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Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator
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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator

Moon Sook Hwang, Ph.D., APN1, Mi Kyung Lee, Ph.D., APN2, Jong Rye Song, Ph.D., APN3
Korean Journal of Adult Nursing 2016;28(5):595-606.
Published online: October 31, 2016

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Corresponding author: Hwang, Moon Sook Department of Nursing Science, School of Oriental Medicine in WooSuk University, 443 Samyre-Ro, Samyre-up, Wanju 55338, Korea. Tel: +82-63-291-1989, Fax: +82-63-291-1547, E-mail: msyellow45@hanmail.net
• Received: September 2, 2016   • Accepted: October 27, 2016

Copyright © 2016 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study aimed to investigate the influencing factors on self care, respiratory difficulty, sleep impediment, anxiety and depression among patients with neuromuscular disease who are dependent on Home Mechanical Ventilator (HMV).
  • Methods
    157 patients were recruited through hospital based home nursing care departments and HMV rental centers. Data were collected by questionnaires. The analytic methods were n (%) / M±SD, x2 / t-test or ANOVA and multiple linear regression.
  • Results
    Patients with Amyotrophic lateral sclerosis were more likely to utilize HMV, had shorter periods of morbidity and the most extended daily use of HMV. As for medical equipment, they had ambu-bag (87.2%) and oxygenator (15.4%). Reports of respiratory difficulty and sleep impediment were low. There were no significant difference. In contrast, reported anxiety and depression were high and showed significant difference between non invasive HMV and invasive HMV. Anxiety contributes to respiratory difficulty (t=3.62, p=.002), sleep impediment (t=2.06, p=.042), and depression (t=7.24, p<.001). However, home nursing care exerts a positive influence in reducing anxiety (t=-2.73, p=.008).
  • Conclusion
    Anxiety contributes to respiratory difficulty, sleep impediment, and depression. However, those who use home nursing care reported less anxiety. Home nursing care positively impacts patients dependent on HMV as a practical service and available resource.
  • Key Words: Ventilator; Respiration; Sleep; Anxiety; Depression
Table 1.
Comparisons of General Characteristics by Applied Method of HMV (N=157)
Variables Categories Total (N=157) Non IHMV (n=55) IHMV (n=102) x2 or t p
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Gender Male 101 (64.3) 42 (76.4) 59 (57.8) 5.34 .021
Female 56 (35.7) 13 (23.6) 43 (42.2)
Age (year) ＜45 68 (43.6) 41 (75.9) 27 (26.5)   ＜.001†
45~＜65 61 (39.1) 10 (18.5) 51 (50.0)
≥65 27 (17.3) 3 (5.6) 24 (23.5)
  43.46±21.71 30.87±17.46 51.12±20.82 -5.80 ＜.001
Religion No 50 (31.8) 18 (32.7) 32 (31.4) 0.03 .862
Yes 107 (68.2) 37 (67.3) 70 (68.6)
Family member Couple 24 (15.4) 5 (9.1) 19 (18.8) 3.10 .212
Couple & offspring 97 (62.2) 35 (63.6) 62 (61.4)
Parent & others 35 (22.4) 15 (28.3) 20 (19.8)
Number of caring person 1.75±0.80 1.63±0.77 1.81±0.82 -1.25 .215

Missing data be excluded; IHMV=invasive home mechanical ventilator;

†Fisher's exact test.

