基于信息-动机-行为技巧模型的随访干预在骨质疏松性髋部骨折术后老年患者中的应用

Follow-up intervention based on IMB model in elderly patients with osteoporotic hip fracture

目的评价基于信息-动机-行为技巧模型(information-motivation-behavioral skills model,IMB)的随访干预对骨质疏松性髋部骨折术后老年患者髋关节功能、功能独立性及心理状况的影响。方法将2018年1月至6月在本院骨科收治的骨质疏松性髋部骨折术后老年患者90例设为对照组,出院后给予常规随访;2018年7月至2019年1月在本院骨科收治的骨质疏松性髋部骨折术后老年患者90例设为干预组,在常规随访基础上辅以基于IMB的随访干预措施。分别在出院时、出院后3个月和出院后6个月评估两组患者髋关节功能,功能独立性及心理状况,同时了解患者出院后再骨折发生情况。结果出院时、出院后3个月和出院后6个月两组患者髋关节功能、功能独立性及抑郁评分的时间效应、组间效应、交互效应比较,差异均有统计学意义(均P<0.001),并且出院后3个月和出院后6个月干预组患者髋关节功能,功能独立性评分高于同期对照组,差异均有统计学意义(P<0.001);抑郁评分低于同期对照组,差异均有统计学意义(P<0.001)。出院后6个月干预组患者再骨折发生率低于对照组(P<0.05)。结论基于IMB模型的随访干预可有效改善骨质疏松性髋部骨折老年患者结局,促进术后髋关节功能恢复,改善患者抑郁情绪。

Objective To investigate the effect of follow-up intervention based on the information-motivation-behavioral skills model(IMB)on hip function,functional independence and psychological status of elderly patients with osteoporotic hip fractures after operation.Methods A group of 90 elderly patients who had osteoporotic hip fracture and treated in our hospital from January to June 2018 were allocated in the control group,and they provided with routine nursing intervention after discharge.Another group of 90 elderly patients with the same disease hospitalised from July 2018 to January 2019 were allocated in the intervention group,and they were followed up with IMB-based interventions other than the routine nursing after discharge.The two groups were compared with hip function,functional independence,depression scores,and re-fracture at the time points of discharge,the 3rd and 6th month after discharge.Results There were significant differences in hip function,time effect,inter-group effect and interaction effect between the two groups before discharge,at months 3 and 6 after discharge(P<0.001).The hip function and functional independence of the intervention group were better than those of the control group at months 3 and 6 after discharge,with statistical significant differences between the groups(P<0.001).The depression score was significantly lower in the control group at the same periods(P<0.001).The incidence of re-fracture in the intervention group was significantly lower than that in the control group at the 6th month after discharge(P<0.05).Conclusion The IMB-based follow-up intervention is able to effectively improve the outcomes of elderly patients with osteoporotic hip fracture,promote the functional recovery of hip joint after surgery,and improve the functional independence.