全膝关节置换术后患者康复行为演变的质性研究

The development of rehabilitation behaviors of patients with total knee arthroplasty:a qualitative study

目的探讨膝关节骨性关节炎患者全膝关节置换术后康复行为演变过程与始动因素。方法以自我损耗理论为框架,于2019年6月—8月选取上海市某三级甲等骨科专科医院12例全膝关节置换术后患者进行半结构式深度访谈,并进行主题分析与理论框架构建。结果在膝关节骨性关节炎病程中,引起患者不良康复行为的始动因素包括症状困扰、健康知识与社会支持缺乏、负性事件和手术应激。在始动因素诱发下,患者出现认知、情绪、注意及社会互动控制受损,继发冲动决策、消极情绪、意志减退与人际失谐,最终导致不良康复行为。结论全膝关节置换术后患者的不良康复行为是多因素持续消耗心理能量、引发自我损耗的结果。在认知、情绪、注意及社会互动控制层面进行干预,可促进术后患者建立有效康复行为。

Objective To investigate the process and initiating factors of rehabilitation behaviors of knee osteoarthritis patients with total knee arthroplasty(TKA).Methods A qualitative research guided by grounded theory was conducted,and data collected by semi-structured in-depth interviews with 12 patients of a tertiary orthopedic hospital in Shanghai from June to August 2019.Thematic analysis was adopted under the theoretical structure of ego depletion.Results 4 main reasons for ego depletion were identified,including symptom distress,deficiency in health knowledge and social support,negative life events and surgical stress.The impairment of controlling in cognition,emotion,attention and social interaction led to the impulse decision making,negative emotion,decreased motivation and social interaction failure,which eventually resulted in negative rehabilitation behaviors.Conclusion The negative rehabilitation behaviors of TKA patients are the outcomes of ego depletion,which is influenced by multifactor.The major aspects of self-control concluded from this theoretical framework could work as preferences to intervention strategies in promoting positive rehabilitation behaviors.