基于跨理论模型的运动干预对社区老年膝关节炎患者的影响研究

doi:10.376/j.issn.0254-1769.2022.12.001

摘要/Abstract

摘要：

目的评价基于跨理论模型的运动干预对社区老年膝关节炎患者运动依从性的长期效果。方法采用集群随机对照试验的方法,选择北京市14个社区,以社区为单位进行随机分组,纳入189例符合入选标准的老年膝关节炎患者。该研究共持续48周,其中干预时间0~24周,随访时间24~48周。试验组实施基于跨理论模型的运动干预,对照组实施常规居家运动指导。比较两组运动依从性、自我效能、决策均衡和膝关节疼痛程度。结果共有156例患者（试验组87例,对照组69例）完成了研究。干预24周时,试验组运动依从性得分为（7.58±1.29）分,对照组得分为（5.00±1.53）分;干预36周时,试验组运动依从性得分为（6.55±1.28）分,对照组得分为（3.89±1.53）分;干预48周时,试验组运动依从性得分为（5.56±1.00）分,对照组得分为（3.16±1.31）分,两组比较,差异均具有统计学意义（P<0.05）。试验组患者的运动自我效能、感知益处高于对照组,感知障碍和膝关节疼痛程度低于对照组（P<0.05）。结论基于跨理论模型的运动干预能够长期改善老年膝关节炎患者的运动依从性,优化运动自我效能和决策均衡,降低膝关节疼痛症状。

关键词: 膝关节骨性关节炎, 老年, 运动干预, 依从性, 跨理论模型, 护理

Abstract:

Objective The aim of this study is to evaluate the effects of transtheoretical model（TTM） based on exercise intervention mode on adherence of elderly patients with knee osteoarthritis（KOA） in communities. Methods The cluster randomized controlled trial was applied in this study. 14 communities in Beijing were enrolled,and they were randomly divided into 2 groups,and a total of 189 elderly KOA patients who met the inclusion criteria were included. The present study lasted 48 weeks,with the intervention time of 0-24 weeks and follow-up time of 24-48 weeks. The experimental group was given a TTM-based exercise intervention mode,and the control group was given the routine home exercise guidance. The exercise adherence,self-efficacy,decisional balance and pain intensity of knee were compared between the 2 groups. Results A total of 156 patients（87 in the experimental group and 69 in the control group） completed the study. After 24 weeks,the score of exercise adherence was（7.58±1.29） in the experimental group and（5.00±1.53） in the control group. After 36 weeks,the score of exercise adherence was（6.55±1.28） in the experimental group and（3.89±1.53） in the control group. After 48 weeks,the score of exercise adherence was（5.56±1.00） in the experimental group and（3.16±1.31） in the control group. There was significant difference between the 2 groups（P<0.05）. Meanwhile,during the study period,the exercise self-efficacy and perceived benefits of patients in the experimental group were significantly higher than those in the control group,and the degree of perceived barriers and pain intensity of knee in the experimental group were significantly lower than those in the control group（P<0.05）. Conclusion The TTM-based exercise intervention mode can improve the exercise adherence of elderly patients with KOA for a long time,optimize the exercise self-efficacy and decisional balance,and reduce the symptoms of knee pain.

Key words: Knee Osteoarthritis（KOA）, Elderly, Exercise Intervention, Adherence, Transtheoretical Model （TTM）, Nursing Care

陈泓伯, 胡永华, 王韵璘, 刘聪颖, 鲁寒, 王丽敏, 尚少梅. 基于跨理论模型的运动干预对社区老年膝关节炎患者的影响研究[J]. 中华护理杂志, 2022, 57(12): 1413-1420.

CHEN Hongbo, HU Yonghua, WANG Yunlin, LIU Congying, LU Han, WANG Limin, SHANG Shaomei. Effect of exercise intervention based on transtheoretical model on elderly patients with knee osteoarthritis in communities[J]. Chinese Journal of Nursing, 2022, 57(12): 1413-1420.

