心脏起搏器植入术后患者肩关节恐动症认知行为干预方案的构建与应用研究

Study on the construction and application of a cognitive behavioral intervention program for shoulder joint kinesiophobia in patients after pacemaker implantation

目的构建心脏起搏器植入术后肩关节恐动症患者认知行为干预方案,并评价其应用效果。方法在文献研究和专家会议的基础上构建干预方案。采用便利抽样法,选取温州市某三级甲等医院心脏起搏器植入术后肩关节恐动症患者101例为研究对象,按随机数字表法分为观察组51例、对照组50例。对照组实施常规运动康复方案,观察组在对照组基础上实施心脏起搏器植入术后患者肩关节恐动症认知行为干预方案。比较两组患者心脏病患者运动恐惧量表、肩关节疼痛与功能障碍指数和一般自我效能感量表评分。结果两组患者心脏病患者运动恐惧量表评分差异有统计学意义(F_(时间)=253.871、F_(组间)=18.596、F_(时间×组间)=9.549,P均<0.001)。两组患者肩关节疼痛评分差异有统计学意义(F_(时间)=1999.425、F_(组间)=9.281、F_(时间×组间)=4.126,P均<0.05)。两组患者肩关节功能障碍评分差异有统计学意义(F_(时间)=2596.840、F_(组间)=17.140、F_(时间×组间)=11.081,P均<0.001)。两组患者一般自我效能感量表评分差异有统计学意义(F_(时间)=277.839、F_(组间)=12.021、F_(时间×组间)=8.019,P均<0.001)。结论心脏起搏器植入术后患者肩关节恐动症认知行为干预方案安全、可行,能够降低患者的运动恐惧水平,增强其自我效能感,加速肩关节功能早期康复。

Objective To construct a cognitive behavioral intervention program for shoulder joint kinesiophobia in patients after pacemaker implantation and to evaluate its application effect.Methods Based on literature research and expert meetings,a intervention program was constructed.A total of 101 patients with shoulder joint kinesiophobia who underwent pacemaker implantation in a tertiary hospital in Wenzhou were selected as the research subjects by convenience sampling.They were randomly divided into an observation group(51 cases)and a control group(50 cases).The control group implemented the routine exercise rehabilitation program.The observation group implemented the cognitive behavioral intervention program for shoulder joint kinesiophobia in patients after pacemaker implantation based on the control group.The Tampa Scale for Kinesiophobia Heart(TSK-SV Heart),Shoulder Pain and Disability Index(SPADI),and General Self-Efficacy Scale(GSES)scores were compared between the two groups of patients.Results There were statistically significant differences in the TSK-SV Heart scores between the two groups of patients(F_(time)=253.871,F_(group)=18.596,F_(time×group)=9.549,P<0.001).There were statistically significant differences in the SPADI pain scores between the two groups of patients(F_(time)=1999.425,F_(group)=9.281,F_(time×group)=4.126,P<0.05).There were statistically significant differences in the SPADI disability scores between the two groups of patients(F_(time)=2596.840,F_(group)=17.140,F_(time×group)=11.081,P<0.001).There were statistically significant differences in the GSES scores between the two groups of patients(F_(time)=277.839,F_(group)=12.021,F_(time×group)=8.019,P<0.001).Conclusion The cognitive behavioral intervention program for shoulder joint kinesiophobia in patients after pacemaker implantation is safe and feasible.It can reduce the level of patients'exercise fear,enhance their self-efficacy,and accelerate the early rehabilitation of shoulder joint function.