Table 2.
Comparisons of Disease related Characteristics by Applied Method of HMV (N=157)
Variables Categories Total (N=157) Non IHMV (n=55) IHMV (n=102) x2 or t p
n (%)/M±SD n (%)/M±SD n (%)/M±SD
Physical functional status 0.82±.087 1.75±0.61 0.32±0.51 14.88 ＜.001
   Diagnosis ALS 87 (55.1) 13 (23.6) 74 (75.2) 35.22 ＜.001
SMA & PMD 51 (32.9) 32 (58.2) 19 (18.6)
Others 19 (12.0) 10 (6.4) 9 (8.8)
Morbidity duration of disease (month) 100.53±73.82 128.75±77.31 85.38±67.55 3.51 .001
   Diagnosis ALSa 75.41±63.24 62.08±58.32 73.28±52.87
SMA & PMDb 141.26±69.69 151.93±66.60 125.00±75.01
Othersc 109.00±82.65 141.50±86.11 72.89±65.12
F (p) 13.92 (＜.001) 7.42 (.002) 5.23 (.007)
  b＞c＞a b, c＞a b＞a, c
Utility duration of HMV (month) 43.42±35.37 44.43±35.09 42.87±35.68 0.26 .795
   Diagnosis ALS 39.20±31.50 34.69±24.16 40.18±32.91
SMA & PMD 52.00±38.53 47.97±36.70 57.29±42.31
Others 40.37±42.11 45.10±42.45 34.00±41.11
F (p) 1.78 (.154) 0.66 (.521) 1.90 (.155)
Applied hours of HMV (day) 18.77±7.17 11.79±6.08 22.46±4.47 -11.41 ＜.001
   Diagnosis ALSa 21.99±5.35 14.67±8.52 23.16±3.51
SMA & PMDb 14.40±6.95 10.77±4.67 20.33±5.88
Othersc 15.89±7.78 11.60±6.22 20.67±6.63
F (p) 26.04 (＜.001) 1.86 (.165) 3.89 (.024)
  a＞b, c   a＞b, c
Type of HMV Volume 102 (65.0) 41 (74.5) 61 (59.8) 3.41 .065
Pressure 55 (35.0) 14 (25.5) 41 (40.2)
Parameter of HMV In case of TV 636.76±273.88 840.24±209.77 561±209.77 7.22 ＜.001
In case of PIP 13.41±4.38 11.82±5.09 13.97±4.02 -1.60 .116
Respiratory rate 15.43±4.41 14.69±3.13 15.85±4.94 -1.56 .120
Change of parameter (6 months) No 103 (65.6) 35 (63.6) 68 (66.7) 0.14 .764
Yes 54 (34.4) 20 (36.4) 34 (33.3)
Reason† (yes only) RD 23 (33.3) 5 (19.2) 18 (11.4) 1.67 .232
Headache 23 (33.3) 10 (38.5) 13 (12.8)
Problem of HMV 4 (5.8) 1 (3.8) 3 (2.0)
After check up 6 (8.7) 0 (0.0) 6 (3.9)
Others 13 (18.8) 10 (38.5) 3 (7.0)
Changer of parameter Physician 74 (67.9) 35 (83.3) 39 (58.2)   .014*
Home care nurse 13 (11.9) 4 (9.5) 9 (13.4)
Employer of equipment 22 (20.2) 3 (7.1) 19 (28.4)
Home nursing care No 60 (38.2) 48 (87.3) 12 (11.8) 86.28 ＜.001
Yes 97 (61.8) 7 (12.7) 90 (88.2)

Missing data be excluded; IHMV=invasive home mechanical ventilator; ALS=amytrophic lateral sclerosis; SMA=spinal muscular atrophy; PMD=primary muscular disease; TV=tidal volume; PIP=peak inspiratory pressure; RD=respiratory difficulty;

†Fisher's exact test.