图/表 5

表1 依据跨理论模型制订的通识教育阶段干预实施方案（0~2周）

Table 1 TTM based intervention plan for general education stage（0~2 weeks）

表2 依据跨理论模型制订的个体化阶段干预实施方案（3~24周）

Table 2 TTM based intervention plan for individualized stage（3~24 weeks）

表3 两组一般资料比较（n=189）

Table 3 Comparison of general data in the 2 groups（n=189）

表4 干预前后两组依从性比较（分,$\bar{x}\pm s$）

Table 4 Comparison of exercise adherence between the two groups before and after intervention（points,$\bar{x}\pm s$）

表5 两组干预前后自我效能、决策均衡、膝关节疼痛的比较（分,$\bar{x}\pm s$）

Table 5 Comparison of self efficacy, decision balance and knee pain scores between the two groups before and after intervention（points,$\bar{x}\pm s$）

参考文献 29

[1]	王精明, 王爱平. 膝关节骨性关节炎患者运动治疗护理方案的研究进展[J]. 中华护理杂志, 2019, 54(3):458-462.
	Wang JM, Wang AP. Research progress on exercise therapy nursing program for patients with knee osteoarthritis[J]. Chin J Nurs, 2019, 54(3):458-462.
[2]	Tang X, Wang SF, Zhan SY, et al. The prevalence of symptomatic knee osteoarthritis in China:results from the China health and retirement longitudinal study[J]. Arthritis Rheumatol, 2016, 68(3):648-653. DOI URL
[3]	Zhang YQ, Jordan JM. Epidemiology of osteoarthritis[J]. Clin Geriatr Med, 2010, 26(3):355-369. DOI URL
[4]	Nicolson PJA, Bennell KL, Dobson FL, et al. Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis:a systematic review and meta-analysis[J]. Br J Sports Med, 2017, 51(10):791-799. DOI URL
[5]	Nicolson PJA, Hinman RS, French SD, et al. Improving adherence to exercise:do people with knee osteoarthritis and physical therapists agree on the behavioral approaches likely to succeed?[J]. Arthritis Care Res(Hoboken), 2018, 70(3):388-397.
[6]	Prochaska JO, Velicer WF. The transtheoretical model of health behavior change[J]. Am J Health Promot, 1997, 12(1):38-48. DOI PMID
[7]	Thanawat T, Nualnetr N. Effects of an intervention based on the transtheoretical model on back muscle endurance,physical function and pain in rice farmers with chronic low back pain[J]. J Back Musculoskelet Rehabil, 2017, 30(4):847-856. DOI URL
[8]	Ham OK, Sung KM, Lee BG, et al. Transtheoretical model based exercise counseling combined with music skipping rope exercise on childhood obesity[J]. Asian Nurs Res(Korean Soc Nurs Sci), 2016, 10(2):116-122.
[9]	刘聪颖, 陈泓伯, 万巧琴, 等. 老年膝关节炎患者社区居家运动方案的体系构建[J]. 护理管理杂志, 2019, 19(9):674-677.
	Liu CY, Chen HB, Wan QQ, et al. Construction of community-based exercise program in elderly patients with knee osteoarthritis[J]. J Nurs Adm, 2019, 19(9):674-677.
[10]	Chen HB, Zheng XY, Huang HJ, et al. The effects of a home-based exercise intervention on elderly patients with knee osteoarthritis:a quasi-experimental study[J]. BMC Musculoskelet Disord, 2019, 20(1):160. DOI URL
[11]	中华医学会骨科学分会. 骨关节炎诊治指南(2007年版)[J]. 中国矫形外科杂志, 2014, 22(3):287-288.
	Society of Orthopaedics, Chinese Medical Association. Guidelines for the diagnosis and treatment of osteoarthritis(2007 Edition)[J]. Orthop J China, 2014, 22(3):287-288.
[12]	Nicolson PJA, Hinman RS, Kasza J, et al. Trajectories of adherence to home-based exercise programs among people with knee osteoarthritis[J]. Osteoarthritis Cartilage, 2018, 26(4):513-521. DOI URL
[13]	Leonhardt C, Keller S, Chenot JF, et al. TTM-based motivational counselling does not increase physical activity of low back pain patients in a primary care setting:a cluster-randomized controlled trial[J]. Patient Educ Couns, 2008, 70(1):50-60. PMID
[14]	刘聪颖, 陈泓伯, 万巧琴, 等. 基于跨理论模型的膝关节骨性关节炎老年病人居家运动干预可行性研究[J]. 护理研究, 2018, 32(11):1725-1730.
