基于健康信念模式的奥塔戈运动在全髋关节置换术后患者居家康复中的应用研究

doi:10.3761/j.issn.0254-1769.2025.24.001

摘要/Abstract

摘要：

目的探讨基于健康信念模式的奥塔戈运动在全髋关节置换术后患者居家康复中的应用效果，旨在为临床护理实践提供借鉴。方法采用便利抽样法，选取2022年1—12月湖州市某三级甲等医院收治的60例全髋关节置换术患者作为研究对象，利用SAS软件随机分为试验组和对照组，每组各30例。试验组在常规护理的基础上接受基于健康信念模式的奥塔戈运动干预，对照组接受常规护理，干预时间为3个月。比较两组3个月内功能锻炼依从性得分、一般自我效能感得分、髋关节功能得分、Barthel指数评定量表得分的差异。结果两组均未脱落，重复测量方差分析结果显示，两组出院时和出院后1、2、3个月的功能锻炼依从性得分、一般自我效能感得分、髋关节功能得分、Barthel指数评定量表得分的时间与组别的交互效应具有统计学意义（P<0.001）。试验组出院后1、2、3个月的功能锻炼依从性得分、一般自我效能感得分、髋关节功能得分、Barthel指数评定量表得分高于对照组，差异具有统计学意义（P<0.001）。结论基于健康信念模式的奥塔戈运动有利于提高全髋关节置换术后患者的功能锻炼依从性和自我效能，促进髋关节功能恢复，从而提高日常生活能力。

关键词: 全髋关节置换术, 健康信念模式, 奥塔戈运动, 居家康复, 护理

Abstract:

Objective To explore the application effect of health belief model combined with Otago exercise programme in home rehabilitation of patients after total hip arthroplasty，aiming to provide references for clinical nursing practice. Methods Using convenience sampling method，60 patients undergoing total hip arthroplasty admitted to a tertiary hospital in Huzhou City from January to December 2022 were selected as the research subjects. They were randomly divided into an experimental group and a control group using SAS software，with 30 patients in each group. The experimental group received a health belief model combined with Otago exercise programme intervention program on the basis of routine care，while the control group received routine care for 3 months. The differences in functional exercise compliance scores，general self-efficacy scores，Harris hip joint function scores，and Barthel index scores were compared between 2 groups within 3 months. Results No participants dropped out in the 2 groups. The results of repeated measures analysis of variance showed that the time-group interaction effect of functional exercise compliance scores, general self-efficacy scores, hip joint function scores，and Barthel Index scores between the 2 groups at discharge and 1，2，and 3 months after discharge was statistically significant（P<0.001）. The functional exercise compliance scores, general self-efficacy scores, hip joint function scores, and Barthel Index scores of the experimental group at 1，2，and 3 months after discharge were higher than those of the control group，and the differences were statistically significant（P<0.001）. Conclusion The combination of health belief model and Otago exercise programme is beneficial for improving the functional exercise compliance of patients after total hip arthroplasty，enhancing self-efficacy，promoting hip joint function recovery，and thus enhancing daily living abilities.

Key words: Total Hip Arthroplasty, Health Belief Model, Otago Exercise Programme, Home-Based Rehabilitation, Nursing Care

宋麟茹, 曹亚琴, 闵继康, 张程, 陈婷婷, 陆燕艳. 基于健康信念模式的奥塔戈运动在全髋关节置换术后患者居家康复中的应用研究[J]. 中华护理杂志, 2025, 60(24): 2949-2955.

SONG Linru, CAO Yaqin, MIN Jikang, ZHANG Cheng, CHEN Tingting, LU Yanyan. Application of health belief model combined with Otago exercise programme in home rehabilitation of postoperative patients after total hip arthroplasty[J]. Chinese Journal of Nursing, 2025, 60(24): 2949-2955.

