تاثير گروه درماني مبتني بر پذيرش و تعهد بر افزايش كيفيت زندگي بيماران پيوند كليه و همودياليزي شهر زنجان: يك مطالعه كارآزمايي باليني تصادفي شده

The Effect of Acceptance and Commitment Based Group Therapy on Increasing the Quality of Life in Kidney Transplant and Hemodialysis Patients in Zanjan City: A Randomized Clinical Trial Study

زﻣﯿﻨﻪ و ﻫﺪف: ﺑﯿﻤﺎريﻫﺎي ﮐﻠﯿﻮي ﺳﻼﻣﺖ ﺟﺴﻢ و روان را ﺗﻬﺪﯾﺪ ﻣﯽﮐﻨﻨﺪ. درﻣﺎن ﭘﺬﯾﺮش و ﺗﻌﻬﺪ، ﯾﮑﯽ از درﻣﺎنﻫﺎي رﻓﺘﺎري ﻧﺴﻞ ﺳﻮم اﺳﺖ ﮐﻪ ﺑﺮ ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ ﺑﯿﻤﺎران ﻣﺆﺛﺮ ﺑﻮده اﺳﺖ. ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺗﻌﯿﯿﻦ ﺗﺄﺛﯿﺮ درﻣﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ ﺑﺮ اﻓﺰاﯾﺶ ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ ﺑﯿﻤﺎران ﻫﻤﻮدﯾﺎﻟﯿﺰي و ﭘﯿﻮﻧﺪ ﮐﻠﯿﻪ ﺷﻬﺮ زﻧﺠﺎن اﻧﺠﺎم ﺷﺪ. ﻣﻮاد و روشﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﯾﮏ ﮐﺎرآزﻣﺎﯾﯽ آﻣﻮزﺷﯽ ﺗﺼﺎدﻓﯽ ﺷﺪه ﺑﻮد. ﺟﺎﻣﻌﻪ آﻣﺎري ﭘﮋوﻫﺶ ﺷﺎﻣﻞ ﺗﻤﺎﻣﯽ ﺑﯿﻤﺎران ﻫﻤﻮدﯾﺎﻟﯿﺰي و ﭘﯿﻮﻧﺪ ﮐﻠﯿﻪ ﺷﻬﺮ زﻧﺠﺎن در ﺳﺎل 1396)داراي ﭘﺮوﻧﺪه در اﻧﺠﻤﻦ ﺑﯿﻤﺎران ﮐﻠﯿﻮي( ﺑﻮد. از ﺑﯿﻦ آنﻫﺎ 80 ﺑﯿﻤﺎر اﻧﺘﺨﺎب و ﺑﻪﺻﻮرت ﺗﺼﺎدﻓﯽ در ﮔﺮوه ﮐﻨﺘﺮل )دو ﮔﺮوه( و آزﻣﺎﯾﺶ )دو ﮔﺮوه( ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﮔﺮوهﻫﺎي آزﻣﺎﯾﺸﯽ درﻣﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ را ﻃﯽ ﻫﺸﺖ ﺟﻠﺴﻪ، ﻫﺮ ﻫﻔﺘﻪ ﯾﮏ ﺟﻠﺴﻪ 1/5 ﺳﺎﻋﺘﻪ درﯾﺎﻓﺖ ﮐﺮدﻧﺪ و ﮔﺮوهﻫﺎي ﮐﻨﺘﺮل ﻫﯿﭻ ﻣﺪاﺧﻠﻪاي را درﯾﺎﻓﺖ ﻧﮑﺮد. در ﭘﺎﯾﺎن دوره ﻧﯿﺰ از ﻫﺮ دو ﮔﺮوه ﭘﺲآزﻣﻮن ﺑﻪﻋﻤﻞ آﻣﺪ. دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎد از ﺗﺤﻠﯿﻞ ﮐﻮوارﯾﺎﻧﺲ ﭼﻨﺪ ﻣﺘﻐﯿﺮه )ﻣﺎﻧﮑﻮوا( و ﺗﺤﻠﯿﻞ ﮐﻮوارﯾﺎﻧﺲ ﯾﮏﻣﺘﻐﯿﺮه )ANCOVA( ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﺷﺪﻧﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ و اﻧﺤﺮاف اﺳﺘﺎﻧﺪارد ﺳﻦ ﮔﺮوه آزﻣﺎﯾﺶ )ﭘﯿﻮﻧﺪ ﮐﻠﯿﻪ 41/95±8/98 و ﻫﻤﻮدﯾﺎﻟﯿﺰي 39/10±8/89( و ﮔﺮوه ﮐﻨﺘﺮل )ﭘﯿﻮﻧﺪ ﮐﻠﯿﻪ 42/20±9/12 و ﻫﻤﻮدﯾﺎﻟﯿﺰي 45/35±6/47( ﺳﺎل ﺑﻮد )0/148=p(. در ﻣﺘﻐﯿﺮ ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ و اﺑﻌﺎد آن ﺷﺎﻣﻞ ﺳﻼﻣﺖ روان و ادراك از ﻣﺤﯿﻂ زﻧﺪﮔﯽ ﺑﯿﻦ ﮔﺮوه ﭘﯿﻮﻧﺪ ﮐﻠﯿﻪ، ﻫﻤﻮدﯾﺎﻟﯿﺰ اﺧﺘﻼف ﻣﻌﻨﯽداري وﺟﻮد دارد )0/001

kidney diseases threaten mental and physical health. Acceptance and commitment therapy is a third generation treatment that affects life quality of patients. The present research aimed at determining the effect of acceptance and commitment based therapy on life quality of homodialized and kidney transplant patients in Zanjan city. Materials and Methods: This was a randomized clinical trial study. Statistics of the research includes all homodialized and kidney transplant patients admitted in kidney patients association in 2017. Eighty out of them were chosen and randomly grouped in control (two) and experimental (two) groups. The experimental group of acceptance and commitment based therapy were treated for 8 sessions (a 1.5 hour session per week) and the control groups received no intervention. Posttest was accomplished in both groups at end of the experiment. Data were analyzed using multiple analysis of covariance (MANCOVA) and one-way analysis of covariance (ANCOVA). Results:: Mean and standard deviation of the experimental group age was 41.95±8.98 and 10.39±8.89 years for kidney transplantation and hemodialyzed groups, respectively and in the control group 42.20±9.12 and 45.35±6.47 years for kidney transplantation and hemodialyzed groups, respectively (p=0.148).There was a significant differencein life quality and its dimensions including mental health and perception of life environment between kidney transplantation and hemodialysis groups (p<0.001) Conclusion: According to the findings, using acceptance and commitment based therapy is suggested as an effective and complementary psychological intervention in kidney and homodialyzed patients to improve their life quality.