摘要
目的调查老年全膝关节置换术(TKA)患者术后康复依从性现状及其相关影响因素。方法将2020年1月至2022年1月海南医学院第一附属医院收治的150例行TKA治疗的老年患者纳为研究对象,调查其出院后随访6个月内家庭康复训练依从性,并分析居家康复训练依从性对患者膝关节功能的影响。根据居家康复训练依从性量表得分,将患者分为高、中、低三个等级,并将高、中等级得分者纳为依从性良好组,低等级得分者纳为依从性不佳组。采用二元logistic回归模型分析影响老年TKA患者居家康复训练依从性的相关因素。采用SPSS 20.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、单因素方差分析及χ^(2)检验。结果共回收有效问卷133份,有效问卷回收率为88.67%。74例(55.64%)进行了下肢关节活动范围训练,51例(38.35%)进行了下肢肌肉力量训练,19例(14.29%)患者未进行家庭康复训练;11例(8.27%)患者未坚持训练1个月,67例(50.38%)患者坚持家庭康复训练1个月以上,26例(19.55%)患者坚持训练3个月以上,仅10例(7.52%)患者坚持训练6个月。高、中、低等级患者6个月后HSS量表得分均较出院时升高(P<0.05)。6个月后,不同依从性等级患者美国特种外科医院膝关节(HSS)得分比较,差异均有统计学意义(P<0.05);其中依从性优等者HSS得分高于中等者及差等者,依从性中等者HSS得分进一步高于差等者,差异均有统计学意义(P<0.05)。行二元logistic回归分析观察到,婚姻状况(OR=1.738,95%CI 1.224~2.469)、康复训练重要性认同感(OR=3.747,95%CI 1.228~11.430)、害怕疼痛(OR=2.330,95%CI 1.650~3.290)、社会支持水平(OR=0.263,95%CI 0.091~0.759)、无人指导康复训练(OR=6.679,95%CI 4.417~10.100)、出行不方便(OR=3.501,95%CI 2.417~5.071)是影响其康复训练依从性的相关因素(P<0.05)。结论老年TKA患者术后家庭康复训练依从性普遍不高,婚姻状况、康复训练重要性认同感、害怕疼痛、社会支持水平、无人指导康复训练、出行不方便是影响其康复训练依从性的相关因素。
Objective To investigate the status quo and its related influencing factors of postoperative rehabilitation compliance in elderly patients after total knee arthroplasty(TKA).Methods A total of 150 elderly patients receiving TKA treatment in our hospital between January 2020 and January 2022 were enrolled in this study.The compliance of home-based rehabilitation training within 6 months after discharge was investigated,and the effect of the rehabilitation training compliance on knee function was analyzed.According to rehabilitation compliance scale score,they were divided into high-,middle-and low-level grades,and then those with high-level and middle-level grades were assigned into good compliance group,while those with low-level grades into poor compliance group.Binary logistic regression model was applied to analyze the related factors of home-based rehabilitation training compliance in the elderly patients after TKA.SPSS statistics 20.0 was used for statistical analysis.Data comparison between two groups was performed using t test,One-way analysis of variance orχ^(2) test depending on data type.Results In our survey,133 valid questionnaires were obtained,with a recovery rate of 88.67%.Among them,74 patients(55.64%)received motion training in lower limb joint range,51 cases(38.35%)underwent strength training for lower limb muscle,and 19 patients(14.29%)did not carry out any home-based rehabilitation training.Eleven patients(8.27%)did not persist in training for 1 month,67 patients(50.38%)persisted in home-based rehabilitation training for over 1 month,26 patients(19.55%)persisted in training for more than 3 months,and only 10 patients(7.52%)persisted in training for 6 months.The hospital for special surgery knee(HSS)scale score was increased in all the patients with different compliance levels after 6 months than the score at discharge(P<0.05),and significant differences were observed in the score after 6 months of training among the 3 compliance groups(P<0.05),with the high-level compliance group having the highest score,followed by the middle-level and then low-level compliance groups in order(P<0.05).Binary logistic regression analysis showed that marital status(OR=1.738,95%CI 1.224-2.469),recognition of the importance of rehabilitation training(OR=3.747,95%CI 1.228-11.430),fear of pain(OR=2.330,95%CI 1.650-3.290),social support level(OR=0.263,95%CI 0.091-0.759),no guidance for rehabilitation training(OR=6.679,95%CI 4.417-10.100)and inconvenient travel(OR=3.501,95%CI 2.417-5.071)were related factors affecting the rehabilitation training compliance(P<0.05).Conclusion The compliance of postoperative family rehabilitation training is generally not high in elderly patients after TKA.Marital status,recognition of the importance of rehabilitation training,fear of pain,social support level,no guidance for rehabilitation training,and inconvenient travel are related factors affecting the compliance of rehabilitation training.
作者
朱雪飞
陈唯
欧阳云朗
Zhu Xuefei;Chen Wei;Ouyang Yunlang(Department of Joint Surgery,First Affiliated Hospital of Hainan Medical University,Haikou 570000,China)
出处
《中华老年多器官疾病杂志》
2024年第9期659-664,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
海南省卫生计生行业科研项目(20A200507)。
关键词
老年人
全膝关节置换术
家庭康复训练
依从性
影响因素
aged
total knee arthroplasty
home-based rehabilitation training
compliance
influencing factors
作者简介
通信作者:朱雪飞,E-mail:zhuxuefei898@163.com。
