老年全膝关节置换术患者术后康复训练依从性观察及其影响因素
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(武汉市第一医院康复医学科,武汉430000)

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R687.4;R592

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武汉市卫健委青年项目(WX21Q19)


Compliance to postoperative rehabilitation training and its influencing factors in elderly patients after total knee arthroplasty
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(Department of Rehabilitation Medicine, Wuhan First Hospital, Wuhan 430000, China)

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    摘要:

    目的 探讨老年全膝关节置换术(TKA)患者术后康复训练依从性及其影响因素分析。方法 回顾性分析2022年1月至2023年1月于武汉市第一医院行TKA的244例老年患者的临床资料,且在术后3个月评估所有患者康复训练依从性,并比较不同临床特征老年TKA患者康复训练依从性评分差异。通过多因素logistic回归分析影响老年TKA患者康复训练依从性的危险因素并构建风险预测模型。通过受试者工作特征(ROC)曲线分析风险预测模型预测老年TKA患者康复训练依从性的价值。选用SPSS 22.0统计软件对数据进行处理。根据数据类型,分别采用tF检验进行组间比较。结果 244例老年TKA患者康复训练依从性评分中身体锻炼依从评分为(13.27±3.09)分、主动寻求锻炼依从评分为(6.88±2.04)分、锻炼监督依从评分为(6.12±1.81)分;康复训练依从性总分为15~32(23.27±6.94)分。女性、年龄≥80岁、合并疾病>2种、初中文化程度、无配偶、独居、月收入<500元、有慢性疼痛的老年TKA患者康复训练依从性总分显著低于男性、年龄<80岁、合并疾病≤2种或无、高中及以上文化程度、有配偶、与配偶或子女同住或其他、月收入≥500元、无慢性疼痛的老年TKA患者,差异有统计学意义(P<0.05)。经多因素logistic回归分析证实,女性(OR=3.544,95%CI 1.036~12.123)、年龄≥80岁(OR=1.052,95%CI 1.024~1.081)、合并疾病>2种(OR=4.418,95%CI 1.274~15.321)、初中文化程度(OR=4.274,95%CI 1.542~11.846)、无配偶(OR=3.245,95%CI 1.244~8.465)、独居(OR=1.226,95%CI 1.105~1.360)、月收入<500元(OR=2.429,95%CI 1.442~4.092)、有慢性疼痛(OR=2.015,95%CI 1.009~4.024)为影响老年TKA患者康复训练依从性的危险因素。经ROC分析证实,风险预测模型预测老年TKA患者康复训练依从性的曲线下面积为0.934,标准误为0.014,95%CI为0.907~0.961,最佳截断点为35.499,灵敏度为0.925,特异度为0.890。结论 老年TKA术后康复训练依从性受到较多因素的影响,同时经ROC分析证实风险预测模型对老年TKA患者康复训练依从性具有较好的预测价值,或可为后续康复训练工作的开展提供帮助。

    Abstract:

    Objective To investigate the compliance to rehabilitation training and its influencing factors in elderly patients after total knee arthroplasty (TKA). Methods The clinical data of 244 elderly patients undergoing TKA in our hospital from January 2022 to January 2023 were collected and retrospectively analyzed. All patients were assessed for rehabilitation training compliance in three months after surgery. The score of training compliance was compared in the patients with different clinical characteristics. Multivariate logistic stepwise regression analysis was used to analyze the risk factors affecting the compliance in the patients, and the obtained risk factors were employed to construct a risk prediction model. Receiver operating characteristics (ROC) curve was plotted to analyze the value of risk prediction models for rehabilitation compliance in the patients. SPSS statistics 22.0 was used to process the data, and student′s t test and F test were applied to compare the data between groups depending on data type. Results For the 244 elderly patients after TKA, the score of physical exercise compliance, active exercise seeking compliance and exercise supervision compliance was (13.27±3.09), (6.88±2.04), and (6.12±1.81) points, respectively. The total score of compliance to rehabilitation training was (23.27±6.94) points, with the lowest score of 15 and the highest one of 32. The total score of rehabilitation training compliance of the patients with female, aged ≥80 years, combined diseases >2, junior high school education level, no spouse, living alone, monthly income <500 Yuan and chronic pain was significantly lower than those of male, aged <80 years, combined diseases ≤2 or no, high school education level or above, having spouse, cohabitation with spouse or children or others, monthly income ≥500 Yuan, and no chronic pain (P<0.05). Multivariate logistic regression analysis confirmed that female (OR=3.544,95%CI 1.036-12.123), aged ≥80 years (OR=1.052,95%CI 1.024-1.081), combined diseases >2 (OR=4.418,95%CI 1.274-15.321), junior high school education (OR=4.274,95%CI 1.542-11.846), no spouse (OR=3.245,95%CI 1.244-8.465), living alone (OR=1.226,95%CI 1.105-1.360), monthly income <500 Yuan (OR=2.429,95%CI 1.442-4.092), and chronic pain (OR=2.015,95%CI 1.009-4.024) were risk factors for the compliance to rehabilitation training in elderly TKA patients. ROC analysis indicated that the constructed risk model had an area under the curve of 0.934, standard error of 0.014,95%CI of 0.907-0.961, best cut off value of 35.499, sensitivity of 0.925, specificity of 0.890 for predicting rehabilitation training compliance in elderly TKA patients. Conclusion Many factors affect the compliance to postoperative rehabilitation training in elderly TKA patients. ROC analysis confirms that our risk prediction model has a good predictive value for the compliance, which may be helpful for implementation of subsequent rehabilitation training for these patients.

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梁玉,李艳芳,乔娜.老年全膝关节置换术患者术后康复训练依从性观察及其影响因素[J].中华老年多器官疾病杂志,2024,23(5):341~345

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  • 收稿日期:2023-06-13
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  • 在线发布日期: 2024-05-15
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