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护理学报 ›› 2024, Vol. 31 ›› Issue (7): 63-67.doi: 10.16460/j.issn1008-9969.2024.07.063

• 调查研究 • 上一篇    下一篇

跌倒恐惧在全膝关节置换术后患者疼痛灾难化与恐动症的中介效应

蔡立柏1a, 梁郝2, 刘延锦1b, 魏苗1c, 郭玉茹1a, 李英1d, 崔妙然1a, 秦俊美1a   

  1. 1.郑州大学第一附属医院 a.骨科,b.护理部,c.神经内科,d.泌尿外科医学部,河南 郑州 450053;
    2.郑州医药健康职业学院 临床护理教研室,河南 郑州 452370
  • 收稿日期:2023-09-28 出版日期:2024-04-10 发布日期:2024-05-08
  • 通讯作者: 刘延锦（1959-）,女,河南荥阳人,硕士,主任护师。E-mail：liu-yanjin@126.com
  • 作者简介:蔡立柏（1989-）,男,黑龙江绥化人,满族,硕士,主管护师。
  • 基金资助:
    中华医学会杂志社2022-2023年护理学科研究课题（CMAPH-NRG2022001）; 河南省医学科技攻关计划联合共建项目（LHGJ20190074）; 郑州大学第一附属医院2023 年护理科研专项青年项目（HLKY2023016）

Mediating effect of fear of falling between pain catastrophizing and kinesiophobia in patients undergoing total knee arthroplasty

CAI Li-bai1a, LIANG Hao2, LIU Yan-jin1b, WEI Miao1c, GUO Yu-ru1a, LI Ying1d, CUI Miao-ran1a, QIN Jun-mei1a   

  1. 1a. Dept. of Orthopedics; 1b. Dept. of Nursing Administration; 1c. Dept. of Neurology; 1d. Dept. of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450053, China;
    2. Teaching and Research Office of Clinical Nursing, Zhengzhou Medical College, Zhengzhou 452370, China
  • Received:2023-09-28 Online:2024-04-10 Published:2024-05-08

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摘要： 目的 探讨跌倒恐惧全膝关节置换术后患者疼痛灾难化与恐动症之间的中介效应。方法 采用便利抽样法,选取2022年10月—2023年6月在郑州大学第一附属医院骨科行单侧全膝关节置换术的患者作为研究对象,采用一般资料调查表、恐动症评分简表、疼痛灾难化量表以及简明国际跌倒效能量表对230例受试对象进行问卷调查,构建并检验中介模型。结果 本组全膝关节置换术后患者恐动症总分为（24.70±7.46）分,跌倒恐惧总分为（16.35±5.27）分,疼痛灾难化总分为（29.26±9.64）分。全膝关节置换术后患者恐动症总分与跌倒恐惧总分呈正相关（r=0.670,P<0.001）,与疼痛灾难化总分呈正相关（r=0.710,P<0.001）,疼痛灾难化总分与跌倒恐惧总分呈正相关（r=0.652,P<0.001）。跌倒恐惧在全膝关节置换术后患者疼痛灾难化与恐动症间起部分中介作用,效应占33.1%。结论 本组全膝关节置换术后患者恐动症处于中等水平,跌倒恐惧及疼痛灾难化处于中等偏上水平,跌倒恐惧在全膝关节置换术后患者疼痛灾难化与恐动症间起部分中介作用。建议临床医务工作者应关注全膝关节置换术后患者疼痛灾难化及跌倒恐惧,降低其恐动症,以促进其膝关节功能快速恢复。

