前置化功能锻炼指导对腰椎术后患者锻炼依从性和准确性的影响

Effect of pre-programmed guidance of functional exercise on exercise compliance and accuracy of patients after lumbar surgery

目的 探讨功能锻炼指导前置化对腰椎术后患者早期功能锻炼的依从性和准确性的影响.方法 收集2016年1—3月在南方医科大学南方医院脊柱骨科进行腰椎内固定术的患者60例,按抽签法随机分为观察组与对照组,各30例.对照组患者进行常规术后功能锻炼指导,观察组患者将功能锻炼指导提前至术前2 d进行.根据自行设计的问卷,通过询问、检查、患者演示的方式对两组患者功能锻炼的依从性和准确性进行评估.结果 术后第1天两组患者踝泵运动和直腿抬高运动的掌握程度比较差异无统计学意义（P〉0.05）;在左右摆腿运动方面,观察组掌握程度优于对照组（Z=-5.100,P〈0.001）.拔管后第1天两组患者的踝泵运动和五点抬臀法运动掌握程度差异无统计学意义（P〉0.05）,但观察组患者在直腿抬高运动（Z=-2.316,P=0.021）、左右摆腿运动（Z=-4.238,P〈0.001）、侧卧前后摆腿（Z=-3.027,P=0.002）及侧卧直腿抬高运动（Z=-3.027,P=0.002）方面掌握程度均优于对照组.观察组患者术后功能锻炼的依从性优于对照组（Z=-2.156,P=0.031）.结论 将功能锻炼指导前置化,能提高患者对功能锻炼的认知及对疾病康复的信心,减轻患者的心理焦虑,从而提高功能锻炼的依从性和正确率,促进其早日康复,亦能节省宣教时间,提高工作效率.

Objective To explore effect of pre-programmed guidance of functional exercise on exercise compliance and accuracy of patients after lumbar surgery.Methods From January to March 2016, 60 patients who had undergone the surgery of lumbar spine internal fixation were selected as the research object. All patients were divided into intervention group and control group randomly, 30 patients in each group. Patients in the control group underwent routine postoperative functional exercises. Patients in the intervention group received preoperative functional exercise instruction before 2 days. According to the self-designed questionnaire, we evaluated the compliance and accuracy of functional exercises of the two groups by asking, checking and demonstrating.Results At first day after operation, the proficiency on ankle pump exercises and straight-leg-raising movement showed no significant difference between two groups （P〉0.05）; However, on supine siding leg movement to right-left, compared with the control group, the intervention group were significantly better （Z=-5.100,P〈0.001）. At first day after removing wound drains, the proficiency on ankle pump exercises and raising buttock with five positions showed no significant difference between two groups （P〉0.05）, but on straight-leg-raising movement （Z=-2.316,P=0.021） , supine siding leg movement to right-left （Z= -4.238,P〈0.001）, lateral siding leg movement to front-back （Z=-3.027,P=0.002） and lateral straight-leg-raising movement （Z=-3.027,P=0.002）, the intervention group was significantly better than the control group. Moreover, as far as adherence of exercise, patients in the intervention group were obvious better （Z= -2.156,P=0.031）.Conclusions The pre-programmed guidance of functional exercise can improve the patient＆#39;s awareness and confidence of functional exercise on rehabilitation, reduce the patients＆#39; psychological anxiety, so as to improve the compliance and the correct rate of functional exercise, promote their recovery. It also can save time for propaganda, improve work efficiency.