Tesis

Kualitas Hidup Setelah Enam Bulan Pasca Perawatan Pasien dengan Riwayat Ulkus Kaki Diabetes dan Faktor-Faktor yang Memengaruhi = Six-month-post-hospitalization Quality of Life in Patients with History of Diabetic Foot Ulcer and Its Associated Factors.

Latar belakang. Ulkus kaki diabetes (UKD) merupakan salah satu komplikasi kronik diabetes yang muncul sebagai ulserasi kaki dan menyebabkan morbiditas serta beban finansial yang tinggi. Hal tersebut secara kumulatif menurunkan kualitas hidup pasien UKD. Isu kualitas hidup pasien UKD setelah perawatan dan faktor-faktor yang memengaruhi belum banyak diteliti. Tujuan. Studi ini bertujuan melihat skor kualitas hidup setelah enam bulan pasca perawatan pasien dengan riwayat dan faktor-faktor yang memengaruhi. Metode. Studi ini merupakan studi kohort, dengan data dasar diambil dari registri kaki DM RSCM dan data kualitas hidup didapat melalui proses wawancara. Pasien UKD dengan riwayat perawatan di RSCM dan terdata di registri kaki RSCM periode Januari 2019 - Agustus 2023, dapat diwawancarai, serta tidak memiliki UKD aktif diikutsertakan ke penelitian. Skor kualitas hidup diukur menggunakan kuesioner Diabetic foot ulcer scale-short form (DFS-SF) dan ditampilkan dalam bentuk rerata atau nilai tengah. Hubungan faktor-faktor determinan yang diteliti dengan kualitas hidup dianalisis dengan analisi bivariat, multivariat, dan lajur. Hasil. Sebanyak 131 subjek diikutsertakan dalam penelitian ini. Rerata skor kualitas hidup keseluruhan adalah 57,46. Pada analisis bivariat, lama observasi berhubungan bermakna dengan semua domain kualitas hidup kecuali waktu luang sedangkan neuropati perifer hanya berhubungan dengan domain kesehatan fisik, waktu luang, dan kualitas hidup keseluruhan. Jumlah area keterlibatan ulkus berhubungan dengan domain rasa terganggu. Analisis multivariat menunjukkan bahwa lama observasi berhubungan bermakna dengan kualitas hidup keseluruhan, kesehatan fisik, rasa khawatir, dan rasa terganggu. Neuropati perifer berhubungan dengan domain waktu luang. Analisis lajur mendapati bahwa lama observasi berhubungan langsung dengan kualitas hidup keseluruhan dan neuropati perifer berhubungan langsung sekaligus tidak langsung dengan kualitas hidup melalui derajat infeksi, lama perawatan, dan keluaran ulkus. Diskusi. Studi-studi terdahulu menemukan bahwa secara umum kualitas hidup pasien UKD ditentukan dari faktor fisik, sosioekonomi, dan psikologis. Pada studi dengan desain potong lintang yang dilakukan pada pasien dengan UKD aktif, faktor yang sering memengaruhi adalah derajat luka, kadar gula darah dan tingkat pendapatan. Faktor terkait luka tidak lagi berpengaruh terhadap kualitas hidup pasca perawatan mengindikasikan bahwa selama luka dapat ditatalaksana dengan baik dan penyembuhan luka dapat tercapai, kualitas hidup optimal juga dapat dicapai. Kesimpulan. Kualitas hidup pasca perawatan pasien UKD relatif rendah. Lama observasi dan neuropati perifer berhubungan langsung dengan kualitas hidup.
Kata kunci. Ulkus kaki, diabetes melitus, kualitas hidup, amputasi, pasca rawat.


Background. Diabetic foot ulcer (DFU) is one of chronic complication of diabetes that appear as foot ulceration and causing high morbidity and financial burden. These cumulatively reduce quality of life of DFU patients. The issue of quality of life (QoL) of DFU patients after hospitalization and its influencing factors has not been widely studied yet. Objective. This study aimed to evaluate six-month-post-hopitalization in patients with history DFU and its influencing factors. Method. This study was a cohort study in which baseline data was taken from the diabetic foot registry and QoL data were obtained through interview. Subjects with DFU hospitalized in Cipto Mangunkusumo Hospital from January 2019 - August 2023, registred in diabetic foot registry, could be interviewed, and did not have active DFU were included in the study. Quality of life scores are measured using the Diabetic Foot uUcer Scale-Short Form (DFS-SF) questionnaire and were displayed in mean or median value. The association between determinant factors studied and QoL was analyzed using bivariate, multivariate and path analysis. Results. A total of 131 subjects were included in this study. The overall mean of QoL score was 57.46. In bivariate analysis, length of observation was significantly associated with all quality of life domains except for leisure time, whilst peripheral neuropathy was only associated with the domains of physical health, leisure time and overall QoL. The number of areas involved is related to bothered by ulcer domain. Multivariate analysis showed that length of observation was significantly related to overall QoL, physical health, worry about ulcers, and bothered by ulcers domain. Peripheral neuropathy was related to the leisure domain. Path analysis found that length of observation was directly associated with overall QoL whilst peripheral neuropathy was both directly and indirectly associated with QoL through degree of ulcer infection, length of stay, and ulcer outcome. Discussion. Previous studies found that the QoL of DFU patients was determined by physical, socioeconomic and psychological factors. In those studies conducted on patients with active DFU, factors associated with low QoL were degree of ulcer, blood sugar levels and salary. This study found that wound-condition did not influence QoL after hospitalization. This finding indicated that as long as wound healing can be achieved, optimal quality of life can also be preserved. Conclusion. The quality of life after hospitalization of DFU patients was relatively low. Length of observation and peripheral neuropathy were directly associated with QoL.
Keyword. diabetic foot ulcer, diabetes melitus, quality of life, amputation, post hospitalization