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Assessment of quality of life and fatigue among haemodialysis patients

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Abstract: Fatigue is one of the most common symptoms of haemodialysis patients and is associated with poor quality of life. Purpose: To investigate the levels of fatigue and its correlation with quality of life of haemodialysis patients. Results: Of
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    American Journal of Nursing Science 2015; 4(2-1): 66-73 Published online January 26, 2015 (htt:!!"""#s$ien$eublishin%%rou#$o&!'!a'ns) doi: 10#1164!'#a'ns#s#2015040201#22 **+: 232-5745 (Print); **+: 232-5753 (nline)   Assessment of quality of life and fatigue among haemodialysis patients Tsiamis Georgios 1 , Alikari Victoria 1, * , Fradelos Evangelos 2 , Papapetrou Savvas 3 , !ga So"ia 1   1 eart&ent o. +ursin%, /niersity o. Peloonnese, *arta, ree$e 2 *tate ental osital o. tti$a ahne, thens, ree$e 3 r o. *o$ial Psy$holo%y, du$ator o. +ursin% eart&ent, /niersity o. Peloonnese, *arta, ree$e Email address# ts&%eor%e8%&ail#$o& (9sia&is # ), i$aliari8%&ail#$o& (liari # ), ea%elos.radelos8hot&ail#$o& (<radelos # ), saaetrou8yahoo#$o& (Paaetrou *#) , =y%as8uo#%r (>y%a *#) To cite t$is article# 9sia&is eor%ios, liari i$toria, <radelos an%elos, Paaetrou *aas, >y%a *o.ia# ssess&ent o. ?uality o. @i.e and <ati%ue a&on% ae&odialysis Patients#  American Journal of Nursing Science # *e$ial ssue: ental ealth Aare: se$ts, Ahallen%es and Perse$ties# ol# 4, +o# 2-1, 2015, # 66-73# doi: 10#1164!'#a'ns#s#2015040201#22 A%stract# <ati%ue is one o. the &ost $o&&on sy&to&s o. hae&odialysis atients and is asso$iated "ith oor Buality o. li.e#  Purpose: 9o inesti%ate the leels o. .ati%ue and its $orrelation "ith Buality o. li.e o. hae&odialysis atients#  Results: . the 134 hae&odialysis atients, the &a'ority o. atients (52,CD) see&ed to hae lo" rates o. .ati%ue (10 E<* EF 20)# o"eer, 15D o. these atients see&ed to aear hi%h to ery hi%h leels o. .ati%ue (30 E<* EF 50)# *tudyin% the Buality o. li.e o. these atients "e $an obsere a $orrelation bet"een .ati%ue and Buality o. li.e# n arti$ular , atients "ho eGerien$e hi%her rates o. .ati%ue see& to hae "orse Buality o. li.e (?@ total s$ore 2#C0) than those eGerien$in% lo"er rates o. .ati%ue (?@ total s$ore 3#67) ( E0,005)# Conclusions: 9he analysis o. the results enable us to understand the $orrelation bet"een .ati%ue and Buality o. li.e a&on% hae&odialysis atients "ith *H and the i&ortan$e o. reention, dia%nosis and treat&ent o. .ati%ue in order to oti&i=e the Buality o. li.e in dialysis atients "ith *H# &e!'ords# <ati%ue, ?uality o. @i.e, Ahroni$ Iidney isease, ae&odialysis, nd *ta%e Henal isease   1( )ntroduction $$ordin% to +ational Iidney <oundation , nd *ta%e Henal isease (*H) is a %lobal health roble& "hile its  realen$e in the /nited *tates is in$reasin% 1K#9he nu&ber o. atients under%oin% hae&odialysis () has