Table 3.
Comparisons of Self Care by Applied Method of HMV (N=157)
Variables Categories Total (N=157) Non IHMV (n=55) IHMV (n=102) x2 p
n (%) n (%) n (%)
HMV related Holding equipment† (yes only) Equipment for suction 109 (69.9) 14 (12.8) 95 (87.2) 75.77 ＜.001
Equipment for oxygen 24 (15.4) 4 (16.7) 20 (83.3)   .061
Ambu bag 136 (87.2) 44 (32.4) 92 (67.6) 2.40 .121
Pulse oxymetry 80 (51.3) 26 (32.5) 54 (67.5) 0.33 .569
Assisted cough 84 (53.8) 49 (58.3) 35 (41.7) 4.00 .046
Changing cycle of circuit q 2 weeks 29 (23.4) 18 (37.5) 11 (14.3) 9.72 .008
q≥1 month 95 (76.6) 30 (62.5) 65 (85.7)
Changer of circuit Family caregiver 44 (29.7) 18 (33.4) 26 (27.7) 4.45 .218
Employer of company 80 (54.1) 24 (44.4) 56 (59.6)
Home care nurse 24 (16.2) 12 (22.2) 12 (12.8)
Changing cycle of filter q 2 weeks 11 (15.1) 1 (4.8) 10 (19.2)   .272
q 1 month and above 62 (74.9) 20 (95.5) 39 (75.0)
Changer of filter Family caregiver 103 (76.5) 33 (58.9) 68 (69.4)   .073
Employer of company 45 (29.0) 17 (30.4) 28 (28.6)
Home care nurse 7 (4.5) 6 (10.7) 2 (2.0)
Life habit related Respiratory exercise (yes only)‡ Cough assisted coughing 90 (59.2) 35 (66.0) 55 (55.6)   .210
Postural drainage 18 (11.3) 3 (6.8) 15 (18.3)   .109
Chest vibration 10 (7.2) 3 (6.5) 7 (7.5)   1.000
Exercise of accumulated air 55 (41.0) 25 (55.6) 30 (33.7) 5.90 .015
Respiratory muscle exercise 29 (21.0) 15 (33.3) 14 (15.1)   .040
Suction of airway 104 (74.3) 9 (21.4) 95 (96.9)   ＜.001
General exercise No 61 (39.1) 23 (42.6) 38 (37.3) 0.42 .516
Yes 95 (60.9) 31 (57.4) 64 (62.7)    
Major type of meal Oral diet 74 (47.1) 48 (87.3.) 26 (25.5) 54.74 ＜.001
Tube feeding 83 (52.9) 7 (12.7) 76 (74.5)    
Elevated upper body during meal No 32 (20.8) 20 (38.5) 12 (11.8) 14.91 ＜.001
Yes 122 (79.2) 32 (61.5) 90 (88.2)    
Oral care No 18 (11.7) 10 (18.9) 8 (7.9) 4.05 .045
Yes 136 (88.3) 43 (81.1) 93 (92.1)    

Missing data be excluded; IHMV=invasive home mechanical ventilator;

†Fisher's exact test;

‡Multiple respondent.

Table 4.
Comparisons by Applied Method and Influencing Factors on Respiratory Difficulty, Sleep Impediment, Anxiety, and Depression (N=157)
Variables Total (n=157) Non IHMV (n=55) IHMV (n=102) t (p) Variables (Constant) B β t p R2 Adj. R2
M±SD M±SD M±SD
Respiratory difficulty 0.88±1.10 0.76±1.07 0.95±1.18 -0.94 (Constant) 3.55   3.61 ＜.001 .16 .14
(.347) Anxiety 0.97 0.30 3.62 .002
Utility duration of HMV -0.02 -0.24 -2.57 .012
Gender (male) -1.31 -0.22 -2.31 .023
Sleep impediment 0.44±0.29 0.43±0.31 0.45±0.28 -0.41 (Constant) 1.30   5.88 ＜.001 .32 .28
(.681) SMA & PMD(yes) 0.50 0.32 2.91 .004
Duration of morbidity -0.01 -0.20 -2.05 .043
Applied method(IHMV) -0.48 -0.31 -3.08 .003
Changing cycle of circuit 0.31 0.19 2.13 .035
Anxiety 0.18 0.21 2.06 .042
Anxiety 1.41±0.85 0.96±0.77 1.69±0.83 -5.27 (Constant) 0.23   1.30 .198    
(＜.001) Depression 0.62 0.62 8.42 ＜.001    
Sleep impediment 0.22 0.19 2.83 .006 .62 .60
Physical functional status -0.35 -0.33 -3.57 .001
HNC(yes) -0.43 -0.24 -2.73 .008
Depression 1.68±0.84 1.13±0.79 2.1±12 -6.60 (Constant) 0.53   3.02 .003 .66 .65
(＜.001) Anxiety 0.51 0.51 7.24 ＜.001
Age 0.02 0.46 5.30 ＜.001
Duration of morbidity -0.01 -0.21 -2.70 .008

Missing data be excluded; Gender: Male (1) vs Female (0); Diagnosis: ALS (no) 0 vs SMA & PMD (yes)1; Applied method: non Invasive (0) vs Invasive (1); HNC (Home nursing care): No (0) vs Yes (1); IHMV=invasive home mechanical ventilator, SMA=spinal muscular atrophy; PMD=primary muscular disease; Adj. R

2=Adjusted R

2.

