만성 폐쇄성 폐질환 환자의 기능적 수행에 관한 구조모형

Abstract

본 연구는 불쾌 증상 이론(Lenz, Pugh, Milligan, Gift, & Suppe, 1997)을 기반으로 만성 폐쇄성 폐질환 환자의 질병 중증도, 불확실성, 사회적 지지, 증상경험, 대처 및 기능적 수행 간의 관계를 규명하고 모형을 구축함으로써 만성 폐쇄성 폐질환 환자의 기능적 수행을 향상시키기 위한 기초자료를 제공하고자 시도되었다. 연구 대상자는 서울시에 위치한 K 종합병원 호흡기 내과 외래에 내원하는 만성 폐쇄성 폐질환 환자를 대상으로 2018년 7월부터 2019년 4월까지 구조화된 설문지를 이용하여 자료를 수집하였고 총 202부가 자료 분석에 이용되었다. 수집된 자료는 SPSS 22.0 프로그램과 Mplus 8.0을 이용하여 실수, 백분율, 평균, 표준편차, Pearson’s correlation coefficients로 분석하였고 연구 모형의 적합도는 χ² 통계량, Normed χ², CFI, SRMR, RMSEA의 적합도 지수로 확인하였다. 연구결과는 다음과 같다. 1. 질병 중증도의 평균값은 59.75±18.98%, 불확실성의 평균값은 2.79± 0.39점, 사회적 지지의 평균값은 3.98±1.19점이고, 증상경험의 평균값0.62±0.47점이었다. 대처 중 문제 해결 중심 대처는 1.74±0.44점, 사회적 지지 추구는 1.64±0.37점이며 기능적 수행의 평균값은 2.41±0.47점이었다. 2. χ² 통계량은 207.97(df=122, p<.001)로 가설적 모형은 기각되었으나 다른 적합도 지수인 Normed χ²=1.705, CFI=.935, SRMR=.059, RMSEA=.055로 모형의 적합도는 양호하였다. 3. 만성 폐쇄성 폐질환 환자의 불확실성이 낮을수록(β=.236, p=.009), 사회적 지지가 높을수록(β=-.200, p=.044) 증상경험은 감소한 반면, 질병 중증도는 증상경험에 유의한 영향을 주지 않았으며(β=-.025, p=.745) 증상경험에 대한 이들 변수의 설명력은 11.9%였다. 4. 만성 폐쇄성 폐질환 환자의 사회적 지지(β=.278, p=.012), 증상경험(β=.172, p=.047)이 높을수록 대처가 높은 반면, 질병 중증도(β=.060, p=.407), 불확실성(β=-.043, p=.617)은 대처에 유의한 영향을 주지 않았으며 대처에 대한 이들 변수의 설명력은 9.4%였다. 5. 만성 폐쇄성 폐질환 환자의 질병 중증도(β=.238, p=.000), 불확실성(β=-.164, p=.021), 증상경험(β=-.558, p=.000)이 낮을수록 기능적 수행이 증가한 반면, 사회적 지지(β=.082, p=.261), 대처(β=.029, p=.646)는 기능적 수행에 유의한 영향을 주지 않았으며 기능적 수행에 대한 이들 변수의 설명력은 51.8%였다. 6. 만성 폐쇄성 폐질환 환자의 증상경험은 불확실성과 기능적 수행의 관계에서 매개효과가 있었다(B=-.136, 95% CI=［-.283, -.011］). 본 연구에서 만성 폐쇄성 폐질환 환자의 질병 중증도, 불확실성, 증상경험이 낮을수록 기능적 수행은 증가하였다. 또한 불확실성이 낮을수록 증상경험은 감소되었고, 이렇게 감소된 증상경험은 기능적 수행을 증가시켰다. 이러한 결과는 만성 폐쇄성 폐질환 환자의 기능적 수행을 향상시키기 위한 방안을 모색하는데 근거자료로 이용될 수 있을 것이다.;This study was attempted to provide basic data to improve the functional performance of patients with chronic obstructive pulmonary disease by clarifying the relationship among disease severity, uncertainty, social support, symptom experience, coping and functional performance in patients with chronic obstructive pulmonary disease based on the theory of unpleasant symptoms (Lenz, Pugh, Milligan, Gift, & Suppe, 1997), and establishing a model regarding them. The subjects of this study were outpatients with chronic obstructive pulmonary disease who visited respiratory clinic of K General Hospital located at Seoul. The data were collected using the structured questionnaires targeting them from July 2018 to April 2019, of which 202 questionnaires in total were used for data analysis. Collected data were analyzed by real number, percentage, mean, standard deviation, and Pearson's correlation coefficients using SPSS 22.0 program and Mplus 8.0. And, the goodness of the study model was confirmed by the goodness of fit index of the χ² statistic, normed χ², CFI, SRMR, and RMSEA The study results are described as follows. 1. Mean disease severity was 59.75±18.98%, mean uncertainty was 2.79±0.39 points, mean social support was 3.98±1.19 points, and mean symptom experience was 0.62±0.47 points, respectively. With regards to the coping strategies, the problem-centered coping was 1.74±0.44 points, the social support pursuit was 1.64±0.37 points, and the mean functional performance was 2.41±0.47 points, respectively. 2. As the χ²statistic was 207.97(df=122, p<.001), the hypothetical model was rejected, however, the other goodness-of-fit indexes were normed χ²=1.705, CFI=.935, SRMR=.059, RMSEA=.055, which resulted in the excellent goodness of fit of the model. 3. The lower the uncertainty of patients with chronic obstructive pulmonary disease(β=.236, p=.009) and the higher the social support(β=-.200, p=.044), the less symptom experience, while the severity of the disease did not have significant effect on symptom experience (Β=-.025, p=.745) and the explanatory power of these variables on symptom experience was 11.9%. 4. The higher the social support(β=.278, p=.012) and the symptom experience(β=.172, p=.047) of patients with chronic obstructive pulmonary disease, the higher the coping, however, the severity of the disease(β=.060, p=.407) and uncertainty (β=-.043, p=.617) did not have significant effect on coping, and the explanatory power of these variables on coping was 9.4%. 5. The lower the disease severity(β=.238, p=.000), the uncertainty(β=-.164, p=.021) and the symptom experience (β=-.558, p=.000) in patients with chronic obstructive pulmonary disease, the more increased the functional performance, while the social support(β=.082, p=.261) and the coping(β=.029, p=.646) did not have significant effect on the functional performance, and the explanatory power of these variables on functional performance was 51.8%. 6. The symptom experience of patients with chronic obstructive pulmonary disease had a mediating effect in the relationship between uncertainty and functional performance(B=-.136, 95% CI=[-.283, -.011]). In this study, it is concluded that the lower the severity, uncertainty, and symptom experience of the patients with chronic obstructive pulmonary disease, the higher the functional performance, and the lower the uncertainty, the lower the symptom experience, which increased the functional performance. These results will be able to be used as a basis for finding ways to improve the functional performance of patients with chronic obstructive pulmonary disease.