in$reased .ro& aroGi&ately 10#000 in 1C73 to 615#CC in 2011 2K#   *H $an $ause not only disorders o. basi$ .un$tions o. the or%ani=ation but also leads to deeer oerturn o. the e&otional, so$ial and e$ono&i$ balan$e o. the indiidual and its .a&ily 3K# esite the in$rease o. surial o. atients "ith *H, $o&li$ations o. the disease or its treat&ent, su$h as $ardioas$ular roble&s, a&yloidosis and &alnutrition, are still roble&s "hi$h &ust be addressed# 9he surial o.   atients is related to the adeBua$y o. , the .reBuen$y but not "ith duration o. dialysis session 4,5,6K# *eeral studies indi$ate that the Buality o. li.e (?o@) o.   atients deends on the so$ial and e$ono&i$ stru$ture o. ea$h $ountry, atientLs a%e, seG, edu$ation leel and "orldie"# lso, .a$tors su$h as early re.erral to the do$tor, re%ular &onitorin%, the basi$ disease or $on$o&itant diseases as "ell as .a$tors related to the &ethod o. treat&ent, a..e$t the ?o@ o. the atient# *i%ni.i$ant i&a$t on ?o@ has, also, the la$e "here treat&ent is $arried out (at ho&e or in hosital) 7,,CK# <ati%ue is one o. the &ost $o&&on sy&to&s o. hae&odialysis atients and is asso$iated "ith oor Buality o. li.e10,11,12K# 9he $on$et o. .ati%ue is un$lear "hile it is too di..i$ult to be de.ined and assessed, Bualitatiely and Buantitatiely# /sually, the ter& .ati%ue in$ludes seeral $o&onents, su$h as redu$ed hysi$al and &ental .un$tion, de$reased ener%y and er.or&an$es lo"er than eGe$ted 13K# 9he realen$e o. .ati%ue ran%es .ro& 60D - C7D a&on%  atients on lon%-ter& renal rela$e&ent theray 14K# 9he si%ni.i$an$e o. .ati%ue a&on% atients "ith renal .ailure is underlined by the .a$t that C4D o. these atients "ere een to under%o &ore dialysis sessions, i. there "as a ossibility o. su$h an in$rease in the leel o. their ener%y 15K# 9he leel o. .ati%ue a&on%  atients is one o. the hi%hest o. all $hroni$   &eri$an Journal o. +ursin% *$ien$e 2015; 4(2-1): 66-73 67  atients 16K in$ludin% those "ith seere deression 17K ,$an$er atients under%oin% $he&otheray 1K, and  atients "ith luus 1CK#  atients are su..i$iently si&ilar to those su..erin% .ro& $hroni$ .ati%ue syndro&e, sin$e they hae %enerali=ed "eaness, 20K , de$reased toleran$e in eGer$ise 21K, and slee disorders 22K# 9hese sy&to&s lead to a sense o. Mla$ o. ener%yM 23K# oreoer, the &a'ority o.  atients $o&lain about arious Mnon-se$i.i$M sy&to&s are ery o.ten $onsidered by health ro.essionals as MirreleantM to the .ati%ue# o"eer, i. these MirreleantM sy&to&s $ould be obsered .ro& the ie" o. a Msyndro&eM, it is liely that the .inal dia%nosis and treat&ent o. sy&to&s "ould be ery di..erent 24K# esite the %reat si%ni.i$an$e o. .ati%ue .or  atients, health ro.essionals are una"are o. both the eGisten$e and seerity o. .ati%ue# <or this reason, dia%nosis o. .ati%ue is i&ortant in order to identi.y and treat the $auses o. .ati%ue# ia%nosis o. .ati%ue $an be di..i$ult sin$e the re$oery .ro& .ati%ue sho"s %reat ariability bet"een atients 25K# 