基于干预映射理论构建的残疾时点匹配干预方案在精神分裂症残疾患者中的应用研究

Application of Disability Point Matching Intervention Programme Based on Intervention Mapping Theory in Patients with Schizophrenia Disability

背景精神分裂症是导致伤残和影响生命存活时间的前十大疾病之一,是引发精神残疾的主要原因。目前国内外学者对精神残疾患者早期干预及健康管理的研究相对较少,尤其是我国尚缺乏针对不同时点的精神残疾开展的干预研究。目的 探讨基于干预映射构建的残疾时点匹配(DPM)干预方案对精神分裂症残疾患者残疾程度、阴性症状、自知力、自尊水平及家庭功能等方面的干预效果。方法 采用类实验性研究设计,通过SPSS生成随机数字的方式将P1(残疾1~<2年,70例)、P2(残疾2~<3年,70例)、P3(残疾≥3年,70例)三个时点的患者分别随机分为对照组(35例)及干预组(35例)。三个时点的对照组均实施常规护理,干预组在常规护理的基础上实施DPM干预。干预时间为8周,1次/周。分别在干预前、干预8周后、干预8周后3个月及干预8周后6个月时采用WHO残疾评定量表(WHO-DASⅡ)、阳性与阴性症状量表-阴性症状分量表(PANSS-N)、自知力及治疗态度问卷(ITAQ)、自尊量表(SES)、家庭功能评估问卷(APGAR)进行评估。采用重复测量方差分析对各时点两组患者的健康结局进行比较。结果 DPM干预后P1时点患者的WHO-DASⅡ、PANSS-N、ITAQ、SES评分均存在时间、组别主效应及交互效应(P<0.05),APGAR评分存在时间主效应及时间与组别的交互效应(P<0.05),DPM干预8周后、干预8周后3个月及干预8周后6个月时干预组的WHO-DASⅡ、PANSS-N评分低于对照组(P<0.05),ITAQ、SES、APGAR评分高于对照组(P<0.05)。DPM干预后P2时点患者的WHO-DASⅡ、ITAQ、SES、APGAR评分均存在时间、组别主效应及交互效应,DPM干预8周后及干预8周后6个月时WHO-DASⅡ评分低于对照组、SES评分高于对照组(P<0.05),DPM干预8周后、干预8周后3个月及干预8周后6个月时ITAQ、APGAR评分高于对照组(P<0.05)。DPM干预后P3时点患者的WHO-DASⅡ、ITAQ评分存在时间、组别主效应及交互效应。DPM干预8周后、干预8周后3个月及干预8周后6个月时干预组WHO-DASⅡ评分低于对照组(P<0.05),ITAQ评分高于对照组(P<0.05)。结论 基于干预映射构建的DPM干预方案在改善精神分裂症残疾患者的残疾程度及阴性症状,提高自知力、自尊及家庭功能方面的效果显著。

Background Schizophrenia is considered as one of the top 10 leading causes of disability and life survival time threatening,which is the main cause of mental disability.There are relatively few researches on early intervention and health management for patients with mental disability in China and abroad.In particular,there is a lack of research on interventions for mental disability at different time points in China.Objective To explore the effect of disability point matching(DPM)intervention programme based on intervention mapping theory on degree of disability,negative symptoms,insight,self-esteem level and family function in patients with schizophrenia disability.Methods A quasi-experimental study design was used in the research.The patients at P1(disability1~2 year,70 cases),P2(disability 2~3 years,70 cases) and P3(disability ≥ 3 years,70 cases)were randomly divided into the intervention group(35 cases) and control group(35cases)by using random numbers generated by SPSS.The control group at all three time points received routine care,and the intervention group received DPM based on the routine care.The duration of the intervention was 8 weeks,once a week.The patients were assessed using WHO Disability Rating Scale(WHO-DAS Ⅱ),Positive and Negative Syndrome Scale-Negative Subscale(PANSS-N),Self-knowledge and treatment attitude questionnaire(ITAQ),Self-Esteem Scale(SES) and family adaptation,partnership,growth,affection,resolve(APGAR) before intervention,after 8 weeks of intervention,3months after 8 weeks of intervention and 6 months after 8 weeks of intervention,respectively.The health outcomes between the two groups at each time point were compared by using repeated measures analysis of variance.Results There were main effects and interaction effects of time and group in the WHO-DAS Ⅱ,PANSS-N,ITAQ and SES scores at P1 after DPM intervention(P<0.05),there were main effects and interaction effects of time and group in the APGAR score at P1 after DPM intervention(P<0.05).WHO-DAS Ⅱ and PANSS-N scores were lower and ITAQ(P<0.05),SES,and APGAR scores were higher in the intervention group than the control group at after 8 weeks of intervention,3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention(P<0.05).There were main effects and interaction effects of time and group in WHO-DAS Ⅱ、ITAQ、SES、APGAR scores of patients at P2 after DPM intervention.WHO-DAS Ⅱ score was lower and SES score was higher in the intervention group than the control group at after 8 weeks of intervention and 6 months after 8 weeks of intervention(P<0.05),ITAQ and APGAR scores were higher in the intervention group than the control group at after 8 weeks of intervention,3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention(P<0.05).There were main effects and interaction effects of time and group in WHO-DAS Ⅱ and ITAQ scores at P3 after DPM intervention.WHO-DAS Ⅱ I score was lower and ITAQ score was higher than the control group at after 8 weeks of intervention,3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention(P<0.05).Conclusion The DPM intervention program based on intervention mapping theory is effective in improving the disability degree,negative symptoms,insight,self-esteem and family function in patients with schizophrenic disability.