退行性脊柱畸形患者的自我管理现状及影响因素分析
nalysis of the Current Status and Influencing Factors of Self-management in Patients with Degenerative Spinal Deformity
背景 近年来，退行性脊柱畸形（DSD）的患病率逐年上升，从疾病发生到需手术干预之前，患者将与疾病长期共存，期间自我管理对 DSD 的发展及转归至关重要。然而，DSD 患者的自我管理现状及影响因素尚不明确，无法针对性地制定有效的干预措施。目的 研究 DSD 患者的自我管理现状并分析其影响因素，为制定针对性的干预方案提供临床参考。方法 采用便利抽样法对 2020 年 6 月—2022 年 12 月于陆军军医大学第一附属医院骨科就诊的 200例 DSD 患者进行问卷调查，收集患者的人口统计学资料、视觉模拟评分、Oswestry 功能障碍指数问卷评分、医疗社会支持量表评分以及慢病自我管理行为量表评分。构建多元线性回归模型分析患者慢病自我管理行为量表评分的影响因素。结果 共回收有效问卷 191 份（95.5%），患者的平均年龄为（62.6±11.6）岁，其中脊柱侧弯 144 例（75.4%），后凸 37 例（19.4%），侧后凸 10 例（5.2%）。慢病自我管理行为量表总分为（22.94±11.97）分，各维度标准化得分由高到低依次为认知症状管理（26.27±15.83）分，医患交流（23.53±16.27）分和运动锻炼（18.42±11.00）分。相关性分析结果显示，年龄、BMI、家庭人均月收入、受教育程度、吸烟史、功能障碍、医疗社会支持与慢病自我管理行为量表各维度评分和总分显著相关（P<0.05）。多元线性回归分析模型结果显示，医疗社会支持、受教育程度、家庭人均月收入和骨密度是 DSD 患者慢病自我管理行为量表评分的影响因素（P<0.05）。结论 DSD 患者的自我管理行为水平较低，医疗社会支持、受教育程度、经济水平和骨密度是 DSD 患者自我管理的影响因素，医护人员在临床实践中应从加强教育、提升社会支持等方面增强患者的自我管理行为，帮助患者有效管理疾病。
BackgroundIn recent yearsthe prevalence of degenerative spinal deformityDSD has been increasing annually. Patients have to live with DSD for a long time from the onset of disease until surgical intervention is requiredand self-management during this period is crucial for the development and progression of DSD. Howeverthe current status and influencing factors of self-management in DSD patients remain unclearmaking it difficult to tailor effective intervention measures. ObjectiveTo investigate the current status and influencing factors of self-management in patients with DSDso as to provide a clinical reference for the development of targeted intervention programs. MethodsA total of 200 patients with DSD who attended the department of orthopedics in the first Affiliated Hospital of the Army Medical University from June 2020 to December 2022 using a convenience sampling method to conduct questionnaire survey. The demographic informationVisual Analogue ScaleVAS scoreOswestry Disability IndexODI scoreMedical Outcomes Study Social Support SurveyMOS-SSS scoreand Chronic Disease Self-management Behavior Scale score were collected. Multiple linear regression were used to analyze the influencing factors of chronic disease self-management behaviors of patients. ResultsA total of 19195.5% valid questionnaires were recovered. The average age of the patients was62.6±11.6 yearsincluding 144 cases75.4% of scoliosis37 cases19.4% of kyphosis and 10 cases5.2% of lateral kyphosis. The total score of selfmanagement behaviors was22.94±11.97. Thestandardized scores for each dimension of self-management behaviors were cognitive symptom management26.27±15.83doctor-patient communication23.53±16.27 and exercise18.42±11.00 in descending order. The results of correlation analysis showed that ageBMImonthly per capita household incomeeducation levelsmoking historyfunction disorder and medical social support were significantly correlated with the scores of each dimension and total score of Chronic Disease Self-management Behavior ScaleP<0.05. The multiple linear regression analysis results showed that medical social supporteducation levelmonthly per capita household incomeand bone mineral density were influencing factors of Chronic Disease Self-management Behavior Scale scoresP<0.05. ConclusionThe level of selfmanagement behavior in patients with DSD is low. Medical social supporteducation leveleconomic leveland bone mineral density are the main influencing factors of self-management behaviors. Healthcare providers should improve self-management behaviors of DSD patients in clinical practice to help them manage their diseases effectively by strengthening education and enhancing social support.
刘蕾、罗飞、郑婷婷、张曌、王钰姝
10.12114/j.issn.1007-9572.2023.0262
临床医学外科学
脊柱疾病退行性脊柱畸形自我管理影响因素分析多元线性回归
Spinal diseasesegenerative spinal deformity，Self-managementRoot cause analysisMultiple linear regression
刘蕾,罗飞,郑婷婷,张曌,王钰姝.退行性脊柱畸形患者的自我管理现状及影响因素分析[EB/OL].(2023-07-04)[2025-07-19].https://chinaxiv.org/abs/202308.00123.点此复制
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