Abstract:

Objective To test the longitudinal mediating mechanism of kinesophobia between family functioning and exercise adherence in elderly patients with postoperative adjacent vertebral re-fracture after osteoporotic vertebral compression fracture（OVCF）. Methods Convenience sampling method was used to admit to the Department of Orthopaedics of a tertiary hospital in Xuzhou City with adjacent vertebral re-fracture after OVCF were conveniently selected as the survey subjects，and longitudinal investigation was conducted using the APGAR，Functional Exercise Adherence Scale，and TSK Scale. Unconditional potential growth model，structural equation and Bootstrap method were used for statistical analysis. Results A total of 232 valid questionnaires were collected. Longitudinal mediation modeling revealed that the intercept of family functioning significantly negatively predicted the intercept of kinesophobia（β=-0.456，P<0.001） and the slope of family functioning significantly negatively predicted the slope of kinesophobia（β=-0.962，P<0.001）. The intercept for kinesophobia significantly negatively predicted the intercept for exercise adherence（β=-0.623，P<0.001） and significantly negatively predicted the slope for exercise adherence（β=-0.354，P=0.013）. Conclusion The initial level and rate of development of kinesophobia play a fully longitudinal mediating role in the development of family functioning on exercise adherence. Medical professionals should assess and manage patients’ family functioning and kinesophobia in a timely manner，and rationally utilize their interrelationships to improve the level of exercise adherence as much as possible.

Key words: Aged, Vertebral Compression Fractures, Adjacent Vertebral Re-Fracture, Family Function, Exercise Adherence, Kinesophobia, Nursing Care

摘要：

目的 探讨老年骨质疏松性椎体压缩性骨折术后邻近椎体再骨折患者（简称“老年邻近椎体再骨折患者”）运动恐惧在家庭功能及锻炼依从性间的纵向中介作用。方法 采用便利抽样法，选取2022年1月—2024年2月徐州市某三级甲等医院骨科收治的233例老年邻近椎体再骨折患者作为调查对象，采用家庭关怀度指数、功能锻炼依从性量表及运动恐惧评分量表对其进行纵向调查。采用无条件潜变量增长模型、结构方程及Bootstrap法进行统计分析。结果 回收有效问卷232份。纵向中介模型显示，老年邻近椎体再骨折患者的家庭功能的截距负向预测其运动恐惧的截距（β=-0.456，P<0.001），家庭功能的斜率负向预测运动恐惧的斜率（β=-0.962，P<0.001）。老年邻近椎体再骨折患者的运动恐惧的截距能负向预测其锻炼依从性的截距（β=-0.623，P<0.001），并负向预测锻炼依从性的斜率（β=-0.354，P=0.013）。结论 老年邻近椎体再骨折患者的运动恐惧初始水平和变化速率在家庭功能对锻炼依从性影响中起完全纵向中介作用。建议医护人员针对患者的家庭功能、运动恐惧进行评估和管理，利用其相互关系，以改善患者的锻炼依从性水平。

关键词: 老年人, 椎体压缩性骨折, 邻近椎体再骨折, 家庭功能, 锻炼依从性, 运动恐惧, 护理