图/表 2

参考文献 25

[1]	陈端勇, 李梦远, 杨育晖, 等. 人工全髋关节置换术后髋关节运动学变化特征研究[J]. 中国修复重建外科杂志, 2024, 38(7):849-854.
	Chen DY, Li MY, Yang YH, et al. Analysis of kinematic changes of hip joint after total hip arthroplasty[J]. Chin J Reparative Reconstr Surg, 2024, 38(7):849-854.
[2]	王文慧, 张利峰, 李信欣, 等. 髋关节置换术后患者不同时期关节功能变化及其影响因素研究[J]. 中华护理杂志, 2017, 52(6):649-653.
	Wang WH, Zhang LF, Li XX, et al. Joint function and its influencing factors of patients underwent hip arthroplasty[J]. Chin J Nurs, 2017, 52(6):649-653.
[3]	李信欣, 吕启圆, 李江圳, 等. 髋关节置换术后患者院外功能锻炼依从性与健康信念的纵向研究[J]. 中华护理杂志, 2019, 54(8):1180-1184. DOI URL
	Li XX, Lü QY, Li JZ, et al. Correlation between exercise compliance after discharge and health belief in patients underwent hip arthroplasty:a longitudinal study[J]. Chin J Nurs, 2019, 54(8):1180-1184.
[4]	李汶静, 王莹, 赵福云, 等. 老年髋部骨折患者术后居家运动康复体验的质性研究[J]. 中华护理杂志, 2025, 60(10):1171-1176. DOI URL
	Li WJ, Wang Y, Zhao FY, et al. Experiences of postoperative home-based exercise rehabilitation in elderly patients with hip fracture:a qualitative study[J]. Chin J Nurs, 2025, 60(10):1171-1176.
[5]	Campbell AJ, Robertson MC, Gardner MM, et al. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women[J]. BMJ, 1997, 315(7115):1065-1069. DOI PMID
[6]	徐永能, 黄巧, 卢少萍, 等. 护患互动健康信念模式在预防住院老年病人跌倒中的应用效果[J]. 护理研究, 2020, 34(7):1300-1304.
	Xu YN, Huang Q, Lu SP, et al. Effect of nurse-patient interactive health belief model on preventing falls in elderly patients in hospital[J]. Chin Nurs Res, 2020, 34(7):1300-1304.
[7]	孙振球. 医学统计学[M]. 3版. 北京: 人民卫生出版社, 2010.
	Sun ZQ, Medical statistics[M]. 3rd ed. Beijing: People’s Medical Publishing House, 2010.
[8]	努尔古丽·买提哈提. 互动式健康教育在加速康复外科理念下髋关节置换术患者中的应用研究[D]. 乌鲁木齐: 新疆医科大学, 2019.
	Nuerguli·Maitihati. Application of interactive health education based on enhanced recovery after surgery in patients with total hip arthroplasty[D]. Urumqi: Xinjiang Medical University, 2019.
[9]	Tuvemo J S, Anens E, Johansson A C, et al. The otago exercise program with or without motivational interviewing for community-dwelling older adults:a 12-month follow-up of a randomized,controlled trial[J]. J Appl Gerontol, 2021, 40(3):289-299. DOI URL
[10]	肖美慧, 王琴, 刘傥, 等. 奥塔戈运动对老年股骨颈骨折髋关节置换术患者肢体功能恢复的效果[J]. 中南大学学报(医学版), 2022, 47(9):1244-1252.
	Xiao MH, Wang Q, Liu T, et al. Effect of Otago exercise programme on limb function recovery in elderly patients with hip arthroplasty for femoral neck fracture[J]. J Cent South Univ Med Sci, 2022, 47(9):1244-1252.
[11]	Ahn S, Oh J. Effects of a health-belief-model-based osteoporosis-and fall-prevention program on women at early old age[J]. Appl Nurs Res, 2021, 59:151430. DOI URL
[12]	谭媛媛, 和晖, 杨秀贤, 等. 骨科患者功能锻炼依从性量表的编制及信度效度检验[J]. 中国护理管理, 2019, 19(11):1626-1631.
	Tan YY, He H, Yang XX, et al. Development and reliability and validity test of the Compliance Scale of Functional Exercise for Orthopedic Patients[J]. Chin Nurs Manag, 2019, 19(11):1626-1631.
[13]	王才康, 胡中锋, 刘勇. 一般自我效能感量表的信度和效度研究[J]. 应用心理学, 2001, 7(1):37-40.
