自我效能理论主导的居家康复方案在颞下颌关节盘复位术后的应用效果

Application effect of home-based rehabilitation program led by self-efficacy theory after temporomandibular joint disk repositioning

目的·评价自我效能理论主导的居家康复方案在颞下颌关节盘复位术后的应用效果。方法·采用便利抽样法,选取2020年8月—2021年1月上海交通大学医学院附属第九人民医院口腔外科收治的确诊为颞下颌关节盘不可复性移位并接受颞下颌关节盘复位术的患者为对照组,2021年2月—2021年7月收治的确诊为颞下颌关节盘不可复性移位并接受颞下颌关节盘复位术的患者为干预组。对照组患者给予常规居家康复训练方案,干预组在对照组的基础上实施自我效能理论主导的居家康复训练方案。采用一般资料问卷收集患者的一般资料。测定关节活动度,采用康复锻炼依从性问卷、中文版一般自我效能感量表(General Self-efficacy Scale,GSES)、中文版Mishel疾病不确定感量表(Mishel′s Uncertainty in Illness Scale,MUIS)进行调查,比较2组患者基线及术后1、3、6个月时的关节活动度、康复锻炼依从性得分、自我效能得分、疾病不确定感得分的差异。结果·共纳入167例确诊为颞下颌关节盘不可复性移位并接受关节盘复位术的患者,其中对照组96例,干预组71例。2组患者的一般资料的差异无统计学意义(P>0.05)。2组患者基线时最大张口度,最大向左、右侧方运动幅度,自我效能得分,疾病不确定感得分,差异均无统计学意义(P>0.05)。对照组基线时的最大前伸运动幅度大于干预组,差异有统计学意义(P=0.008)。重复测量方差分析结果显示:术后1、3、6个月干预组的自我效能得分均显著高于对照组(P=0.006,P=0.003,P=0.016);术后1、3个月干预组的疾病不确定感复杂性维度得分显著低于对照组(P=0.003,P=0.000);术后1、6个月干预组的康复锻炼依从性得分显著高于对照组(P=0.000,P=0.016);术后6个月干预组的最大前伸运动幅度、最大向右侧方运动幅度均大于对照组(P=0.024,P=0.008)。结论·自我效能理论主导的居家康复训练方案有助于提高颞下颌关节盘复位术后患者的自我效能和康复锻炼依从性,降低疾病不确定感,对关节功能恢复具有积极效果。

Objective·To explore the effects of home-based rehabilitation program led by self-efficacy theory after temporomandibular joint disk repositioning.Methods·Convenient sampling method was used.Patients with temporomandibular joint disk displacement who received temporomandibular joint disk repositioning in Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine from August 2020 to January 2021 were selected as the control group,and patients admitted from February 2021 to July 2021 were selected as the intervention group.The control group received the conventional home-based rehabilitation care,while the intervention group were given home-based rehabilitation program led by self-efficacy theory.The general information questionnaire was used to collect the general information about patients.The joint range of motion measuring,rehabilitation exercise compliance questionnaire,General Self-efficacy Scale(GSES),and Mishel's Uncertainty in Illness Scale(MUIS)were used to investigate the joint range of motion,the rehabilitation exercise compliance score,the selfefficacy score and the uncertainty in illness score in the two groups at baseline and at 1,3 and 6 months after surgery.Results·A total of 167 patients with temporomandibular joint disk displacement who received temporomandibular joint disk repositioning surgery were enrolled,including 96 cases in the control group and 71 cases in the intervention group.There was no difference in the general information between the two groups(P>0.05).There were no differences in the maximal mouth opening,maximum rightward lateral movement,maximum leftward lateral movement,self-efficacy score and uncertainty in illness score between the two groups at baseline(all P>0.05).The maximal forward extension in the intervention group was significantly less than that in the control group(P=0.008).Repeated measurement variance analysis showed that the self-efficacy scores in the intervention group were higher than those in the control group at 1,3 and 6 months after surgery,and the differences were statistically significant(P=0.006,P=0.003,P=0.016).At 1 and 3 months after surgery,the scores of complexity dimension of uncertainty in illness in the intervention group were significantly lower than those in the control group(P=0.003,P=0.000).At 1 and 6 months after surgery,the rehabilitation exercise compliance scores in the intervention group were significantly higher than those in the control group(P=0.000,P=0.016).At 6 months after surgery,the maximum forward extension and maximum rightward lateral movement were significantly greater than those in the control group(P=0.024,P=0.008).Conclusion·The home-based rehabilitation program led by self-efficacy theory has a positive effect on improving the self-efficacy and compliance of rehabilitation exercise,reducing the disease uncertainty,and promoting the joint function recovery in patients receiving temporomandibular joint disk repositioning.