多学科协作干预对腰椎术后恐动症患者康复结局的影响
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摘要
目的评价多学科协作干预对腰椎术后恐动症患者康复结局的影响。方法将脊柱外科收治的172例腰椎融合术后恐动症患者按入院时间分为观察组和对照组各86例。对照组按常规进行护理干预及随访,观察组在对照组的基础上,根据脊柱外科医生、麻醉师、康复师、心理咨询师、护士等多学科协作制订的干预方案实施干预。分别于术后24 h、出院后1个月、3个月及6个月评估患者恐动情况、腰椎康复情况及生活质量。结果出院后1个月、3个月及6个月观察组恐动症TSK评分显著低于对照组,JOA评分显著高于对照组(均P<0.01);出院后3个月、6个月观察组生活质量评分显著高于对照组(均P<0.01)。结论多学科协作干预可以降低腰椎术后患者恐动程度,改善患者康复结局及提高生活质量。
Objective To evaluate the effect of multidisciplinary cooperative intervention on the rehabilitation outcome of lumbar surgery patients with kinesiophobia.Methods A total of 172 postoperative kinesiophobia patients after lumbar fusion surgery in the department of spine surgery were divided into an observation group and a control group chronologicall, with 86 patients in each group. The control group received routine nursing and follow up, while the observation group additionally received the intervention formulated by spinal surgeons, anesthesiologists, rehabilitators, psychological counselors, nurses, and others. Patients′ kinesiophobia, lumbar spine rehabilitation and quality of life were evaluated at 24 hours after surgery, 1 month, 3 months, and 6 months after discharge respectively.Results At 1 month, 3 months and 6 months after discharge, the TSK score of the observation group were significantly lower than those of the control group, and the score of JOA were significantly higher than those of the control group(P<0.01 for all);at 3 months and 6 months after discharge, the quality of life score of the observation group were significantly higher than those of the control group(P<0.01 for both).Conclusion The multidisciplinary cooperative intervention could reduce the degree of postoperative phobia for patients after lumbar surgery, improve their rehabilitation outcome and quality of life.
Objective To evaluate the effect of multidisciplinary cooperative intervention on the rehabilitation outcome of lumbar surgery patients with kinesiophobia.Methods A total of 172 postoperative kinesiophobia patients after lumbar fusion surgery in the department of spine surgery were divided into an observation group and a control group chronologicall, with 86 patients in each group. The control group received routine nursing and follow up, while the observation group additionally received the intervention formulated by spinal surgeons, anesthesiologists, rehabilitators, psychological counselors, nurses, and others. Patients′ kinesiophobia, lumbar spine rehabilitation and quality of life were evaluated at 24 hours after surgery, 1 month, 3 months, and 6 months after discharge respectively.Results At 1 month, 3 months and 6 months after discharge, the TSK score of the observation group were significantly lower than those of the control group, and the score of JOA were significantly higher than those of the control group(P<0.01 for all);at 3 months and 6 months after discharge, the quality of life score of the observation group were significantly higher than those of the control group(P<0.01 for both).Conclusion The multidisciplinary cooperative intervention could reduce the degree of postoperative phobia for patients after lumbar surgery, improve their rehabilitation outcome and quality of life.
引文
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[11] Monticone M,Ambrosini E,Rocca B,et al.A multidisciplinary rehabilitation programme improves disability,kinesiophobia and walking ability in subjects with chro-nic low back pain:results of a randomised controlled pilot study[J].Eur Spine J,2014,23(10):2105-2113.
[12] 王凌燕,张春梅,王宋超,等.浙江省腰椎微创术患者运动恐惧心理及影响因素分析[J].医学与社会,2018,31(8):78-79,89.
[13] Monticone M,Baiardi P,Bonetti F,et al.The Italian version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I):cross-cultural adaptation,factor analysis,reliability,validity,and sensitivity to change[J].Spine,2012,37(6):E374-E380.
[14] 杜世正,胡玲莉,柏亚妹,等.自我效能和恐惧-回避信念与应对方式对慢性腰背痛患者生命质量的影响路径[J].中国全科医学,2017,20(35):4397-4403,4411.
[15] 冯倩茜,金三丽.腰椎管狭窄症患者术后康复水平及康复行为的纵向研究[J].护理学杂志,2017,32(24):85-87.
[16] 王龙虎,孙义,闫娟,等.重力肌群锻炼对胸腰椎骨折术后患者功能恢复的影响[J].护理学杂志,2018,33(4):1-3.
[2] Svensson G L,Mari L,Hans C O,et al.High degree of kinesiophobia after lumbar disc herniation surgery:a cross-sectional study of 84 patients[J].Acta Orthopaedica,2011,82(6):732-736.
[3] Archer K R,Devin C J,Vanston S W,et al.Cognitive-behavioral-based physical therapy for patients with chronic pain undergoing lumbar spine surgery:a randomized controlled trial[J].J Pain,2016,17(1):76-89.
[4] Adnan R,Van Oosterwijck J,Cagnie B,et al.Deter-ming predictive outcome factors for a multimodal treatment program in low back pain patients:a retrospective cohort study[J].J Manipulative Physiol Ther,2017,40(9):659-667.
[5] 宋莹莹,张岚,梁瑛琳,等.慢性下腰痛患者恐动症的研究进展[J].护理管理杂志,2018,18(8):572-575.
[6] Trocoli T O,Botelho R V.Prevalence of anxiety ,depression and kinesiophobia in patients with low back pain and their association with the symptoms of low back spinal pain[J].Rev Bras Reumatol Engl Ed,2016,56(4):330-336.
[7] Miller R P,Kori S,Todd D.The Tample Scale:a mea-sure of kinesiophobia[J].Clin J Pain,1991,7(1):51-52.
[8] Archer K R,Wegener S T,Seebach C,et al.The effect of fear of movement beliefs on pain and disability after surgery for lumbar and cervical degenerative conditions[J].Spine,2011,36(19):1554-1562.
[9] Monticone M,Ferrante S,Teli M,et al.Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis:a randomised controlled trial[J].Eur Spine J,2014,23(1):87-95.
[10] Acar S,Savci S,Keskinoglu P,et al.Tampa Scale of Kinesiophobia for Heart Turkish Version Study:cross-cultural adaptation,exploratory factor analysis and reliability[J].J Pain Res,2016,23(9):445-451.
[11] Monticone M,Ambrosini E,Rocca B,et al.A multidisciplinary rehabilitation programme improves disability,kinesiophobia and walking ability in subjects with chro-nic low back pain:results of a randomised controlled pilot study[J].Eur Spine J,2014,23(10):2105-2113.
[12] 王凌燕,张春梅,王宋超,等.浙江省腰椎微创术患者运动恐惧心理及影响因素分析[J].医学与社会,2018,31(8):78-79,89.
[13] Monticone M,Baiardi P,Bonetti F,et al.The Italian version of the Fear-Avoidance Beliefs Questionnaire (FABQ-I):cross-cultural adaptation,factor analysis,reliability,validity,and sensitivity to change[J].Spine,2012,37(6):E374-E380.
[14] 杜世正,胡玲莉,柏亚妹,等.自我效能和恐惧-回避信念与应对方式对慢性腰背痛患者生命质量的影响路径[J].中国全科医学,2017,20(35):4397-4403,4411.
[15] 冯倩茜,金三丽.腰椎管狭窄症患者术后康复水平及康复行为的纵向研究[J].护理学杂志,2017,32(24):85-87.
[16] 王龙虎,孙义,闫娟,等.重力肌群锻炼对胸腰椎骨折术后患者功能恢复的影响[J].护理学杂志,2018,33(4):1-3.
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