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      Shahrokh Yousefzadeh-Chabok, Naema Khodadadi-Hassankiadeh, Alia Saberi, Atefeh Ghanbari Khanghah, Homa Zarrabi, Mohammad Reza Yeganeh, Hamideh Hakimi, Anoush Dehnadi Moghadam
      Caspian Journal of Neurological Sciences.2018; 4(15): 159.     CrossRef

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    Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator
    Korean J Adult Nurs. 2016;28(5):595-606.   Published online October 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.5.595
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    Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator
    Korean J Adult Nurs. 2016;28(5):595-606.   Published online October 31, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.5.595
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    Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator
    Survey on Self Care, Respiratory Difficulty, Sleep Impediment, Anxiety and Depression among Patients with Neuromuscular Disease dependent on Home Mechanical Ventilator

    Comparisons of General Characteristics by Applied Method of HMV (N=157)

    Variables Categories Total (N=157) Non IHMV (n=55) IHMV (n=102) x2 or t p
    n (%) or M±SD n (%) or M±SD n (%) or M±SD
    Gender Male 101 (64.3) 42 (76.4) 59 (57.8) 5.34 .021
    Female 56 (35.7) 13 (23.6) 43 (42.2)
    Age (year) ＜45 68 (43.6) 41 (75.9) 27 (26.5)   ＜.001†
    45~＜65 61 (39.1) 10 (18.5) 51 (50.0)
    ≥65 27 (17.3) 3 (5.6) 24 (23.5)
      43.46±21.71 30.87±17.46 51.12±20.82 -5.80 ＜.001
    Religion No 50 (31.8) 18 (32.7) 32 (31.4) 0.03 .862
    Yes 107 (68.2) 37 (67.3) 70 (68.6)
    Family member Couple 24 (15.4) 5 (9.1) 19 (18.8) 3.10 .212
    Couple & offspring 97 (62.2) 35 (63.6) 62 (61.4)
    Parent & others 35 (22.4) 15 (28.3) 20 (19.8)
    Number of caring person 1.75±0.80 1.63±0.77 1.81±0.82 -1.25 .215

    Missing data be excluded; IHMV=invasive home mechanical ventilator;

    †Fisher's exact test.

    Comparisons of Disease related Characteristics by Applied Method of HMV (N=157)

    Variables Categories Total (N=157) Non IHMV (n=55) IHMV (n=102) x2 or t p
    n (%)/M±SD n (%)/M±SD n (%)/M±SD
    Physical functional status 0.82±.087 1.75±0.61 0.32±0.51 14.88 ＜.001
       Diagnosis ALS 87 (55.1) 13 (23.6) 74 (75.2) 35.22 ＜.001
    SMA & PMD 51 (32.9) 32 (58.2) 19 (18.6)
    Others 19 (12.0) 10 (6.4) 9 (8.8)
    Morbidity duration of disease (month) 100.53±73.82 128.75±77.31 85.38±67.55 3.51 .001
       Diagnosis ALSa 75.41±63.24 62.08±58.32 73.28±52.87
    SMA & PMDb 141.26±69.69 151.93±66.60 125.00±75.01
    Othersc 109.00±82.65 141.50±86.11 72.89±65.12
    F (p) 13.92 (＜.001) 7.42 (.002) 5.23 (.007)
      b＞c＞a b, c＞a b＞a, c
    Utility duration of HMV (month) 43.42±35.37 44.43±35.09 42.87±35.68 0.26 .795
       Diagnosis ALS 39.20±31.50 34.69±24.16 40.18±32.91
    SMA & PMD 52.00±38.53 47.97±36.70 57.29±42.31
    Others 40.37±42.11 45.10±42.45 34.00±41.11
    F (p) 1.78 (.154) 0.66 (.521) 1.90 (.155)
    Applied hours of HMV (day) 18.77±7.17 11.79±6.08 22.46±4.47 -11.41 ＜.001
       Diagnosis ALSa 21.99±5.35 14.67±8.52 23.16±3.51
    SMA & PMDb 14.40±6.95 10.77±4.67 20.33±5.88
    Othersc 15.89±7.78 11.60±6.22 20.67±6.63
    F (p) 26.04 (＜.001) 1.86 (.165) 3.89 (.024)
      a＞b, c   a＞b, c
    Type of HMV Volume 102 (65.0) 41 (74.5) 61 (59.8) 3.41 .065
    Pressure 55 (35.0) 14 (25.5) 41 (40.2)
    Parameter of HMV In case of TV 636.76±273.88 840.24±209.77 561±209.77 7.22 ＜.001
    In case of PIP 13.41±4.38 11.82±5.09 13.97±4.02 -1.60 .116
    Respiratory rate 15.43±4.41 14.69±3.13 15.85±4.94 -1.56 .120
    Change of parameter (6 months) No 103 (65.6) 35 (63.6) 68 (66.7) 0.14 .764
    Yes 54 (34.4) 20 (36.4) 34 (33.3)
    Reason† (yes only) RD 23 (33.3) 5 (19.2) 18 (11.4) 1.67 .232
    Headache 23 (33.3) 10 (38.5) 13 (12.8)
    Problem of HMV 4 (5.8) 1 (3.8) 3 (2.0)
    After check up 6 (8.7) 0 (0.0) 6 (3.9)
    Others 13 (18.8) 10 (38.5) 3 (7.0)
    Changer of parameter Physician 74 (67.9) 35 (83.3) 39 (58.2)   .014*
    Home care nurse 13 (11.9) 4 (9.5) 9 (13.4)
    Employer of equipment 22 (20.2) 3 (7.1) 19 (28.4)
    Home nursing care No 60 (38.2) 48 (87.3) 12 (11.8) 86.28 ＜.001
    Yes 97 (61.8) 7 (12.7) 90 (88.2)

