**2. QOL of patients with muscular dystrophy**

Muscular dystrophy has an early onset, and thereafter body functions decrease progressively beginning with a decrease in motor functions that require the use of a wheelchair to maintain mobility and a decrease in the breathing function that require a ventilator to maintain breathing, which makes the patients bedridden. As a result, the patients' behavior repertoire becomes severely restricted, and they require considerable assistance. Netterlund et al. investigated activities of daily living (ADL) and the QOL of 45 people (mean age 44 years) with muscular

dystrophy [2] and reported that all the sampled patients were living at home. The QOL was assessed by the Sickness Impact Scale (SIP) and the Psychosocial Well-Being Questionnaire, which indicated that their disability and dependence on others increased, whereas ADL decreased during the previous 5 years. Moreover, the patients' QOL and life satisfaction also decreased. Boström and Ahlström investigated 46 people with muscular dystrophy through interviews using a qualitative research approach for 10 years [3]. They reported that nearly all muscular dystrophy patients had decreasing functions such as limited mobility, increasing fatigue, and feebleness, accompanied by psychological distress. Moreover, if there is a difficulty in securing assistance for patients to continue living in their homes, they must live in recuperation wards.

Ueda et al. [4] investigated the QOL of 50 inpatients with muscular dystrophy. The QOL was assessed by the World Health Organization-Quality of Life 26 (WHO-26). Results indicated that the mean QOL score (SD) of patients with muscular dystrophy was 2.96 (0.34), which was significantly lower than the general Japanese population (mean 3.75) or patients with cancer (mean 3.3). The results of the comparison between patients' conditions indicated that those who could move by using a wheelchair had higher QOL scores than those who were bedridden. The QOL score of patients that had throat surgery was higher than those who had no surgery. The comparison between clinical types indicated that the QOL in myotonic dystrophy was significantly lower than limb girdle-type muscular dystrophy or Fukuyama-type congenital muscular dystrophy. They also investigated factors that could affect the QOL of patients with muscular dystrophy, including age, gender, clinical type, duration of the diseases, throat surgery, duration from throat surgery, functional independence (Barthel Index), use of a ventilator, use of a wheelchair, use of a computer, the frequency of family visits, and participation in activities. The results of categorical regression analysis (R2 = 0.671, R2 = 0.400, F = 2.479, P < 0.05) showed that only the use of a computer influenced the QOL (β = 0.598). These results suggest that using a computer could be an effective method of maintaining or improving the QOL of muscular dystrophy inpatients, with deteriorated body functions and limited activities due to the progression of the disease.