9he urose o. this study "as to inesti%ate and $orrelate the leels o. .ati%ue and Buality o. li.e a&on% hae&odialysis  atients# 2( aterials and et$ods  sa&le o. 134 atients under%oin% hae&odialysis, "as re$ruited .ro& dialysis units in the broader area o. thens and  roin$e# *ele$tion $riteria in$luded "ere to be at least 1 years old or &ore, hae the ability to $o&&uni$ate in ree, they &ust hae been dia%nosed "ith end-sta%e renal disease and they &ust had satis.yin% leel o. $ooeration and  er$eied ability# ll alid data "as entered into a sreadsheet .or&at, and analyses "ere er.or&ed usin% *tatisti$al Pa$a%e .or *o$ial *$ien$es, ersion 20#0# 9he sy$ho&etri$ tools "hi$h "ere used in the study are resented belo"# 2.1. Instruments art .ro& the Buestionnaire "ith so$io-de&o%rahi$ $hara$teristi$s o. the atients, t"o Buestionnaires "ere distributed to the arti$iants: The Missoula–VITAS Qualit of !ife In"e# $%& 'MVQ(!I $%&) scale : 9he issoula-9* ?uality o. @i.e ndeG (?@) is an assess&ent tool that %athers in.or&ation about the ?o@ o. atients durin% an adan$ed disease# 9he ree ersion in$ludes 15 Buestions o. the n%lish ori%inal# 9he Buestions are %eneral# ns"ers use a .ie-oint s$ale (@iert), so that the lo"est s$ore indi$ates the least desirable state and i$e ersa# 9he Buestionnaire $onsists o. .ie di&ensions (sy&to&s, .un$tion, interersonal, "ell-bein%, trans$endent) and oerall Buality o. li.e# t is desi%ned se$i.i$ally to assess the ersonal eGerien$e o. ea$h atient in ea$h o. these di&ensions or do&ains o. ?o@# 9he di&ension "ith ne%atie s$ores, a..e$t ne%atiely ?o@# 9he di&ension "ith ositie s$ores, a..e$t ositiely ?o@ 26K# a$h di&ension %ie us in.or&ation about : (a) ssess&ent () - o. er$eied $ir$u&stan$e) (b) *atis.a$tion (*) - o. the status or a$$etan$e o. an a$tual $ir$u&stan$e ($) &ortan$e (the de%ree to "hi$h a %ien di&ension has an i&a$t on the oerall Buality o. li.e)#9he ?@ ite&s are s$ored as .ollo"s: ssess&ent: -2 to N2, *atis.a$tion: -4 to N4, &ortan$e: 1 to 5# 9he s$ore o. ssess&ent and *atis.a$tion $an ran%e .ro& -6 to N6# 9he su& o. ssess&ent and *atis.a$tion is &ultilied by &ortan$e and the result is the oerall i&a$t o. the di&ension on ?o@# 9he internal alidity o. the ree ersion o. the Buestionnaire "as satis.a$tory "ith Aronba$hLs alha 0#74# 27K The *+atigue Assessment Scale '+AS),-  9his Buestionnaire inesti%ates and ealuates the ability o. the atient to $oe in di..erent a$tiities# t $onsists o. ten Buestions "ith "hi$h the in$iden$e o. .ati%ue is eGa&ined# 9he .ie o. the& related to .ati%ue and hal. &ental .ati%ue# 9he 5-oint ratin% s$ale aries .ro& 1F neer, 2 F *o&eti&es; 3 F He%ularly; 4 F .ten and 5 F l"ays# Ohe total s$ore $o&es out addin% the s$ore o. ea$h Buestion# *$ore on the <* $an ran%e .ro& 10 to 50 2K# o"eer, this Buestionnaire is $onsidered as one-di&ensional and, there.ore, "e $an assess only a total s$ore# 2.2. Ethics 9o $ondu$t this resear$h, the sa.ety o. the &aterial "as  resered, anony&ity