基于微信提高全膝关节置换术患者居家功能锻炼依从性的干预效果研究

发布时间：2018-12-13 05:04

【摘要】：背景:全膝关节置换术(Total Knee Arthroplasty,TKA)是治疗严重膝关节骨性关节炎的最佳措施,手术成功率高,但患者术后仍需进行康复治疗以减轻功能障碍,促进康复。术后3～6个月是患者康复的关键时期,然而TKA患者居家功能锻炼依从性低,导致其丧失了功能恢复的最佳时机,康复未达到预期效果。微信集文字、语音、视频等为一体,具有即时化、操作简单、成本低等特点,已被作为一种健康传播手段广泛运用于不同健康领域。本研究拟借助微信的功能优势,探索基于微信的干预对提高全膝关节置换术患者居家功能锻炼依从性的效果。目的:探讨基于微信的干预对全膝关节置换术患者居家功能锻炼依从性及康复效果的影响。方法:采用便利取样的方法,于2016年9月至2017年3月,选取于北京市某三甲医院行TKA术,术后转往医联体内康复机构接受康复治疗,符合纳入排除标准的患者72例,入组后随机分为干预组(37例)和对照组(35例)。干预组研究对象在出院前掌握微信平台使用方法,按照出院时的居家运动计划,在微信干预下进行居家功能锻炼;对照组根据与干预组锻炼内容相同的功能锻炼手册和居家运动计划,进行居家功能锻炼。在干预前、术后1个月和术后3个月,采用居家功能锻炼依从性问卷、医用量角器、AKS膝关节功能评分量表和SF-36简明健康调查量表分别调查及测量两组研究对象的居家功能锻炼依从性、膝关节活动度、膝关节功能和生活质量。术后3个月时对微信干预方式进行评价。结果:共完成63例研究对象的资料收集(干预组33例,对照组30例)。结果显示(1)基于微信干预后,干预组研究对象术后1个月和3个月的功能锻炼依从率分别为45.71%和71.47%,对照组研究对象的功能锻炼依从率分别为44.86%和54.73%,术后3个月时干预组研究对象功能锻炼依从率显著高于同期对照组(P0.001)。干预组研究对象AKS评分的症状维度及活动维度得分,SF-36量表的总平均分、生理功能维度得分及躯体疼痛维度得分,在术后1个月及3个月时显著高于同期对照组,AKS评分总平均分、满意度维度得分及期望维度得分在术后3个月时显著高于同期对照组(P0.05)。两组研究对象其他指标差异无统计学意义(P0.05)。(2)研究对象对微信干预方式表现出较高的接受度和满意度。结论:基于微信的干预可提高TKA患者居家功能锻炼依从性,改善患者的膝关节功能,提高生活质量,促进患者康复。
[Abstract]:Background: total knee arthroplasty (Total Knee Arthroplasty,TKA) is the best method for the treatment of severe osteoarthritis of the knee. 3 ~ 6 months after operation is the key period of patients' rehabilitation. However, the compliance of TKA patients with family functional exercise is low, which leads to the loss of the best time of functional recovery, and the recovery does not reach the expected results. WeChat, which integrates text, voice and video, has the characteristics of instant, simple operation and low cost. It has been widely used in different health fields as a means of health communication. The purpose of this study was to explore the effect of WeChat based intervention on improving the compliance of family functional exercise in patients with total knee arthroplasty by virtue of WeChat's functional advantages. Objective: to investigate the effect of WeChat-based intervention on family function exercise compliance and rehabilitation effect of total knee arthroplasty patients. Methods: from September 2016 to March 2017, 72 patients who were selected from September 2016 to March 2017 to receive TKA operation were transferred to the rehabilitation organization in vivo. After entering the group, they were randomly divided into intervention group (37 cases) and control group (35 cases). The subjects of the intervention group mastered the method of using WeChat platform before leaving hospital, and carried on the exercise of home function under the intervention of WeChat according to the home movement plan when discharged from hospital. Control group according to the same exercise content as the intervention group functional exercise manual and home exercise plan, the home function exercise. Before intervention, 1 month after operation and 3 months after operation, the compliance questionnaire of home function exercise was used, and the medical protractor was used. AKS knee function scale and SF-36 brief health survey scale were used to investigate and measure the compliance of home function exercise, knee motion, knee joint function and quality of life of the two groups. WeChat intervention was evaluated 3 months after operation. Results: a total of 63 subjects were collected (33 cases in the intervention group and 30 cases in the control group). The results showed that (1) based on WeChat intervention, the compliance rates of functional exercise were 45.71% and 71.47% in the intervention group 1 month and 3 months after the intervention, respectively. The compliance rate of the subjects in the control group was 44.86% and 54.73% respectively. The compliance rate of the intervention group was significantly higher than that of the control group 3 months after operation (P0.001). The scores of symptom dimension and activity dimension, total average score of SF-36 scale, physiological function dimension and somatic pain dimension of the subjects in the intervention group were significantly higher than those in the control group at 1 month and 3 months after operation. The total average score, satisfaction dimension score and expectation dimension score of AKS score were significantly higher than those of the control group 3 months after operation (P0.05). There was no significant difference in other indexes between the two groups (P0.05). (2). The subjects showed high acceptance and satisfaction with WeChat intervention. Conclusion: the intervention based on WeChat can improve the compliance of the patients with TKA, improve the knee joint function, improve the quality of life, and promote the rehabilitation of the patients.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

【参考文献】