关键词: 关节成形术, 置换, 膝, 疼痛灾难化, 跌倒恐惧, 恐动症, 骨科护理

Abstract: Objective To explore the mediating effect of fear of falling between pain catastrophizing and kinesiophobia in patients undergoing total knee arthroplasty. Methods With convenience sampling, 230 patients who underwent unilateral total knee arthroplasty from the First Affiliated Hospital of Zhengzhou University from October 2022 to June 2023 were selected and surveyed by the general information questionnaire, Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale and Short Falls Efficacy Scale-International. The mediation model was constructed and verified. Results The total score of kinesiophobia, fear of falling, and pain catastrophizing was 24.70±7.46, 16.35±5.27, and 29.26±9.64, respectively. Kinesiophobia in patients undergoing total knee arthroplasty was positively associated with fear of falling（r=0.670, P<0.001）,and pain catastrophizing（r=0.710, P<0.001）; pain catastrophizing was positively associated with fear of falling（r=0.652, P<0.001）. Fear of falling played a partial mediating role between pain catastrophizing and kinesiophobia in patients undergoing total knee arthroplasty, accounting for 33.1% of the total effect. Conclusion In this study, kinesiophobia is at a moderate level, and the fear of falling and the pain catastrophizing are at a moderate to high level. Moreover, fear of falling plays a partial mediating role on the relationship between pain catastrophizing and kinesiophobia in patients undergoing total knee arthroplasty. It is suggested that medical practitioners should pay attention to fear of falling and pain catastrophizing, so as to minimize the level of kinesiophobia and enhance the speedy recovery of knee function in patients following total knee arthroplasty.

Key words: arthroplasty, replacement, knee, pain catastrophizing, fear of falling, kinesiophobia, orthopedics nursing

中图分类号: 