o. arti$iants "as re%istered and the results obtained "ere used solely .or the uroses o. this inesti%ation# roal .ro& the eart&ent o. +ehrolo%y rou Aenters "as ensured# 3( +esults 9he de&o%rahi$ stru$ture o. the sa&le are resented in 9able 1# He%ardin% the &easure&ent o. .ati%ue leels, the "hole  i$ture o. the sub'e$ts is dei$ted in 9able 2# . the 134  atients under%oin% , it see&ed that their ability to $oe, &entally and hysi$ally, "ith di..erent a$tiities, and to $on$entrate durin% an a$tiity is ery li&ited at 0#7D# 9his  er$enta%e %athers the ealuatie $ate%ory M+eer#M lso, rate o. 52#2D ans"ered Mso&eti&esM, rate o. 32#D ans"ered Mre%ularlyM, 12#7D ans"ered Mo.tenM and 1#5D ans"ered Mal"aysM# t is "orth notin% that &en $o&ared to "o&en $onsider, in a hi%her roortion their ability has been redu$ed - in all assed $ate%ories - as atients $oe in all &entally and  hysi$ally a$tiities, and to $on$entrate enou%h durin% a$tiities# *e$i.i$ally, 1#4D o. those "ho ans"ered Mso&eti&esM "ere &en and 1#6D "o&en# oreoer, 57#6D o. &en and 37#1D o. "o&en ans"ered Mso&eti&es (9ablet 3)# *hould be noted that they re$ede u to 100D o. the ealuatie $ate%ories Mal"aysM and Mneer#M 9he aera%e total s$ore o. atients in <* "as 22,0# He%ardin% the ealuation o. .ati%ue assess&ent indi$ated that the 52,CD o. the atients eGhibits a .ati%ue rate o. 10-20 on the s$ale <*# He%ardin% the ariable o. %ender, it is "orth notin% that the aera%e total s$ore .or "o&en is sli%htly hi%her (0#1CD 0) than &en (22#22 ersus 22,03) ( E0#005)# *$ores distribution o. <* is sho"n in 9able 4#  6 9sia&is eor%ios et al  #: ssess&ent o. ?uality o. @i.e and <ati%ue a&on% ae&odialysis Patients Table 1.  .emographic characteristics of the sample Freuenc! Percent - Valid percent .umulative Percent *eG en CC 73,C 73,C 73,C Qo&en 35 26,1 26,1 100,0 9otal 134 100,0 100,0 %e E 30 3 2,2 2,3 2,3 31- 40 7 5,2 5,3 7,5 41 -50 21 15,7 15, 23,3 51 - 60 31 23,1 23,3 46,6 61 - 70 43 32,1 32,3 7,C 71 - 0 22 16,4 16,5 C5,5 1 R 6 4,5 4,5 100,0 *ubtotal 133 CC,3 100,0  +ot ans"er 1 ,7 9otal 134 100,0 du$ational @eel Pri&ary s$hool 3 2,4 2,6 2,6 *e$ondary s$hool 27 20,1 20,3 4,C i%h s$hool 37 27,6 27, 76,7 /niersity 27 20,1 20,3 C7,0 aster de%ree 4 3,0 3,0 100,0 *ubtotal 133 CC,3 100,0  +ot ans"er 1 ,7 9otal 134 100,0 arital *tatus /n&arried 25 1,7 1,7 1,7 arried C 66,4 66,4 5,1 ior$ed 11 ,2 ,2 C3,3 Qido"ed C 6,7 6,7 100,0 9otal 134 100,0 100,0 $$uation /ne&loyed 4 3,0 3,0 3,0 Aollar e&loyees C 6,7 6, C, Aiil serants 6 4,5 4,5 14,3 <reelan$ers C 6,7 6, 21,1 ousehold 1C 14,2 14,3 35,3 Hetired 5 63,4 63,C CC,2 *tudent 1 ,7 , 100,0 *ubtotal 133 CC,3 100,0  +ot ans"er 1 ,7 9otal 134 100,0 Table 2.  +atigue Assessment Scale $ +AS 'o/erall) Freuenc! Percent - Valid percent .umulative Percent  +eer 1 1 ,7 ,7 ,7 *o&eti&es 2 70 52,2 52,2 53,0 He%ularly 3 44 32, 32, 5, .ten 4 17 12,7 12,7 C,5 l"ays 5 2 1,5 1,5 100,0 9otal 134 100,0 100,0 Table 3.  +ATI012 ASS2SSM2NT SCA!2 –+AS '(/erall) en /omen Total 0 -* -** 0 -* -** 0 -* -**  +eer 1 - - - 1 100 2,C 1 100 0,7 *o&eti&es 2 57 1,4 57,6 13 1,6 37,1 70 100 52,2 He%ularly 3 27 61,4 27,3 17 3,6 4,6 44 100 32, .ten 4 13 76,5 13,1 4 23,5 11,4 17 100 12,7 l"ays 5 2 100 2 - - - 2 100 1,5 9otal CC 73,C 100 35 26,1 100 134 100  +ot ans"er 0 , P E 0,05 S $olu&n reresents the ealuatie $ate%ory SS $olu&n reresents seG Table 4.  .istri3ution of patients in +atigue Assessment Scale Freuenc! Percent - .umulative Percent 10E <* EF20 71 52,C 52,C 20E <* EF30 43 32,1 5,0 30E <* EF40 1 13,5 C5,5 40E <* EF50 2 1,5 100,0 9otal 134 100,0 P E 0,05     &eri$an Journal o. +ursin% *$ien$e 2015; 4(2-1): 66-73 6C s .ar as the .inal results on the ?@-15 s$ale , the ans"ers to ea$h o. the indiidual .a$tors are resented in 9able 5# Table 5.  +inal results of the in"i/i"ual factors on the scale MVQ(!I$%& verall ualit! o" i"e Freuenc! Percent- Valid percent .umulative Percent ery oor 2 1,5 1,5 1,5 Poor C 6,7 6,7 ,2 oderate 51 3,1 3,1 46,3 %ood 56 41, 41, ,1 ery %ood 16 11,C 11,C 100,0 9otal 134 100,0 100,0 *y&to& (*) *tron%ly disa%ree 72 53,7 53,7 53,7 isa%ree 3 2,2 2,2 56,0  +either a%ree nor disa%ree 15 11,2 11,2 67,2 *tron%ly a%ree 22 16,4 16,4 3,6 %ree 22 16,4 16,4 100,0 9otal 134 100,0 100,0 <un$tion (<) *tron%ly disa%ree C 6,7 6,7 6,7 isa%ree 30 22,4 22,4 2C,1  +either a%ree nor disa%ree 1C 14,2 14,2 43,3 *tron%ly a%ree 51 3,1 3,1 1,3 %ree 25 1,7 1,7 100,0 9otal 134 100,0 100,0 nterersonal (P) *tron%ly disa%ree 6 4,5 4,5 4,5 isa%ree 10 7,5 7,5 11,C  +either a%ree nor disa%ree 24 17,C 17,C 2C,C *tron%ly a%ree 74 55,2 55,2 5,1 %ree 20 14,C 14,C 100,0 9otal 134 100,0 100,0 Qell-Tein% (QT) *tron%ly disa%ree 77 57,5 57,5 57,5 isa%ree 23 17,2 17,2 74,6  +either a%ree nor disa%ree 14 10,4 10,4 5,1 *tron%ly a%ree C 6,7 6,7 C1, %ree 11 ,2 ,2 100,0 9otal 134 100,0 100,0 9rans$endent (9) *tron%ly disa%ree 66 4C,3 4C,3 4C,3 isa%ree 33 24,6 24,6 73,C  +either a%ree nor disa%ree 10 7,5 7,5 1,3 *tron%ly a%ree 10 7,5 7,5 , %ree 15 11,2 11,2 100,0 9otal 134 100,0 100,0 9he atientsL &ean s$ore .or the di&ensions o. ?@-15 is sho"n in 9able 6# Table 6. Score of each "imension in MVQ(!I $%&   en /omen Total erall ?o@ 3,63 3,34 3,55 *y&to&s 5,7C 6,42 5,C6 <un$tion 4,04 4,6 4,20 nterersonal 5,64 6,C1 5,C7 Qell-bein% -10,6 -,54 -10,12 9rans$endent -C,C4 -C,57 -C,5 9otal s$ore 14,4 14,CC 14,63 P E 0,00 n order to study ?o@ o. 134 atients $o&ared "ith .ati%ue, "e diided the atients into t"o %rous# 9he .irst %rou $onsisted o. atients "ith a s$ore less than or eBual to 30 (+ F 114) in <* "hile the se$ond %rou $onsisted o. atients "ith a s$ore %reater than 30 in <* (UF20)(E0#005)# (9able 7) Table 7.  .istinguishing patients in 0roups- 0 Percentage - <*EF30 (rou 1) 114 5,0D <* R30 (rou 2) 20 14,C2D 9otal 134 100,0D  E0,005 9he results o. $orrelation bet"een .ati%ue and the di&ensions o. ?o@ are resented in 9able # $$ordin% to 9able , the atients "ith lo" .ati%ue rates (rou 1) aear to eGhibit hi%her s$ore in di&ensions o. ?