腰椎管狭窄术后患者康复功能锻炼最佳循证实践方案的应用

Effects of best evidence-based practice for rehabilitation exercises in patients undergoing surgery for lumbar spinal stenosis

目的探讨腰椎管狭窄术后患者康复功能锻炼最佳循证实践方案的临床应用效果。方法以澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心的循证实践模式为指导,将最佳证据结合临床情境制订临床实践的质量审查指标。2022年12月选取30例腰椎管狭窄术后患者(证据应用前)进行基线审查;2022年12月—2023年2月依据基线审查结果进行分析,明确目前现状与审查指标之间的促进及障碍因素,并根据现有资源实施改进策略;2023年2月选取30例患者(证据应用后)进行应用后效果评价。比较证据应用前后两组患者在术后24 h、术后1个月、术后3个月、术后6个月的腰椎功能评分、脊柱功能障碍评分、恐动症评分、自我效能评分、生活质量评分。比较证据应用前后两组患者的临床质量审查指标执行率及培训前后25名护士康复功能锻炼知识问卷得分。结果两组患者术后24 h的腰椎功能评分、脊柱功能障碍评分、恐动症评分、自我效能评分、生活质量评分比较差异无统计学意义(P>0.05);术后1、3、6个月各评分比较差异均有统计学意义(P<0.01)。证据应用后,7项临床质量审查指标的执行率较证据应用前提升,且25名护士的康复功能锻炼知识问卷得分提高,差异均有统计学意义(P<0.05)。结论基于循证的腰椎管狭窄术后患者康复锻炼实践安全可行,能够规范护士的循证护理实践行为,提高护士知识水平,有效改善患者术后腰椎功能,促进躯体功能康复,提高生活质量。

ObjectiveTo explore the clinical effects of the best evidence-based practice plan for rehabilitation exercises in patients undergoing surgery for lumbar spinal stenosis(LSS).MethodsGuided by the evidence-based practice model of the Joanna Briggs Institute(JBI)Center for Evidence-Based Healthcare in Australia,the best evidence was combined with the clinical context to develop quality review indicators for clinical practice.In December 2022,a baseline review was conducted with 30 patients undergoing surgery for LSS(before evidence application).From December 2022 to February 2023,the baseline review results were analyzed to identify facilitating and obstructive factors between the current status and the review indicators,and improvement strategies were implemented based on available resources.In February 2023,another 30 patients(after evidence application)were selected to evaluate the post-application effects.The Japanese Orthopedic Association(JOA)score,Oswestry Disability Index(ODI),Tampa Scale for Kinesiophobia(TSK)score,General Self-Efficacy Scale(GSES)score,and quality of life scores were compared between the two groups at 24 hours,1 month,3 months,and 6 months postoperatively.The execution rate of clinical quality review indicators and the knowledge scores on rehabilitation exercises of 25 nurses before and after training were also compared.ResultsThere were no statistically significant differences in JOA scores,ODI,TSK scores,GSES scores,and quality of life scores between the two groups at 24 hours postoperatively(P>0.05).However,there were statistically significant differences in these scores at 1,3,and 6 months postoperatively(P<0.01).After evidence application,the execution rate of seven clinical quality review indicators improved,and the knowledge scores on rehabilitation exercises of the 25 nurses increased significantly(P<0.05).ConclusionsThe evidence-based practice for rehabilitation exercises in patients undergoing surgery for LSS is safe and feasible.It standardizes evidence-based nursing practice behavior,enhances nurses'knowledge levels,effectively improves postoperative lumbar function,promotes physical rehabilitation,and enhances the quality of life.