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护理学报 ›› 2019, Vol. 26 ›› Issue (10): 32-37.doi: 10.16460/j.issn1008-9969.2019.10.032

• 循证护理 • 上一篇    下一篇

基于循证实践指南的膝关节骨关节炎患者健康教育指导模块的构建

单亚维1, 陈维佳2, 李玉霞1   

  1. 1.上海中医药大学 护理学院,上海 201203;
    2.上海市光华中西医结合医院 护理部,上海 200052
  • 收稿日期:2019-01-10 发布日期:2020-07-17
  • 作者简介:单亚维（1988-）,女,江苏常熟人,硕士,讲师。
  • 基金资助:
    上海中医药大学护理预算内护理项目（A1-1830101121）

Construction of Health Education Guideline Module for Patients with Knee Osteoarthritis Based on Evidence-based Practice Guidelines

SHAN Ya-wei1, CHEN Wei-jia2, LI Yu-xia1   

  1. 1. School of Nursing, Shanghai University of TCM, Shanghai 201203, China;
    2. Dept. of Nursing Administration, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 200052, China
  • Received:2019-01-10 Published:2020-07-17

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摘要： 目的 构建膝关节骨关节炎（knee osteoarthritis, KOA）患者健康教育指导模块,为医护人员进行健康宣教提供索引与参考,从而促进患者的自我管理。方法 通过自我管理理论与健康教育策略分析,形成健康教育指导层级;通过检索全球膝关节骨关节炎相关循证实践指南,以AGREE II（Appraisal of Guidelines for Research and Evaluation II）评价工具进行严格评价进行指南的筛选;以指南的推荐意见形成遴选条目池和健康教育指导概念图;通过小组会议最终形成健康教育指导模块。结果 本研究共纳入循证实践指南6部,形成23条健康教育条目;通过专家与患者小组会议,最终纳入推荐意见14条,形成了以疾病管理（病因与危险因素、药物治疗或疼痛管理、保守治疗、侵入性治疗）,角色管理和情绪管理为框架的健康教育指导模块。结论 本研究重点强调了疼痛管理、运动策略和体质量控制的核心价值。健康教育工作者应采用个性化的教育和管理途径,促进患者的自我管理,提高患者生活质量,延缓KOA疾病的进程。

关键词: 膝关节骨关节炎, 健康教育, 循证实践

Abstract: Objective To construct health education guideline module for patients with knee osteoarthritis (KOA), and to provide reference for health education and self-management of patients with KOA. Methods Theoretical analysis and literature review were used to form the hierachical of the concepts. Item pool and health education guideline concept map were developed after the retrieval of global evidence-based practice guidelines for KOA, which were evaluated by Appraisal of Guidelines for Research and Evaluation II (AGREE II ). The panel meeting with KOA patients and health care professionals was held to form the final module. Results Six clinical practice guidelines worldwide were employed, providing 23 health education items then the panel meeting excluded 9 itmes. The final module was composed of 3 dimensions, including disease management (etiology; pharmacotherapy or pain management; conservative therapy and invasive therapy ), role management, and emotion management. Conclusion Pain management, exercise strategy and weight control are the core parts in this health guideline module. Practitioners and KOA patients should take all factors involving in the module into consideration while conducting personalized health education,hence to improve patients' self-management ability, quality of life and delay the progression of KOA.

Key words: knee osteoarthritis, health education, evidence based practice

中图分类号: 