@-15 $o&ared to those "ho eGhibit hi%h .ati%ue rates (rou 2)# 9he rou 1 sho"s a lo"er s$ore $o&ared to rou 2 in the di&ension o.  70 9sia&is eor%ios et al  #: ssess&ent o. ?uality o. @i.e and <ati%ue a&on% ae&odialysis Patients trans$endent# 9he total s$ore o. all the di&ensions "as 14#63# Table 8. Comparison of each "imension 3et4een the t4o groups Group 1 Group 2 erall Buality o. li.e 3,67 2,C0 *y&to&s 6,65 2,00 <un$tion 5,00 -0,35 nterersonal 6,33 3,C5 Qell-bein% -C,56 -13,35 9rans$endent -11,65 0,45 9otal s$ore 14,67 14,27 P E 0,005   4( 5iscussion n this study "e atte&ted to inesti%ate the leels o. .ati%ue, Buality o. li.e o.  atients and to $orrelate these t"o ara&eters# 134 atients "ere enrolled# 35 "ere "o&en and CC &en# 9he &a'ority o. atients (55#6D) belon%ed to the a%e %rou 51-70# 9he &a'ority o. atients (63#CD) "ere retired# 9he aera%e total s$ore o. atients in <* Buestionnaire "as 22,0 "hile in ?@-15 "as 14,63 #He%ardin% the %ender, "o&en had sli%htly hi%her (0#1CD 0) .ati%ue rate than &en# 4.1. Fatigue $$ordin% to the .indin%s o. our study and the literature, .ati%ue is a $o&leG heno&enon "hi$h ne%atiely a..e$ts health-related ?o@ o.  atients 2C,30K# enerally,  atients o. our study sho" to hae lo" to &oderate leels o. .ati%ue# n the study o. ori%an et al, .ati%ue see&s to o$$ur at hi%h rates (60D - C7D o.   atients) 31K #9he rates are hi%her than the rates o. our study "hi$h sho"ed that 47#1D hae &oderate to ery hi%h stress leels "hile 52#CD o. atients sho"in% lo" .ati%ue rates# 9he lo" er$enta%e o. &oderate and hi%h .ati%ue and the hi%h  er$enta%e o. lo" .ati%ue in our study is robably due to the .a$t that the &a'ority o. atients "ere non-diabeti$, belo" 70 years and &en (73#CD)# He%ardin% the last .eature "e should note that %ender see&s to in.luen$e the leel o. .ati%ue a&on%  atients# n our study, "o&en had hi%her rate o. .ati%ue in relation to &en# ther studies, also, indi$ate that "o&en su..er .ro& hi%her leels o. .ati%ue than &en 32,33,34K# 4.2. Quality o !ie n ree$e, assess&ent studies o. health-related ?o@ o.   atients are &ini&al 27, 35,36,K# 9he ?@ Buestionnaire has been used a%ain in ree  atients by 9heo.ilou et al 27K# 9he results o. this study tend to be si&ilar to those o. our study# 9he total s$ore o. ?@-15 ?@ s$ale o. the  atients "as 17#36 "hile in our study "as 14#63# 9he ratin% in the study o. 9heo.ilou .or the di&ension o. interersonal relations "as 16#26, &ore than any other di&ension# 9he sa&e alies in our study "here the s$ore .or the di&ension o. interersonal relations "as 5#C7, the hi%hest o. all di&ensions# (E0,005)# 9here.ore, the di&ension o. interersonal relationshis is the di&ension that a..e$ts ositiely in &ost the ?o@ o.  atients# 9his $ould be attributed to the .a$t that these atients are &issin% .ro& their house three ti&es a "ee , they are around health $are ro.essionals and nurses so they .eel l they $an &ae so$ial relationshis# n addition, 66,4D o. the sa&le "as &arried# 9hat "ay erhas it is eGlained that the subs$ale o. interersonal relationshis ositiely a..e$t ?