  • R473.6
[1] Le Stum M, Gicquel T, Dardenne G, et al.Total knee arthroplasty in France: male-driven rise in procedures in 2009-2019 and projections for 2050[J].Orthop Traumatol Surg Res, 2023,109(5):103463. DOI:10.1016/j.otsr.2022.103463.
[2] 单亚维,陈维佳,金丽娟,等.全膝关节置换术加速康复循证护理实践方案的构建[J].护理学报,2020, 27(21):33-39.DOI:10.16460/j.issn1008-9969.2020.21.033.
[3] 何家文,赵晨,钟泓颖,等.全膝关节置换术后恐动症及其影响因素研究[J].中国康复医学杂志,2023,38(1):41-45,51.DOI:10.3969/j.issn.1001-1242.2023.01.007.
[4] 汪世秀, 吕静, 文皓, 等. 疼痛灾难化的研究进展[J]. 中国临床护理, 2023,15(4):252-256. DOI:10.3969/j.issn.1674-3768.2023.04.013.
[5] 徐慧萍,张炎改,刘延锦,等.全膝关节置换术后患者恐动症的影响因素研究[J].中华护理杂志,2021, 56(10):1460-1465.DOI:10.3761/j.issn.0254-1769.2021.10.003.
[6] Vlaeyen J, Linton SJ.Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art[J]. Pain, 2000,85(3):317-332.
[7] Sertel M, Aydogan AS, Tutun YE, et al.Investigation of the relationship between physical activity, kinesiophobia and fear of falling in older adults with chronic pain[J]. Somatosens Mot Res,2021,38(3):241-247.DOI:10.1080/08990220.2021.1958774.
[8] Pinheiro C, Bevilaqua-Grossi D, Florencio LL, et al.Is kinesiophobia related to fear of falling, dizziness disability, and migraine disability in patients with migraine?[J]. Physiother Theory Pract,2022,38(13):2727-2735.DOI:10.1080/09593985.2021.1996496.
[9] 颜艳, 王彤. 医学统计学[M]. 5版. 北京: 人民卫生出版社, 2020:507-508.
[10] Woby SR, Roach NK, Urmston M, et al.Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia[J]. Pain, 2005,117(1-2):137-144. DOI:10.1016/j.pain.2005.05.029.
[11] 蔡立柏, 刘延锦, 徐秋露, 等. 恐动症评估简表中文版在全膝关节置换患者中应用的信效度研究[J]. 中华行为医学与脑科学杂志, 2019,28(3):270-274. DOI:10.3760/cma.j.issn.1674-6554.2019.03.015.
[12] Sullivan M, Bishop S, Pivik J.The Pain Catastrophizing Scale: development and validation[J]. Pain, 1995,7(4):524-532.
[13] Yap JC, Lau J, Chen PP, et al.Validation of the Chinese Pain Catastrophizing Scale(HK-PCS) in patients with chronic pain[J]. Pain Med, 2008,9(2):186-195. DOI:10.1111/j.1526-4637.2007.00307.x.
[14] Kempen GI, Yardley L, van Haastregt JC, et al. The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling[J]. Age Ageing, 2008,37(1):45-50. DOI:10.1093/ageing/afm157.
[15] 邓宁, 张彤, 史宝欣. 简明国际跌倒效能感量表在脑梗死患者中的信度和效度检验[J].中国康复理论与实践, 2015,21(12):1438-1442. DOI:10.3969/j.issn.1006-9771.2015.12.015.
[16] 汤丹丹, 温忠麟. 共同方法偏差检验:问题与建议[J].心理科学,2020,43(1):215-223.DOI:10.16719/j.cnki.1671-6981.20200130.
[17] Yan Z, Wu Y, Liu M, et al.Heterogeneous trajectories of kinesiophobia and their effects on rehabilitation outcomes after total knee arthroplasty: a prospective cohort study[J]. J Orthop Surg Res,2023,18(1):449-458.DOI:10.1186/s13018-023-03881-8.
[18] 蔡立柏,刘延锦,崔妙然,等.全膝关节置换术恐动症患者术后早期功能锻炼体验的质性研究[J].中华护理杂志,2019,54(11):1663-1668. DOI:10.3761/j.issn.0254-1769.2019.11.013.
[19] Zhou Y, Gao W, Gao S, et al.Pain catastrophizing, kinesiophobia and exercise adherence in patients after total knee arthroplasty: the mediating role of exercise self-efficacy[J]. J Pain Res,2023,16:3993-4004.DOI:10.2147/JPR.S432106.
[20] Aily JB, de Almeida AC, Ramírez PC, et al. Lower education is an associated factor with the combination of pain catastrophizing and kinesiophobia in patients with knee osteoarthritis?[J]. Clin Rheumatol, 2021, 40(6):2361-2367. DOI:10.1007/s10067-020-05518-1.
[21] Delbaere K, Close JC, Mikolaizak AS, et al.The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study[J]. Age Ageing, 2010,39(2):210-216. DOI:10.1093/ageing/afp225.
[22] Scheffers-Barnhoorn MN, Haaksma ML, Achterberg WP, et al.Course of fear of falling after hip fracture: findings from a 12-month inception cohort[J]. BMJ Open, 2023,13(3):e68625. DOI:10.1136/bmjopen-2022-068625.
[23] 苟艳君,王锐霞,夏琴,等.疼痛灾难化对全膝关节置换术患者锻炼依从性影响的有调节的中介效应[J].护理学杂志,2023, 38(22):97-100. DOI:10.3870/j.issn.1001-4152.2023.22.097.
[24] 中华医学会骨科学分会关节外科学组,北京医学会骨科专业委员会关节外科学组.中国全膝关节置换术围手术期疼痛管理指南(2022)[J].中华骨与关节外科杂志,2022,15(11):801-821.DOI:10.3969/j.issn.2095-9958.2022.11.01.
[25] 李海云,徐化.Otago运动对老年全膝关节置换术后患者恐动程度及跌倒风险的影响[J].护士进修杂志,2020,35(11):965-969.DOI:10.16821/j.cnki.hsjx.2020.11.002.
[26] Zahedian-Nasab N, Jaberi A, Shirazi F, et al.Effect of virtual reality exercises on balance and fall in elderly people with fall risk: a randomized controlled trial[J]. BMC Geriatr,2021, 21(1):509. DOI:10.1186/s12877-021-02462-w.
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