  • R473.6
[1] Cross M, Smith E, Hoy D, et al.The Global Burden of Hip and Knee Osteoarthritis: Estimates from the Global Burden of Disease 2010 Study[J]. Ann Rheum Dis, 2014,73(7):1323-1330. DOI:10.1136/annrheumdis-2013-204763.
[2] Kao M H, Tsai Y F.Illness Experiences in Middle-aged Adults with Early-stage Knee Osteoarthritis: Findings from a Qualitative Study[J]. J Adv Nurs, 2014,70(7):1564-1572. DOI:10.1111/jan.12313.
[3] Farin E, Ullrich A, Nagl M.Health Education Literacy in Patients with Chronic Musculoskeletal Diseases: Development of a New Questionnaire and Sociodemographic Predictors[J]. Health Educ Res, 2013,28(6):1080-1091. DOI:10.1093/her/cyt095.
[4] National Clinical Guideline Centre. National Institute for Health and Clinical Excellence: Guidance. Osteoarthritis: Care and Management in Adults[S].London: National Institute for Health and Care Excellence (UK), 2014.
[5] Ormandy P.Defining Information Need in Health-assimilating Complex Theories Derived from Information Science[J]. Health Expect,2011,14(1):92-104.DOI:10.1111/j.1369-7625.2010.00598.x.
[6] McNamara M, Sarma K, Aberle D R, et al. Data Model for Personalized Patient Health Guidelines: An Exploratory Study[J]. AMIA Annu Symp Proc, 2014,2014:1835-1844.
[7] Hoffman A J.Enhancing Self-efficacy for Optimized Patient Outcomes through the Theory of Symptom Self-management[J]. Cancer Nurs, 2013,36(1):E16-26. DOI:10.1097/NCC.0b013e31824a730a.
[8] Richardson J, Loyola-Sanchez A, Sinclair S, et al.Self-management Interventions for Chronic Disease: A Systematic Scoping Review[J]. Clin Rehabil, 2014,28(11):1067-1077. DOI:10.1177/0269215514532478.
[9] Lorig K R, Holman H.Self-management Education: History, Definition, Outcomes, and Mechanisms[J]. Ann Behav Med, 2003,26(1):1-7.
[10] Kroon F P, van der Burg L R, Buchbinder R, et al. Self-management Education Programmes for Osteoarthritis[J]. Cochrane Database Syst Rev, 2014(1):CD008963.DOI:10.1002/14651858.CD008963.pub2.
[11] AGREE Enterprise. Appraisal of Guidelines for Research and Evaluation II: AGREE Research Trust; 2017[EB/OL].[2017-12-1].https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Manual-and-23-item-Instrument-2009-Update-2017.pdf.
[12] Jevsevar D S.Treatment of Osteoarthritis of the Knee: Evidence-based Guideline, 2nd Edition[J]. J Am Acad Orthop Surg, 2013,21(9):571-576. DOI:10.5435/jaaos-21-09-571.
[13] National Clinical Guideline Centre. National Institute for Health and Clinical Excellence: Guidance. Implantation of a Shock or Load Absorber for Mild to Moderate Symptomatic Medial Knee Osteoarthritis[S]. London: National Institute for Health and Care Excellence (UK),2015.
[14] National Clinical Guideline Centre. National Institute for Health and Clinical Excellence: Guidance. Osteoarthritis[S]. London: National Institute for Health and Care Excellence (UK). 2015.
[15] Loew L, Brosseau L, Wells G A, et al.Ottawa Panel Evidence-based Clinical Practice Guidelines for Aerobic Walking Programs in the Management of Osteoarthritis[J]. Arch Phys Med Rehabil, 2012, 93(7):1269-1285. DOI:10.1016/j.apmr.2012.01.024.
[16] National Guideline Clearinghouse.Guideline Summary: VA/DoD Clinical Practice Guideline for the Non-surgical Management of Hip and Knee Osteoarthritis[S]. London: National Guideline Clearinghouse (NGC). 2014.