@# ialysis atients, lie other $hroni$ally atients, reBuire a %reat deal o. so$ial suort# 9he de%ree o. .a&ily suort has been des$ribed as an i&ortant redi$tor o. the ?o@ a&on% other  atients 37K# 9yi$ally, the souse is the .irst line o. suort .or the &arried atient; $o&ared to .a&ily and .riends .or non-&arried atients# o"eer, bein% &arried and liin% "ith a $hroni$ disease &ay ne%atiely i&a$t on &arital li.e# 9he di&ensions o. .un$tion (s$ore: 4#26) and sy&to&s (s$ore: 3#3) .ollo" in the study o. 9heo.ilou "hile in our study the di&ensions o. sy&to&s (s$ore: 5,C6) and o. .un$tion .ollo" (s$ore: 4,2 ) ( E0,005)# Qe $on$lude, there.ore, that in both studies the di&ensions o. interersonal relationshis, sy&to&s and .un$tion ositiely a..e$t ?o@ o.  atients# 9he di&ension that a..e$ts, in both studies, &ore ne%atiely the ?o@ o.  atients .ro& all di&ensions, is that o. "ell-bein%# He%ardin% the di&ension o. trans$endent "e .ound di..eren$es bet"een the t"o studies# *e$i.i$ally, in our study the di&ension o. trans$endent (s$ore: -C,5) ne%atiely a..e$ts the ?o@ o.  atients "hereas in the study o. 9heo.ilou a..e$ts ositiely (s$ore: 6,75)# s .ar as the di&ension o. the oerall ?o@ , s$ore "as not si%ni.i$antly di..erent bet"een the t"o studies (3,55 .or our study and 3#25 .or the other study)# ender is a .a$tor "hi$h a..e$ts ?o@ in %eneral oulation and  atients as "ell 3K# <e&ales hae oor ?o@ as $o&ared to &ale atients# n our study "o&en sho"ed hi%her s$ores in interersonal relationshis# n $ontrast, in the study o. nees .e&ales hae oor ?@ as $o&ared to &ale  atients in so$ial relationshi di&ension 32K# 4.3. "orrelation o Fatigue an# Quality o !ie 9o study the $orrelation o. .ati%ue "ith the ?o@ o. 134  atients, "e diided atients into t"o %rous# 9he .irst %rou $onsisted o. atients "ith a s$ore less than or eBual to 30 (+ F 114) in <* "hile the se$ond %rou $onsisted o. atients "ith a s$ore %reater than 30 in <*# 9he results sho"ed that  atients "ith lo" .ati%ue leels see& to en'oy better ?o@ $o&ared to those "ho hae hi%h .ati%ue leels# Aonsiderin% the burden o. the sy&to&s that are daily eGerien$ed by atients under%oin%  ("eaness, nausea, $ra&s, it$hin%, ain) 3C,40K$orrelated the leels o. .ati%ue "ith the subs$ale o. sy&to&s# 9he di&ension o. sy&to&s a..e$tin% &ore ositie Buality o. li.e .or atients "ho are eGerien$in% lo"er leels o. .ati%ue (rou 1s$ore: 6,65) $o&ared to those "ho are eGerien$in% hi%her leels o. .ati%ue (rou 2s$ore: 2) (E0,005)# Jha&b et al 14K reorted that  atients "ith hi%h leels o. .ati%ue $ouldnVt &ana%e hysi$al sy&to&s su$h as ain, "hile <inne%an JJW 9ho&as 41K indi$atin% that .ati%ue, oor body ener%y, and natural $han%es o. the body (su$h as la$in% a $entral enous $atheter), $han%es in nor&al body "ei%ht, s$ares &ay
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