    Missing data be excluded; IHMV=invasive home mechanical ventilator; ALS=amytrophic lateral sclerosis; SMA=spinal muscular atrophy; PMD=primary muscular disease; TV=tidal volume; PIP=peak inspiratory pressure; RD=respiratory difficulty;

    †Fisher's exact test.

    Comparisons of Self Care by Applied Method of HMV (N=157)

    Variables Categories Total (N=157) Non IHMV (n=55) IHMV (n=102) x2 p
    n (%) n (%) n (%)
    HMV related Holding equipment† (yes only) Equipment for suction 109 (69.9) 14 (12.8) 95 (87.2) 75.77 ＜.001
    Equipment for oxygen 24 (15.4) 4 (16.7) 20 (83.3)   .061
    Ambu bag 136 (87.2) 44 (32.4) 92 (67.6) 2.40 .121
    Pulse oxymetry 80 (51.3) 26 (32.5) 54 (67.5) 0.33 .569
    Assisted cough 84 (53.8) 49 (58.3) 35 (41.7) 4.00 .046
    Changing cycle of circuit q 2 weeks 29 (23.4) 18 (37.5) 11 (14.3) 9.72 .008
    q≥1 month 95 (76.6) 30 (62.5) 65 (85.7)
    Changer of circuit Family caregiver 44 (29.7) 18 (33.4) 26 (27.7) 4.45 .218
    Employer of company 80 (54.1) 24 (44.4) 56 (59.6)
    Home care nurse 24 (16.2) 12 (22.2) 12 (12.8)
    Changing cycle of filter q 2 weeks 11 (15.1) 1 (4.8) 10 (19.2)   .272
    q 1 month and above 62 (74.9) 20 (95.5) 39 (75.0)
    Changer of filter Family caregiver 103 (76.5) 33 (58.9) 68 (69.4)   .073
    Employer of company 45 (29.0) 17 (30.4) 28 (28.6)
    Home care nurse 7 (4.5) 6 (10.7) 2 (2.0)
    Life habit related Respiratory exercise (yes only)‡ Cough assisted coughing 90 (59.2) 35 (66.0) 55 (55.6)   .210
    Postural drainage 18 (11.3) 3 (6.8) 15 (18.3)   .109
    Chest vibration 10 (7.2) 3 (6.5) 7 (7.5)   1.000
    Exercise of accumulated air 55 (41.0) 25 (55.6) 30 (33.7) 5.90 .015
    Respiratory muscle exercise 29 (21.0) 15 (33.3) 14 (15.1)   .040
    Suction of airway 104 (74.3) 9 (21.4) 95 (96.9)   ＜.001
    General exercise No 61 (39.1) 23 (42.6) 38 (37.3) 0.42 .516
    Yes 95 (60.9) 31 (57.4) 64 (62.7)    
    Major type of meal Oral diet 74 (47.1) 48 (87.3.) 26 (25.5) 54.74 ＜.001
    Tube feeding 83 (52.9) 7 (12.7) 76 (74.5)    
    Elevated upper body during meal No 32 (20.8) 20 (38.5) 12 (11.8) 14.91 ＜.001
    Yes 122 (79.2) 32 (61.5) 90 (88.2)    
    Oral care No 18 (11.7) 10 (18.9) 8 (7.9) 4.05 .045
    Yes 136 (88.3) 43 (81.1) 93 (92.1)    

    Missing data be excluded; IHMV=invasive home mechanical ventilator;

    †Fisher's exact test;

    ‡Multiple respondent.

