Spare Time Activities ................................................................................................64 III.4.6 Analyses of Outcome Questionnaires ........................................................................66 III.4.6.1 Disability of the Arm, Shoulder and Hand (DASH)............................................66 III.4.6.2 DASH - Sports / Performing Arts (Optional Module).........................................69 III.4.6.3 Hospital Anxiety Depression Score (HADS): Anxiety.........................................72 III.4.6.4 Hospital Anxiety Depression Score (HADS): Depression ..................................75 III.4.6.5 Body - Dysmorphic - Disorder - Examination - Self Report (BDDE - SR).........78 III.4.6.6 FLZ - General Life Satisfaction ..........................................................................81 III.4.6.7 FLZ - Health .......................................................................................................84 III.4.6.8 FLZ - Outer Appearance.....................................................................................87 I III.4.6.9 FBeK - Attractiveness / Self – Confidence..........................................................90 III.4.6.10 FBeK - Accentuation of Physical Appearance....................................................93 III.4.6.11 Relationship of HISS - Categories to Outcome Questionnaires .........................96 III.4.7 Correlation Matrix .....................................................................................................99 III.4.8 Regression - Analysis ..............................................................................................102 III.4.8.1 Regression Analysis of General Life Satisfaction .............................................102 III.4.8.2 Regression Analysis of Satisfaction with Health...............................................105 IV Discussion......................................................................................................108 IV.1 Patients and Methods......................................................................................... 108 IV.1.1 Patient Group ...........................................................................................................108 IV.1.2 Inclusion Criteria .....................................................................................................109 IV.1.3 Hand Injury Severity Scoring System......................................................................109 IV.1.4 Questionnaire Design...............................................................................................110 IV.2 Results ................................................................................................................. 114 IV.2.1 General.....................................................................................................................114 IV.2.2 Outcome Questionnaires..........................................................................................118 IV.2.3 Quality of Life of Replantations versus Terminalizations .......................................128 IV.2.4 Regression Analysis.................................................................................................131 V Summary........................................................................................................134 VI References .....................................................................................................136 VII Page Questionnaire – Adnexe ......................................................................154 II I Introduction I.1 Quality of Life I.1.1 Historical Overview Although the term quality of life was first used in the 20th century, the concept has slowly evolved over time. The idea `quality of life` dates back to the philosophers of the
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