	Wang CK, Hu ZF, Liu Y. Evidences for reliability and validity of the Chinese version of General Self-Efficacy Scale[J]. Chin J Appl Psychol, 2001, 7(1):37-40.
[14]	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969, 51(4):737-755. PMID
[15]	吴佳玲, 黄沛冠, 谢春花, 等. 基于时效性激励理论的适应性护理在老年人工髋关节置换术患者中的应用研究[J]. 军事护理, 2023, 40(5):58-61.
	Wu JL, Huang PG, Xie CH, et al. Application of adaptive nursing based on time-effect incentive theory among elderly patients undergoing hip arthroplasty[J]. Mil Nurs, 2023, 40(5):58-61.
[16]	Mahoney FI, Barthel DW. Functional evaluation:the Barthel Index[J]. Md State Med J, 1965, 14:61-65.
[17]	贾伞伞. 基于动静互补平衡论的功能锻炼对全髋关节置换患者术后髋关节功能的影响[D]. 福州: 福建中医药大学, 2021.
	Jia SS. Effect of functional exercise based on dynamic and static complementary balance theory on hip joint function after total hip replacement[D]. Fuzhou: Fujian University of Traditional Chinese Medicine, 2021.
[18]	蔡静, 徐腾, 李岚, 等. 基于间隔测试效应的康复训练计划在老年髋关节置换病人院外康复中的应用[J]. 护理研究, 2024, 38(23):4260-4264.
	Cai J, Xu T, Li L, et al. Application of rehabilitation training plan based on interval test effect in out-of-hospital rehabilitation of elderly patients with hip replacement[J]. Chin Nurs Res, 2024, 38(23):4260-4264.
[19]	赵改云, 许燕玲. 人工关节置换术后康复训练依从性影响因素研究现状[J]. 解放军护理杂志, 2018, 35(16):41-45.
	Zhao GY, Xu YL. Research status of factors affecting compliance with rehabilitation training after total joint arthroplasty[J]. Nurs J Chin PLA, 2018, 35(16):41-45.
[20]	Meng Y, Deng B, Liang XY, et al. Effectiveness of self-efficacy-enhancing interventions on rehabilitation following total hip replacement:a randomized controlled trial with six-month follow-up[J]. J Orthop Surg Res, 2022, 17(1):225. DOI PMID
[21]	杜新慧, 张登峰. 下肢骨折患者自我效能感、心理弹性与术后康复锻炼的关系[J]. 中国健康心理学杂志, 2021, 29(6):857-861.
	Du XH, Zhang DF. Relationship between self-efficacy,psychological resilience and postoperative rehabilitation exercise in patients with lower extremity fractures[J]. China J Health Psy-chol, 2021, 29(6):857-861.
[22]	邓美玲, 毛孝容, 许叶华, 等. 灾害背景下护士自我效能感研究的范围综述[J]. 中华护理杂志, 2025, 60(20):2542-2548. DOI URL
	Deng ML, Mao XR, Xu YH, et al. Scoping review of research on nurses’ self-efficacy in disaster contexts[J]. Chin J Nurs, 2025, 60(20):2542-2548. DOI URL
[23]	刘珊, 王惠芬, 景婧, 等. 健康信念模式教育对乳腺癌择期手术患者认知水平、心理健康及术后肢体功能的影响[J]. 中国健康心理学杂志, 2023, 31(6):842-846.
	Liu S, Wang HF, Jing J, et al. Effects of health belief model education on cognitive level,mental health and postoperative limb function of breast cancer patients undergoing elective surgery[J]. China J Health Psychol, 2023, 31(6):842-846.
[24]	谷斌, 张千坤, 马茜, 等. 奥塔戈运动在国内外应用的研究进展[J]. 护理研究, 2019, 33(20):3555-3558.
	Gu B, Zhang QK, Ma Q, et al. Research progress on application of Otago exercise program in China and abroad[J]. Chin Nurs Res, 2019, 33(20):3555-3558.
[25]	张政怡, 罗彩凤, 吕妃, 等. 基于电话随访的髋关节置换病人出院后康复需求的质性研究[J]. 循证护理, 2021, 7(6):803-806.
	Zhang ZY, Luo CF, Lü F, et al. Qualitative study on rehabilitation needs of hip replacement patients after discharge based on telephone follow-up[J]. Chin Evid Based Nurs, 2021, 7(6):803-806.