脆性骨折术后患者康复自我效能感的影响因素及路径分析

doi:10.3761/j.issn.0254-1769.2024.24.009

摘要/Abstract

摘要：

目的探讨脆性骨折术后患者症状负担与康复自我效能感间的关系，并分析社会支持和压力知觉对康复自我效能感的影响。方法采用便利抽样法，选择2020年7月—2023年12月就诊于内蒙古医科大学第二附属医院的168例脆性骨折术后患者作为调查对象，采用一般资料调查问卷、症状负担评估量表、慢性病自我效能量表、社会支持评定量表和中文版压力知觉量表对患者进行调查，通过构建结构方程模型探索脆性骨折术后患者症状负担、康复自我效能感、社会支持和压力知觉之间的因果关系路径，明确变量间的中介作用路径。结果回收有效问卷160份，有效问卷回收率为95.24%。脆性骨折术后患者的症状负担与康复自我效能感呈负相关（r=-0.405，P<0.05），社会支持与康复自我效能感呈正相关（r=0.558，P<0.05），压力知觉与康复自我效能感呈负相关（r=-0.330，P<0.05），症状负担与社会支持呈负相关（r=-0.191，P<0.05），社会支持与压力知觉呈负相关（r=-0.280， P<0.05），症状负担与压力知觉呈正相关（r=0.376，P<0.05）。中介效应检验显示，脆性骨折术后患者症状负担对康复自我效能感有直接影响（β= -0.412，t=0.148，P<0.05），并且通过3条中介路径对康复自我效能感产生影响：社会支持的单独中介作用（β=-0.098， 95%CI：-0.112~-0.074）；压力知觉的单独中介作用（β=-0.084，95%CI：-0.104~-0.061）；社会支持-压力知觉的链式中介作用（β=-0.056，95%CI：-0.074~-0.030）。结论脆性骨折术后患者症状负担对康复自我效能感存在直接影响；症状负担通过社会支持和压力知觉的链式中介影响脆性骨折术后患者的康复自我效能感。早期精准评估症状负担、压力知觉及社会支持情况，通过开展个体化健康教育，引导患者进行压力知觉的自我调控，减轻患者的症状负担，并提高其康复自我效能感。

关键词: 脆性骨折, 康复自我效能感, 症状负担, 社会支持, 压力知觉, 护理

Abstract:

Objective To investigate the relationship between symptom burden and rehabilitation self-efficacy of patients after fragility fracture surgery，and to study the chain mediating role of social support and perceived stress in the influence of symptom burden on rehabilitation self-efficacy of such patients. Methods Approved by the Ethics Committee of the hospital，168 patients who met the admission criteria after fragility fracture surgery admitted to the Second Affiliated Hospital of Inner Mongolia Medical University from July 2020 to December 2023 were included in the study by convenient sampling method，and general data of the patients were collected. M. D. Anderson Symptom Inventor（MDASI），Self-Efficacy for Managing Chronic Disease 6-Item Scale（SECD6），Social Support Rating Scale（SSRS） and Perceived Stress Scale（CPSS） were used to investigate the above patients，and multiple sets of quantitative data were analyzed for attribution association profile and mediation effect. Results After removing invalid questionnaires，a total of 160 valid questionnaires were collected，with an effective response rate of 95.24%. Correlation analysis showed that symptom burden was negatively correlated with rehabilitation self-efficacy（r=-0.405，P<0.05）；social support was significantly positively correlated with rehabilitation self-efficacy（r=0.558，P<0.05）；perceived stress was negatively correlated with rehabilitation self-efficacy（r=-0.330，P<0.05）；symptom burden was negatively correlated with social support（r=-0.191，P<0.05）；social support was negatively correlated with perceived stress（r=-0.280，P<0.05）；symptom burden was positively correlated with perceived stress（r=0.376，P<0.05）. Mediating effect test showed that the symptom burden of patients after fragility fracture surgery had a direct impact on rehabilitation self-efficacy（β=-0.402，t=0.148，P<0.05），and had an impact on rehabilitation self-efficacy through 3 mediating pathways：first，the mediating effect of social support alone（β=-0.098，95%CI：-0.112~-0.074）；the second was the mediating effect of stress perception alone（β=-0.081，95%CI：-0.104~-0.061）；the third is the chain mediating effect of social support and stress perception（β=-0.056，95%CI：-0.074~-0.030）. Conclusion The burden of symptoms after fragility fracture surgery has a direct effect on rehabilitation self-efficacy. Symptom burden influences postoperative self-efficacy of patients with fragility fractures through the chain mediation of social support and perceived stress. Early and accurate assessment of symptom burden，stress perception and social support should be conducted. According to needs，the multidisciplinary medical team provides individualized and diversified health education support to actively help and guide the self-regulation of patients’ stress perception，so as to reduce patients’ symptom burden and promote the improvement of their self-efficacy in the process of rehabilitation.

Key words: Fragility Fracture, Self-Efficacy, Symptom Burden, Social Support, Perception of Pressure, Nursing Care

李莉, 申雅文, 李德龙, 程芳芳, 于喜凤, 潘琳琳, 庄淑渊, 董思鸿, 吴娇, 梁艳, 臧苑彤. 脆性骨折术后患者康复自我效能感的影响因素及路径分析[J]. 中华护理杂志, 2024, 59(24): 3003-3008.

LI Li, SHEN Yawen, LI Delong, CHENG Fangfang, YU Xifeng, PAN Linlin, ZHUANG Shuyuan, DONG Sihong, WU Jiao, LIANG Yan, ZANG Yuantong. Analysis of influencing factors and pathways of postoperative self-efficacy in patients with fragility fracture[J]. Chinese Journal of Nursing, 2024, 59(24): 3003-3008.

图/表 4

表1 脆性骨折术后患者的一般资料（n=160）

Table 1 General data of patients with fragility fractures included in the survey（n=160）

表2 脆性骨折术后患者的症状负担、康复自我效能感、社会支持与压力知觉的相关性分析结果（r值）

Table 2 Results of correlation analysis among symptom burden，rehabilita-tion self-efficacy，social support and perceived stress of patients with fragility fracture（r value）

表3 社会支持和压力知觉对症状负担和康复自我效能的中介效应检验（n=160）

Table 3 Mediating effects of social support and stress perception on symptom burden and rehabilitation self-efficacy（n=160）

图1 社会支持和压力觉知对症状负担和自我效能的链式中介模型

Figure 1 Chain mediation model of social support and stress perception on symptom burden and self-efficacy

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