成年烧伤患者恐动症发生现状及其影响因素的横断面调查

A cross-sectional investigation on the current status and influencing factors of kinesiophobia in adult burn patients

目的了解成年烧伤患者恐动症发生现状并分析其影响因素。方法采用单中心横断面调查研究方法。2018年10月—2019年12月,四川大学华西医院整形外科/烧伤科收治170例符合入选标准的成年烧伤患者。采用自制一般资料调查问卷调查患者入院时性别、年龄、文化程度、婚姻状况、医疗费用支付方式、致伤因素及烧伤总面积等一般资料;在入院后1个月或者出院前,采用恐动症Tampa量表(TSK)评估患者是否存在恐动症及恐动症程度,采用视觉模拟评分法评估患者烧伤当时、清创换药时、烧伤术后及安静休息时的疼痛程度(结果取均值),采用社会支持评定量表评估患者社会支持水平,采用医院焦虑抑郁量表评估患者焦虑、抑郁程度。根据TSK评分,将>37分的患者纳入恐动症组,≤37分的患者纳入非恐动症组,统计2组患者一般资料及前述疼痛评分、社会支持水平评分、焦虑评分和抑郁评分。对2组患者数据比较行χ2检验、独立样本t检验及Mann-Whitney U检验等单因素分析。以单因素分析中差异有统计学意义的因素作为自变量进行二分类多因素logistic回归分析,筛选成年烧伤患者发生恐动症的独立影响因素。结果共收集170例患者的问卷及各量表,回收率100%;剔除2例合并颅骨骨折加重患者资料,有效资料168份,有效率98.82%。168例患者中男88例(52.38%)、女80例(47.62%),年龄18~71(41±6)岁,大部分患者为中学及以下文化程度、已婚、医疗费用非自费,致伤因素以火焰和热液为主,烧伤总面积为2%~75%[(28±5)%]体表总面积,TSK评分为(41±5)分,疼痛评分为4.0(2.6,7.0)分,社会支持水平评分为(40±5)分,焦虑评分为8.5(7.0,13.0)分,抑郁评分为9.5(6.5,12.0)分。共98例患者存在恐动症,恐动症发生率为58.33%。恐动症组及非恐动症组患者在性别、年龄、文化程度、婚姻状况、致伤因素等方面比较,差异均无统计学意义(P>0.05);恐动症组患者自费百分比、烧伤总面积、疼痛评分、焦虑评分、抑郁评分显著高于非恐动症组(χ2=6.402,t=2.39,Z=-8.05、-6.68、-7.89,P<0.05或P<0.01),社会支持水平评分显著低于非恐动症组(t=5.22,P<0.01)。二分类多因素logistic回归分析显示,烧伤总面积、疼痛评分、社会支持水平评分、焦虑评分、抑郁评分是成年烧伤患者发生恐动症的独立影响因素(比值比=0.79、1.45、0.78、1.15、1.17,95%置信区间=0.80~0.92、1.24~1.74、0.65~0.91、1.06~1.29、1.03~1.24,P<0.01)。结论成年烧伤患者恐动症发生率较高,恐动症程度主要受烧伤总面积、疼痛、社会支持水平、焦虑及抑郁程度等因素的影响,制订降低恐动症发生率及恐动症程度干预措施时应考虑这些影响因素。

Objective To investigate the current status and influencing factors of kinesiophobia in adult burn patients.Methods A single center cross-sectional research method was conducted.A total of 170 adult burn patients,meeting the inclusion criteria,were admitted to the Department of Plastic Surgery and Burns of the West China Hospital of Sichuan University from October 2018 to December 2019.On admission,the self-made general information questionnaire was used to investigate the gender,age,education level,marital status,payment method of medical expenses,injury factors,and total burn area of patients.One month after admission or before discharge,the presence and degree of kinesiophobia of patients were evaluated by the Tampa Scale for Kinesiophobia(TSK),their pain degrees(results averaged)at the time of burn,debridement and dressing change,after burn operation,and at rest were evaluated by the Visual Analogue Scale,their social support levels were evaluated by the Social Support Revalued Scale,and their degrees of anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale.According to the TSK score,the patients with score>37 points were included into kinesiophobia group,and the patients with score≤37 points were included into non-kinesiophobia group.The general information of patients in the two groups,as well as the pain score,social support level score,anxiety score,and depression score mentioned above,were recorded.Data of patients between the two groups were statistically analyzed with unifactor analysis including chi-square test,independent sample t test,and Mann-Whitney U test.The factors with statistically significant differences in unifactor analysis were used as variables for multivariate logistic regression analysis to screen out the independent influencing factors of kinesiophobia in adult burn patients.Results Questionnaires and scales of 170 patients were collected,and the recovery rate was 100%.The data of two patients complicated with cranial fracture aggravation were removed,and 168 valid data were obtained,with the effective rate of 98.82%.Among the 168 patients,88 were male(52.38%)and 80 were female(47.62%),aged from 18 to 71(41±6)years.Most of the patients had secondary school education or below,were married,and with no out-of-pocket medical expenses.The main factors of injury were flame and hydrothermal fluid,and the total burn area was 2%-75%((28±5)%)total body surface area.The TSK score was(41±5)points,the pain score was 4.0(2.6,7.0)points,the social support level score was(40±5)points,the anxiety score was 8.5(7.0,13.0)points,and the depression score was 9.5(6.5,12.0)points.A total of 98 patients had kinesiophobia,and the incidence of kinesiophobia was 58.33%.There were no statistically significant differences in gender,age,educational level,marital status,or injury factors of patients between kinesiophobia group and non-kinesiophobia group(P>0.05).The percentage of out-of-pocket expenses,total burn area,pain score,anxiety score,and depression score of patients in kinesiophobia group were significantly higher than those in non-kinesiophobia group(χ2=6.402,t=2.39,Z=-8.05,-6.68,-7.89,P<0.05 or P<0.01),and the social support level score of patients in kinesiophobia group was significantly lower than that in non-kinesiophobia group(t=5.22,P<0.01).The multivariate logistic regression analysis showed that total burn area,pain score,social support level score,anxiety score,and depression score were the independent influencing factors for the development of kinesiophobia in adult burn patients(odds ratio=0.79,1.45,0.78,1.15,1.17,95%confidence interval=0.80-0.92,1.24-1.74,0.65-0.91,1.06-1.29,1.03-1.24,P<0.01).Conclusions The incidence of kinesiophobia in adult burn patients is high,and the degree of kinesiophobia is mainly affected by total burn area,pain,social support level,anxiety and depression degrees,and so on.Thus these factors should be taken into consideration when designing interventions to reduce the incidence and degree of kinesiophobia.