[17] Ravaud P, Flipo R M, Boutron I, et al.ARTIST (Osteoarthritis Intervention Standardized) Study of Standardised Consultation Versus Usual Care for Patients with Osteoarthritis of the Knee in Primary Care in France: Pragmatic Randomised Controlled Trial[J].BMJ,2009(338):b421. DOI:10.1136/bmj.b421.
[18] Cowan P, Lovasik D A.American Chronic Pain Association: Strategies for Surviving Chronic Pain[J]. Orthop Nurs, 1990,9(4):47-49.
[19] Service UDoHaH. Physical Activity Guidelines for Americans (Second Edition) Washington, DC2018 [EB/OL].(2018-01-24). https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf.
[20] Geneen L J, Moore R A, Clarke C, et al.Physical Activity and Exercise for Chronic Pain in Adults: An Overview of Cochrane Reviews. Cochrane Database of Systematic Reviews [Internet].(2018-01-24). Physical Activity and Exercise for Chronic Pain in Adults: An Overview of Cochrane Reviews. Cochrane Database of Systematic Reviews [Internet].(2018-01-24). http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD011279.pub3/abstract.
[21] Dulay G S, Cooper C, Dennison E M. Knee Pain, Knee Injury, Knee Osteoarthritis & Work[J]. Best Pract Res Clin Rheumatol, 2015,29(3):454-461.DOI:10.1016/j.berh.2015.05.005.
[22] 付至江. 膝骨关节炎患者的健康管理及依从性分析[D]. 广州:广州中医药大学, 2015.
[23] Liu Q, Niu J, Huang J, et al.Knee Osteoarthritis and All-cause Mortality: The Wuchuan Osteoarthritis Study[J]. Osteoarthritis Cartilage, 2015,23(7):1154-1157. DOI:10.1016/j.joca.2015.03.021.
[24] Unver B, Ertekin O, Karatosun V.Pain, Fear of Falling and Stair Climbing Ability in Patients with Knee Osteoarthritis before and after Knee Replacement:6 Month Follow-up Study[J]. J Back Musculoskelet Rehabil, 2014,27(1):77-84. DOI:10.3233/bmr-130422.
[25] Khalaj N, Abu Osman N A, Mokhtar A H, et al. Effect of Exercise and Gait Retraining on Knee Adduction Moment in People with Knee Osteoarthritis[J]. Proc Inst Mech Eng H, 2014,228(2):190-199.DOI:10.1177/0954411914521155.
[26] Runhaar J, van Middelkoop M, Reijman M, et al. Prevention of Knee Osteoarthritis in Overweight Females:The First Preventive Randomized Controlled Trial in Osteoarthritis[J]. Am J Med,2015,128(8):888-895.DOI:e884.10.1016/j.amjmed.2015.03.006.
[27] Riddle D L, Makowski M, Kong X.Knee Osteoarthritis Worsening Across the Disease Spectrum and Future Knee Pain, Symptoms, and Functioning: A Multisite Prospective Cohort Study[J]. Arthritis Care Res (Hoboken), 2015,67(12):1722-1729. DOI:10.1002/acr.22654.
[28] Stubbs B, Hurley M, Smith T.What are the Factors that Influence Physical Activity Participation in Adults with Knee and Hip Osteoarthritis? A Systematic Review of Physical Activity Correlates[J]. Clin Rehabil, 2015,29(1):80-94. DOI:10.1177/0269215514538069.
[29] Zhou Z, Hou Y, Lin J, et al.Patients' Views toward Knee Osteoarthritis Exercise Therapy and Factors Influencing Adherence - A Survey in China[J]. Phys Sportsmed, 2018:1-7. DOI:10.1080/00913847.2018.1425595.
[30] 粟迎春,雷小俊. 关节腔内注射透明质酸钠联合塞来昔布治疗早中期膝关节骨关节炎的疗效分析[J]. 中华关节外科杂志(电子版), 2017,11(2):204.
[31] Ethgen O, Vanparijs P, Delhalle S, et al.Social Support and Health-related Quality of Life in Hip and Knee Osteoarthritis[J]. Qual Life Res, 2004,13(2):321-330. DOI: 10.1023/B:QURE.0000018492.40262.d1.
[32] Jung J H, Seok H, Kim J H, et al.Association between Osteoarthritis and Mental Health in a Korean Population: A Nationwide Sudy[J]. Int J Rheum Dis, 2018,21(3):611-619. DOI:10.1111/1756-185x.13098.
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