基于碎片化时间的多元化功能康复锻炼对老年腰椎间盘突出症患者遵医行为、应对方式、腰椎功能和疼痛程度的影响

The impact of diversified functional rehabilitation exercises based on fragmented time on the compliance behavior,coping strategies,lumbar spine function,and pain level of elderly patients with lumbar disc herniation

目的探究基于碎片化时间的多元化功能康复锻炼对老年腰椎间盘突出症患者遵医行为、应对方式、腰椎功能和疼痛程度的影响,以期为临床老年腰椎间盘突出症患者的康复锻炼方法及干预策略提供理论依据。方法采用随机对照试验方法,便利抽样法选取2020年12月至2022年12月于中国人民解放军海军军医大学第一附属医院住院接受治疗的老年腰椎间盘突出症患者136例为研究对象,采用随机数字表法分为观察组(68例)和对照组(68例),对照组给予常规康复锻炼,观察组采用基于碎片化时间的多元化功能康复锻炼,比较2组患者遵医行为、疼痛、应对方式及腰椎功能情况。结果对照组男40例,女28例,年龄(72.84±3.17)岁;观察组男42例,女26例,年龄(73.28±4.23)岁。干预后,观察组遵医行为中的遵嘱用药、健康的生活方式、康复锻炼、避免诱发维度所占比例分别为82.35%(56/68)、72.06%(49/68)、76.47%(52/68)、69.12%(47/68),高于对照组的63.24%(43/68)、51.47%(35/68)、60.29%(41/68)、51.47%(35/68),差异均有统计学意义(χ^(2)值为4.42~6.28,均P<0.05);干预后,观察组应对方式中面对维度得分为(25.35±2.08)分,高于对照组的(23.25±1.97)分,观察组回避和屈服维度得分分别为(10.25±2.67)、(7.19±2.16)分,低于对照组的(13.62±2.18)、(8.64±2.03)分,2组比较差异均有统计学意义(t=6.35、8.47、4.24,均P<0.05);观察组日本矫形外科学会腰痛评分与视觉模拟疼痛评分分别为(24.28±4.73)、(0.94±0.38)分,低于对照组(26.32±5.32)、(1.62±0.54)分,差异均有统计学意义(t=2.48、8.92,均P<0.05);观察组腰椎躯干前屈、后伸、旋转患侧、旋转健侧肌力分别为(116.51±31.20)、(138.32±26.32)、(52.21±19.32)、(46.65±12.30)Nm,高于对照组的(104.32±35.27)、(121.30±20.17)、(42.20±17.15)、(41.20±10.25)Nm,差异均有统计学意义(t值为2.24~4.45,均P<0.05);观察组腰椎前屈、后伸、旋转患侧、旋转健侧活动度分别为(28.31±6.35)°、(24.74±5.61)°、(13.54±3.54)°、(18.25±2.05)°,高于对照组(24.14±6.51)°、(22.32±5.22)°、(11.52±3.29)°、(17.24±1.54)°,差异均有统计学意义(t值为2.74~3.97,均P<0.05)。结论基于碎片化时间的多元化功能康复锻炼,可以提高老年腰椎间盘突出症患者的康复锻炼效果与遵医行为,有助于疼痛控制,促进患者积极面对康复锻炼与腰椎功能恢复。

Objective To explore the effects of diversified functional rehabilitation exercises based on fragmented time on the compliance behavior,coping strategies,lumbar function,and pain level of elderly patients with lumbar disc herniation,in order to provide theoretical basis for rehabilitation exercise methods and intervention strategies for clinical elderly patients with lumbar disc herniation.Methods A randomized controlled trial was conducted using convenience sampling to select 136 elderly patients with lumbar disc herniation who received treatment at the First Affiliated Hospital of the Chinese People′s Liberation Army Navy Medical University from December 2020 to December 2022 as the study subjects.The patients were randomly divided into an observation group(68 cases)and a control group(68 cases)using a random number table method.The control group received routine rehabilitation exercise,while the observation group received diversified functional rehabilitation exercise based on fragmented time.The compliance behavior,pain,coping styles,and lumbar spine function of the two groups of patients were compared.Results There were 40 males and 28 females in the control group,with an age of(72.84±3.17)years;there were 42 males and 26 females in the observation group,with an age of(73.28±4.23)years.After intervention,the proportion of medication adherence,healthy lifestyle,rehabilitation exercise,and avoidance of triggering dimensions in the observation group's compliance with medical advice were 82.35%(56/68),72.06%(49/68),76.47%(52/68),and 69.12%(47/68),respectively,which were higher than the control group's 63.24%(43/68),51.47%(35/68),60.29%(41/68),and 51.47%(35/68),and the differences were statistically significant(χ^(2)values were 4.42-6.28,all P<0.05);after intervention,the coping strategies of the observation group had a face dimension score of(25.35±2.08)points,which was higher than the control group′s(23.25±1.97)points.The avoidance and surrender dimension scores of the observation group were(10.25±2.67)and(7.19±2.16)points,respectively,which were lower than the control group′s(13.62±2.18)and(8.64±2.03)points,there was a statistically significant difference between the two groups(t=6.35,8.47,4.24,all P<0.05);the treatment score evaluated by the Japanese Orthopaedic Association and Visual Analog Score in the observation group were(24.28±4.73)and(0.94±0.38)points,respectively,which were lower than the control group′s(26.32±5.32)and(1.62±0.54)points,and the differences were statistically significant(t=2.48,8.92,both P<0.05);the muscle strength of the lumbar trunk flexion,extension,rotation affected side,and rotation healthy side in the observation group were(116.51±31.20),(138.32±26.32),(52.21±19.32),and(46.65±12.30)Nm,higher than those in the control group(104.32±35.27),(121.30±20.17),(42.20±17.15),and(41.20±10.25)Nm,and the differences were statistically significant(t values were 2.24-4.45,all P<0.05).The range of motion of the lumbar trunk flexion,extension,rotation affected side,and rotation healthy side in the observation group was(28.31±6.35)°,(24.74±5.61)°,(13.54±3.54)°,and(18.25±2.05)o,higher than those in the control group(24.14±6.51)°,(22.32±5.22)°,(11.52±3.29)°,and(17.24±1.54)o and the differences were statistically significant(t values were 2.74-3.97,all P<0.05).Conclusions Diversified functional rehabilitation exercises based on fragmented time can improve the rehabilitation exercise effect and compliance behavior of elderly patients with lumbar disc herniation,help with pain control,and promote patients to actively face rehabilitation exercises and lumbar function recovery.