随访方式对烧伤后严重瘢痕患者康复和遵医行为的影响

Influences of follow-up methods on rehabilitation and compliance of patients with severe scar after burns

目的观察不同随访方式对烧伤后严重瘢痕患者康复和遵医行为产生的影响。方法回顾性分析笔者单位2012年1月—2016年5月收治的116例符合入选标准的创面愈合后出院的烧伤后严重瘢痕患者的病历资料,按不同随访方法将患者分为面对面组59例[男45例、女14例,年龄(36±9)岁]、常规组57例[男44例、女13例,年龄(35±9)岁]。于出院当日、1个月、3个月及6个月,对2组患者采用温哥华瘢痕量表(VSS)评估关节部位增生性瘢痕情况,采用日常生活活动能力(ADL)量表评估残疾情况;于出院1、3、6个月,对2组患者采用遵医行为调查表评估并计算遵医行为率。对数据行χ2检验、t检验并行Bonferroni校正、重复测量方差分析。结果(1)面对面组、常规组患者出院当日VSS评分分别为(11.1±0.7)、(11.7±0.7)分,二者相近(t=2.021,P>0.05),面对面组患者出院1、3、6个月VSS评分[(10.5±0.6)、(8.6±0.7)、(4.7±0.5)分]均明显低于常规组[(11.4±0.7)、(10.9±1.0)、(9.4±0.8)分,t=2.034、2.033、2.042,P<0.05或P<0.01]。(2)面对面组、常规组患者出院当日ADL评分相近(t=1.781,P>0.05),面对面组患者出院1、3、6个月ADL评分均明显高于常规组(t=9.683、8.584、9.772,P<0.01)。(3)面对面组患者出院后坚持康复锻炼、合理饮食、按时复诊行为率均明显高于常规组(χ2=19.015、13.251、8.652,P<0.01)。结论面对面随访相对于电话随访更能直观评估烧伤后严重瘢痕患者的瘢痕情况和ADL,并提高患者的遵医行为率,值得临床推广。

Objective To observe the influences of different follow-up methods on rehabilitation and compliance of patients with severe scar after burns.Methods From January 2012 to May 2016,medical records of 116 patients with severe scar after burns who were admitted to our unit,discharged after wound healing and conforming to the criteria,were retrospectively analyzed.They were divided into face-to-face follow-up group[n=59,45 males and 14 females,aged(36±9)years]and routine follow-up group[n=57,44 males and 13 females,aged(35±9)years]based on different follow-up methods they received.On the day of discharge and in post discharge month(PDM)1,3,and 6,the Vancouver Scar Scale(VSS)was used to evaluate the hypertrophic scar in joints,Activities of Daily Living(ADL)scale was used to evaluate the disability of patients in the 2 groups.In PDM 1,3,and 6,Medical Compliance Behavior Questionnaire was used to investigate the medical compliance behaviors of patients in the 2 groups.Data were processed with chi-square test,t test with Bonferroni correction,and analysis of variance for repeated measurement.Results(1)The VSS score of patients in face-to-face follow-up group on the day of discharge was(11.1±0.7)points,which was close to(11.7±0.7)points of routine follow-up group(t=2.021,P>0.05).The VSS scores of patients in face-to-face follow-up group in PDM 1,3,and 6 were(10.5±0.6),(8.6±0.7),and(4.7±0.5)points,which were significantly lower than(11.4±0.7),(10.9±1.0),and(9.4±0.8)points of routine follow-up group respectively(t=2.034,2.033,2.042,P<0.05 or P<0.01).(2)The ADL score of patients in face-to-face follow-up group on the day of discharge was close to that of routine follow-up group(t=1.781,P>0.05).The ADL scores of patients in face-to-face follow-up group in PDM 1,3,and 6 were higher than those of routine follow-up group respectively(t=9.683,8.584,9.772,P<0.01).(3)The compliance rates of consisted rehabilitation,reasonable diet,and timing consultation of patients in face-to-face follow-up group were better than those of routine follow-up group respectively(χ2=19.015,13.251,8.652,P<0.01).Conclusions Compared with routine follow-up by phone,face-to-face follow-up can do better in evaluating the scar condition and ADL of patients with severe scar after burns,and improve the medical compliance rates of patients,which is worthy of clinical promotion.