自我效能和恐惧-回避信念与应对方式对慢性腰背痛患者生命质量的影响路径研究

发布时间：2018-10-24 08:24

【摘要】：目的探讨自我效能、恐惧-回避信念和应对方式对社区慢性腰背痛患者生命质量的影响路径。方法2016年3—9月,采用便利抽样法选择南京市和常州市11个社区的慢性腰背痛患者为调查对象。分别采用慢性病管理自我效能量表、中文版恐惧-回避信念问卷(FABQ-CHI)、简易应对方式问卷(SCSQ)和简明健康状况量表(SF-36)评价患者自我效能、恐惧-回避信念、应对方式和生命质量。采用Pearson相关、多元逐步线性回归和结构方程模型分析自我效能、恐惧-回避信念、应对方式对生命质量的影响机制。结果本研究共发放问卷250份,回收有效问卷221份,有效回收率为88.4%。SF-36生理健康领域(PCS)评分为(53.96±19.93)分,心理健康领域(MCS)评分为(60.83±22.70)分,各维度得分均低于常模(P0.01)。Pearson相关分析显示,慢性病管理自我效能量表总分与FABQ-CHI总分呈负相关,与SCSQ积极应对维度评分呈正相关,与SF-36各维度评分呈正相关(P0.05);FABQ-CHI总分与SCSQ消极应对维度评分呈正相关,与SF-36各维度评分呈负相关(P0.05);SCSQ积极应对维度评分与SF-36生理功能(PF)维度、活力(VT)维度、精神健康(MH)维度评分呈正相关(P0.05);SCSQ消极应对维度评分与SF-36 PF维度、总体健康(GH)维度、社会功能(SF)维度、MH维度评分呈负相关(P0.05)。多元线性回归分析显示,慢性病管理自我效能量表、FABQ-CHI、SCSQ的积极应对维度和消极应对维度评分均可预测SF-36 PCS评分,慢性病管理自我效能量表、FABQ-CHI、SCSQ的消极应对维度评分可预测SF-36 MCS评分(P0.05)。结构方程模型显示,自我效能对生命质量有直接正向预测作用(b=0.35),并通过中介变量积极应对(b=0.31)间接正向影响生命质量(b=0.19);恐惧-回避信念对生命质量有直接负向预测作用(b=-0.33),并通过中介变量消极应对(b=0.32)间接负向影响生命质量(b=-0.32)。结论自我效能、恐惧-回避信念可直接及分别通过积极应对、消极应对间接影响慢性腰背痛患者生命质量。医护人员应通过健康教育,提高患者的自我效能,降低恐惧-回避信念,改善应对方式,提高其生命质量水平。
[Abstract]:Objective to explore the influence of self-efficacy, fear-avoidance beliefs and coping styles on the quality of life of patients with chronic low back pain in community. Methods from March to September 2016, patients with chronic low back pain in 11 communities of Nanjing and Changzhou were selected by convenience sampling method. Chronic disease management self-efficacy scale, Chinese version fear avoidance belief questionnaire (FABQ-CHI), simple coping style questionnaire (SCSQ) and brief Health status scale (SF-36) were used to evaluate patients' self-efficacy, fear avoidance belief, coping style and quality of life. Pearson correlation, multiple stepwise linear regression and structural equation model were used to analyze the influence mechanism of self-efficacy, fear avoidance belief and coping style on quality of life. Results A total of 250 questionnaires were sent out and 221 valid questionnaires were collected. The effective recovery rate was (53.96 卤19.93) in 88.4%.SF-36 physical health and (60.83 卤22.70) in mental health. The scores of each dimension were lower than those of the norm (P0.01). Pearson correlation analysis showed that the recovery rate was (53.96 卤19.93) and (60.83 卤22.70) respectively). The total score of chronic disease management self-efficacy scale was negatively correlated with the total score of FABQ-CHI, positively correlated with the score of positive coping dimension of SCSQ, and positively correlated with the score of each dimension of SF-36 (P0.05); the total score of FABQ-CHI was positively correlated with the score of negative coping dimension of SCSQ. There was a negative correlation between the scores of each dimension of SF-36 (P0.05); SCSQ positive coping dimension score and SF-36 physiological function (PF) dimension, dynamic (VT) dimension, mental health (MH) dimension score positive correlation (P0.05); SCSQ negative coping dimension score and SF-36 PF dimension, overall health (GH) dimension; Social function (SF) dimension, MH dimension score was negatively correlated (P0.05). Multiple linear regression analysis showed that chronic disease management self-efficacy scale, FABQ-CHI,SCSQ positive coping dimension and negative coping dimension score can predict SF-36 PCS score, chronic disease management self-efficacy scale, FABQ-CHI,SCSQ negative coping dimension score can predict SF-36 MCS score (P0.05). The structural equation model shows that, Self-efficacy has direct positive predictive effect on quality of life (b.35), and indirect positive effect on quality of life through intermediate variable (bG0.31), fear avoidance belief has direct negative predictive effect on quality of life (b-0.33), and through intermediary change, it has indirect positive effect on quality of life (BQOL). The quantity of negative coping (bt0. 32) indirectly and negatively affected the quality of life (bPQ-0. 32). Conclusion Self-efficacy, fear-avoidance belief can directly and separately affect the quality of life of patients with chronic low back pain through positive coping and negative coping. Health care workers should improve their self-efficacy, reduce fear-avoidance beliefs, improve coping styles and improve their quality of life through health education.
【作者单位】：南京中医药大学护理学院;南京大学医学院附属鼓楼医院核医学科;上海市健康促进中心;
【基金】：教育部人文社会科学研究青年基金(14YJCZH024) 江苏省高校“青蓝工程”(2016~2019年度)资助项目江苏省优势学科二期项目南京中医药大学护理学一级学科指令性课题(YSHL2016-032)
【分类号】：R681.55

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