老年全髋关节置换术患者术后早期运动恐惧的潜在剖面分析及影响因素研究

Latent profile analysis and influencing factors of early postoperative kinesiophobia in elderly patients with total hip arthroplasty

目的探讨老年全髋关节置换术(THA)术后早期运动恐惧的不同类型特点,并分析影响因素,为制订针对性的护理对策提供参考。方法本研究为横断面研究。采用便利抽样法,选取2022年5月—2023年6月空军军医大学第二附属医院收治的225例老年THA患者为研究对象。采用一般资料调查表、运动恐惧症量表(TSK)、疼痛数字评分法、疼痛灾难化量表、Groningen骨科社会支持量表进行评价。结果共发放问卷225份,回收有效问卷210份,有效回收率为93.33%。210例老年THA患者TSK得分为(38.76±8.52)分,其中49.52%(104/210)的患者存在运动恐惧(TSK>37分)。潜在剖面分析结果显示,老年THA患者术后早期运动恐惧可分为3个潜在类别:灾难化认知-高运动恐惧组(48.57%,102/210)、不确定性认知-中等运动恐惧组(20.48%,43/210)、积极认知-低运动恐惧组(30.95%,65/210)。Logistic回归分析结果显示,年龄≥76岁、文化程度小学及以下、高合并症、中重度疼痛、疼痛灾难化阳性是灾难化认知-高运动恐惧组患者的影响因素(P<0.05),文化程度小学及以下、低社会支持是不确定性认知-中等运动恐惧组患者的影响因素(P<0.05)。结论老年THA患者术后早期运动恐惧存在明显的异质性,主要影响因素为高龄、躯体疼痛、社会支持及文化程度等。建议医护人员根据不同类别患者早期运动恐惧的特点开展心理疏导,增强社会支持以纠正患者错误认知,减轻其运动恐惧,提高早期康复训练行为。

Objective To explore the different characteristics of early postoperative kinesiophobia in elderly patients with total hip arthroplasty(THA)and analyze the influencing factors,so as to provide reference for formulating targeted nursing strategies.Methods This study was a cross-sectional study.Using the convenient sampling method,a total of 225 elderly THA patients admitted to the Second Affiliated Hospital of Air Force Medical University of PLA from May 2022 to June 2023 were selected as the research objects.The evaluation was conducted using the general information questionnaire,Tampa Scale for Kinesiophobia(TSK),Numeric Rating Scale,Pain Catastrophizing Scale and Groningen Orthopedic Social Support Scale.Results A total of 225 questionnaires were distributed and 210 valid questionnaires were collected,with an effective response rate of 93.33%.The TSK score of 210 elderly THA patients was(38.76±8.52),among which 49.52%(104/210)of patients had kinesiophobia(TSK>37 points).The latent profile analysis results showed that early postoperative kinesiophobia in elderly THA patients could be divided into three potential categories,such as catastrophic cognition-high kinesiophobia group(48.57%,102/210),uncertain cognition-moderate kinesiophobia group(20.48%,43/210)and positive cognition-low kinesiophobia group(30.95%,65/210).The results of Logistic regression analysis showed that age greater than or equal to 76 years old,education level of primary school or below,high comorbidity,moderate to severe pain and positive catastrophic pain were the influencing factors for patients in the catastrophic cognition-high kinesiophobia group(P<0.05),while education level of primary school or below and low social support were the influencing factors for patients in the uncertain cognition-moderate kinesiophobia group(P<0.05).Conclusions There is significant heterogeneity in early postoperative kinesiophobia among elderly patients with total hip arthroplasty,with the main influencing factors being advanced age,physical pain,social support and educational level.It is suggested that medical staff should carry out psychological counseling according to the characteristics of early kinesiophobia of different categories of patients,strengthen social support to correct wrong cognition of patients,reduce their kinesiophobia and improve early rehabilitation training behavior.