基于循证原则的综合化认知行为干预对社区高危女性骨质疏松人群预防行为及骨密度的影响

Comprehensive cognitive behavioral intervention grounded in evidence-based principles:effects on preventive behavior and BMD among community females with high-risk for osteoporosis

目的探讨基于循证原则的综合化认知行为干预对社区高危女性骨质疏松人群自我管理能力、预防行为及骨密度(BMD)的影响。方法选取2019年6月至2020年6月青浦区盈浦街道社区骨质疏松性骨折高危患者120例,根据随机设计、对照设计试验原则进行随机分组,各60例,干预8个月后对比2组骨质疏松相关知识、预防行为、自我效能、生活质量、血清骨代谢生化指标[抗酒石酸酸性磷酸酶(TRAP-5b)、骨特异性碱性磷酸酶(ALP)、骨钙素(BGP)]及股骨粗隆(TROCH)、华氏三角(Ward)、股骨颈(NECK)等位置BMD。结果干预后观察组运动知识、钙知识、危险因素等知识评分及知识掌握度总分均大于对照组,差异有统计学意义(P<0.05);干预后观察组运动行为、钙摄入行为、相关生活习惯等评分及预防行为总分均大于对照组,差异有统计学意义(P<0.05);干预后观察组食钙自我效能量表评分、锻炼自我效能量表评分、总分及生活质量评分大于对照组,差异有统计学意义(P<0.05);干预后观察组TROCH、Ward、NECK等部位BMD大于对照组,ALP、BGP、TRAP-5b低于对照组,差异有统计学意义(P<0.05)。结论基于循证原则的综合化认知行为干预对提高社区高危女性骨质疏松人群认知度具有重要作用,能提高患者预防行为,有助于降低骨质疏松发生风险。

Objective To investigate how the comprehensive cognitive behavior intervention grounded in evidence-based principles relates to self-management ability,preventive behavior and bone mineral density(BMD)among communityfemales at high-risk for osteoporosis.Methods Included were 120 patients who were at high-risk for osteoporotic fractures in Yingpu community between June 2019 and June 2020 were included.According to randomized controlled study design,the subjects were randomly assigned to two groups(n=60 each).After 8 months of intervention,the two groups were compared for osteoporosis-related knowledge,preventive behavior,self-efficacy,quality of life,serum biochemical indicators of bone metabolism[anti-tartrate acid phosphatase(TRAP-5b),bone specific alkaline phosphatase(ALP),osteocalcin(BGP)]and BMD in the femoral trochanter(TROCH),Ward triangle(Ward),and femoral neck(NECK).Results After intervention,the study group recorded higher scores about knowledges on exercises,calcium,and risk factors,as well as higher score of overall knowledge mastery,than did the control group,with statistically significant differences(P<0.05).After intervention,the study group also recorded higher behavior scores on exercise,calcium intake,and related life style,as well as higher overall scores of preventive behaviors,than did the control group,with statistically significant differences(P<0.05).After intervention,the study group recorded higher scores for self-efficacy scales on calcium intake and exercise,overall scores of self-efficacy,higher quality of life,than did the control group,with statistically significant differences(P<0.05).After intervention,the study group showed higher TROCH,Ward,and NECK BMDs,as well as lower ALP,BGP,and TRAP-5b,than did the control group,with statistically significant differences(P<0.05).Conclusion Comprehensive cognitive behavior intervention grounded in evidence-based principles plays an important role in improving the awareness of knowledge in community females at high-risk of osteoporosis.The intervention may promote preventive behavior and help reduce the risk of osteoporosis in these patients.