    Comparisons by Applied Method and Influencing Factors on Respiratory Difficulty, Sleep Impediment, Anxiety, and Depression (N=157)

    Variables Total (n=157) Non IHMV (n=55) IHMV (n=102) t (p) Variables (Constant) B β t p R2 Adj. R2
    M±SD M±SD M±SD
    Respiratory difficulty 0.88±1.10 0.76±1.07 0.95±1.18 -0.94 (Constant) 3.55   3.61 ＜.001 .16 .14
    (.347) Anxiety 0.97 0.30 3.62 .002
    Utility duration of HMV -0.02 -0.24 -2.57 .012
    Gender (male) -1.31 -0.22 -2.31 .023
    Sleep impediment 0.44±0.29 0.43±0.31 0.45±0.28 -0.41 (Constant) 1.30   5.88 ＜.001 .32 .28
    (.681) SMA & PMD(yes) 0.50 0.32 2.91 .004
    Duration of morbidity -0.01 -0.20 -2.05 .043
    Applied method(IHMV) -0.48 -0.31 -3.08 .003
    Changing cycle of circuit 0.31 0.19 2.13 .035
    Anxiety 0.18 0.21 2.06 .042
    Anxiety 1.41±0.85 0.96±0.77 1.69±0.83 -5.27 (Constant) 0.23   1.30 .198    
    (＜.001) Depression 0.62 0.62 8.42 ＜.001    
    Sleep impediment 0.22 0.19 2.83 .006 .62 .60
    Physical functional status -0.35 -0.33 -3.57 .001
    HNC(yes) -0.43 -0.24 -2.73 .008
    Depression 1.68±0.84 1.13±0.79 2.1±12 -6.60 (Constant) 0.53   3.02 .003 .66 .65
    (＜.001) Anxiety 0.51 0.51 7.24 ＜.001
    Age 0.02 0.46 5.30 ＜.001
    Duration of morbidity -0.01 -0.21 -2.70 .008

    Missing data be excluded; Gender: Male (1) vs Female (0); Diagnosis: ALS (no) 0 vs SMA & PMD (yes)1; Applied method: non Invasive (0) vs Invasive (1); HNC (Home nursing care): No (0) vs Yes (1); IHMV=invasive home mechanical ventilator, SMA=spinal muscular atrophy; PMD=primary muscular disease; Adj. R

    2=Adjusted R

    2.
    Table 1. Comparisons of General Characteristics by Applied Method of HMV (N=157)

    Missing data be excluded; IHMV=invasive home mechanical ventilator;

    Fisher's exact test.

    Table 2. Comparisons of Disease related Characteristics by Applied Method of HMV (N=157)

    Missing data be excluded; IHMV=invasive home mechanical ventilator; ALS=amytrophic lateral sclerosis; SMA=spinal muscular atrophy; PMD=primary muscular disease; TV=tidal volume; PIP=peak inspiratory pressure; RD=respiratory difficulty;

    Fisher's exact test.

    Table 3. Comparisons of Self Care by Applied Method of HMV (N=157)

    Missing data be excluded; IHMV=invasive home mechanical ventilator;

    Fisher's exact test;

    Multiple respondent.

    Table 4. Comparisons by Applied Method and Influencing Factors on Respiratory Difficulty, Sleep Impediment, Anxiety, and Depression (N=157)

    Missing data be excluded; Gender: Male (1) vs Female (0); Diagnosis: ALS (no) 0 vs SMA & PMD (yes)1; Applied method: non Invasive (0) vs Invasive (1); HNC (Home nursing care): No (0) vs Yes (1); IHMV=invasive home mechanical ventilator, SMA=spinal muscular atrophy; PMD=primary muscular disease; Adj. R

    =Adjusted R

    .

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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