	Liu CY, Chen HB, Wan QQ, et al. Feasibility of home-based exercise intervention for elderly patients with knee osteoarthritis based on transtheoretical model of change[J]. Nurs Res China, 2018, 32(11):1725-1730.
[15]	Brewer BW, van Raalte JL, Petitpas AJ, et al. Preliminary psychometric evaluation of a measure of adherence to clinic-based sport injury rehabilitation[J]. Phys Ther Sport, 2000, 1(3):68-74. DOI URL
[16]	Renskers L, van Uden RJJC, Huis AMP, et al. Comparison of the construct validity and reproducibility of four different types of patient-reported outcome measures(PROMs) in patients with rheumatoid arthritis[J]. Clin Rheumatol, 2018, 37(12):3191-3199. DOI PMID
[17]	Bandura A. Guide for constructing Self-Efficacy Scales[M]. Greenwich: Information Age Publishing, 2006:307-337.
[18]	Marcus BH, Rakowski W, Rossi JS. Assessing motivational readiness and decision making for exercise[J]. Health Psychol, 1992, 11(4):257-261. PMID
[19]	Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee[J]. J Rheumatol, 1988, 15(12):1833-1840. PMID
[20]	Xie F, Li SC, Goeree R, et al. Validation of Chinese Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) in patients scheduled for total knee replacement[J]. Qual Life Res, 2008, 17(4):595-601. DOI URL
[21]	Baysal HY, Hac flu N. The effect of transtheoretical model-based education and follow-up on providing overweight women with exercise behavior[J]. Int J Caring Sci, 2017, 10(2):897-906.
[22]	任子淇. 基于跨理论模型的运动康复干预在减重代谢手术患者中的应用效果研究[D]. 南京: 南京医科大学, 2019.
	Ren ZQ. The application of exercise rehabilitation based on the trans-theoretical model in patients after bariatric surgery[D]. Nanjing: Nanjing Medical University, 2019.
[23]	刘玮萍, 陆皓, 汉瑞娟. 跨理论模型指导的健康教育对高原基层官兵防晒行为的影响研究[J]. 中华护理杂志, 2017, 52(8):986-991.
	Liu WP, Lu H, Han RJ. Impact of transtheoretical model on sun protection behaviors of soldiers in plateau area[J]. Chin J Nurs, 2017, 52(8):986-991.
[24]	王巧稚, 姚静, 吴海洋, 等. 跨理论模型健康教育对老年慢性心衰患者生活质量、自我运动效能及健康行为的影响[J]. 中国卫生工程学, 2019, 18(5):708-710.
	Wang QZ, Yao J, Wu HY, et al. Effects of transtheoretical model health education on quality of life,self exercise efficacy and health behavior of elderly patients with chronic heart failure[J]. Chin J Public Heal Eng, 2019, 18(5):708-710.
[25]	Scruggs S, Mama SK, Carmack CL, et al. Randomized trial of a lifestyle physical activity intervention for breast cancer survivors:effects on transtheoretical model variables[J]. Health Promot Pract, 2018, 19(1):134-144. DOI URL
[26]	Pirzadeh A, Mostafavi F, Ghofranipour F, et al. Applying transtheoretical model to promote physical activities among women[J]. Iran J Psychiatry Behav Sci, 2015, 9(4):e1580.
[27]	Kaplan Serin E, Citlik Saritas S. The effect of the transtheoretical model based walking exercise training and follow-up on improving exercise behavior and metabolic control in patients with type 2 diabetes[J]. Clin Nurs Res, 2021, 30(3):273-284. DOI URL
[28]	刘甜, 刘杏, 李胜玲, 等. 基于跨理论模型的社区家庭访视护理对老年高血压患者服药遵从行为的影响[J]. 中华护理杂志, 2016, 51(5):629-634.
	Liu T, Liu X, Li SL, et al. Impact of trans-theoretical model based home visiting on medication compliance behavior in community elderly hypertensive patients[J]. Chin J Nurs, 2016, 51(5):629-634.
[29]	王丽, 蔡巧生, 孙慧娟, 等. 基于跨理论模型个体化访视护理形式在产后盆底肌功能锻炼的应用效果[J]. 广东医学, 2019, 40(8):1168-1171.
	Wang L, Cai QS, Sun HJ, et al. Application effect of individualized visit nursing based on transtheoretical model in postpartum pelvic floor muscle functional exercise[J]. Guangdong Med J, 2019, 40(8):1168-1171.