膝关节置换术后康复应用基于保护动机理论的健康教育

doi:10.3877/cma.j.issn.1674-134X.2023.05.023

目的

探讨基于保护动机理论(PMT)的健康教育在全膝关节置换术后患者康复锻炼中的应用效果。

方法

选取2021年7月至2022年2月在广东省第二中医院接受单侧全膝关节置换术的72例膝骨关节炎患者，按随机数字表法分为对照组和实验组各36例。对照组给予常规健康教育，实验组在对照组基础上实施基于PMT的健康教育；比较两组患者康复自我效能评分、康复锻炼依从性评分及膝关节功能评分情况。计量资料采用独立样本t检验，计数资料采用卡方检验。

结果

两组患者干预前的康复自我效能各维度评分、康复锻炼依从性各维度评分及膝关节功能评分比较，差异无统计学意义(均为P>0.05)；干预后实验组患者的康复自我效能各维度评分、康复锻炼依从性各维度评分及膝关节功能评分均高于对照组，差异有统计学意义(t＝4.865、3.984、5.901、5.514、5.304、4.183，均为P<0.05)。

结论

基于PMT的健康教育能提高全膝关节置换术后患者的康复自我效能感和康复锻炼依从性，有效促进术后膝关节功能的恢复。

关键词: 关节成形术，置换，膝, 健康教育, 运动疗法

Objective

To explore the application effect of health education based on protective motivation theory(PMT) in rehabilitation exercise of patients after total knee arthroplasty.

Methods

Seventy-two patients with knee osteoarthritis who underwent unilateral total knee arthroplasty in Guangdong Second Traditional Chinese Medicine Hospital from July 2021 to February 2022 were selected and randomized to control group and experimental group according to random number table, 36 patients in each group. The control group received routine health education, while the experimental group received health education based on PMT besides the routine health education. The rehabilitation self-efficacy score, rehabilitation exercise compliance score and knee joint function score of the two groups were compared. The independent sample t test was used for measurement data, and chi square test was used for counting data.

Results

There was no significant difference in the scores of rehabilitation self-efficacy, rehabilitation exercise compliance or knee function between the two groups before intervention (all P>0.05). After intervention, the scores of all dimensions of rehabilitation self-efficacy, rehabilitation exercise compliance and knee joint function of patients in the experimental group were higher than those in the control group, and the difference was statistically significant (t=4.865, 3.984, 5.901, 5.514, 5.304, 4.183, all P<0.05).

Conclusion

Health education based on PMT can improve the sense of rehabilitation self-efficacy and rehabilitation exercise compliance of patients after total knee arthroplasty, and effectively promote the recovery of knee joint function.

Key words: Arthroplasty, replacement, knee, Health education, Exercise therapy

图1 基于PMT(保护动机理论)的健康教育方案

Figure 1 Health education plan based on PMT

表2 两组患者一般资料比较

Table 2 Comparison of general information between two groups

组别Groups	例数Case number	性别(女/男)Gender(female/male)	年龄Age[岁，(±s)]	身体质量指数Body mass index[kg/cm²，(±s)]	术侧(右/左)Surgical side(right/left)
实验组Experimental group	36	29/7	70±8	26±3	18/18
对照组Control group	36	27/9	69±8	26±4	19/17
统计值		χ²＝0.321	t＝0.548	t＝0.020	χ²＝0.056
P值		0.571	0.585	0.984	0.814
组别Groups	例数Case number	合并症(有/无)Complication(yes/no)	文化程度(例)Education level
组别Groups	例数Case number	合并症(有/无)Complication(yes/no)	小学及以下Primary school and below	高中或中专Senior school or technic school	大专及以上College and above
实验组Experimental group	36	21/15	21	11	4
对照组Control group	36	20/16	24	9	3
统计值		χ²＝0.057	χ²＝0.730
P值		0.812	0.466

表2 两组患者一般资料比较

Table 2 Comparison of general information between two groups

组别Groups	例数Case number	性别(女/男)Gender(female/male)	年龄Age[岁，(±s)]	身体质量指数Body mass index[kg/cm²，(±s)]	术侧(右/左)Surgical side(right/left)
实验组Experimental group	36	29/7	70±8	26±3	18/18
对照组Control group	36	27/9	69±8	26±4	19/17
统计值		χ²＝0.321	t＝0.548	t＝0.020	χ²＝0.056
P值		0.571	0.585	0.984	0.814
组别Groups	例数Case number	合并症(有/无)Complication(yes/no)	文化程度(例)Education level
组别Groups	例数Case number	合并症(有/无)Complication(yes/no)	小学及以下Primary school and below	高中或中专Senior school or technic school	大专及以上College and above
实验组Experimental group	36	21/15	21	11	4
对照组Control group	36	20/16	24	9	3
统计值		χ²＝0.057	χ²＝0.730
P值		0.812	0.466

表3 两组患者干预前后SER评分比较(±s)

Table 3 Comparison of SER scores before and after intervention between two groups

组别Groups	例数Case number	康复锻炼自我效能Rehabilitation exercise self-efficacy
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	31±6	41±4	15.412	<0.001
对照组Control group	36	30±6	36±6	17.744	<0.001
t值		0.597	4.865
P值		>0.05	<0.001
组别Groups	例数Case number	应对自我效能Dealing with self-efficacy
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	38±7	52±5	12.467	<0.001
对照组Control group	36	40±8	47±7	12.083	<0.001
t值		0.736	3.984
P值		>0.05	<0.001

表3 两组患者干预前后SER评分比较(±s)

Table 3 Comparison of SER scores before and after intervention between two groups

组别Groups	例数Case number	康复锻炼自我效能Rehabilitation exercise self-efficacy
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	31±6	41±4	15.412	<0.001
对照组Control group	36	30±6	36±6	17.744	<0.001
t值		0.597	4.865
P值		>0.05	<0.001
组别Groups	例数Case number	应对自我效能Dealing with self-efficacy
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	38±7	52±5	12.467	<0.001
对照组Control group	36	40±8	47±7	12.083	<0.001
t值		0.736	3.984
P值		>0.05	<0.001

表4 两组患者干预前后康复锻炼依从性评分比较(±s)

Table 4 Comparison of rehabilitation exercise compliance scores before and after intervention between two groups

组别Groups	例数Case number	锻炼依从Exercise compliance
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	13.3±2.3	17.5±1.1	10.498	<0.001
对照组Control group	36	13.1±2.1	15.4±1.9	7.051	<0.001
t值		0.372	5.901
P值		0.711	<0.001
组别Groups	例数Case number	主动寻求意见依从Actively seeking opinions and compliance
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	5.9±1.3	9.9±1.3	17.278	<0.001
对照组Control group	36	6.3±1.3	8.0±1.5	9.950	<0.001
t值		0.996	5.514
P值		0.323	<0.001
组别Groups	例数Case number	锻炼监督依从Exercise supervision compliance
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	6.7±1.3	10.3±1.2	12.081	<0.001
对照组Control group	36	6.8±1.4	8.7±1.3	8.774	<0.001
t值		0.433	5.304
P值		0.666	<0.001

表4 两组患者干预前后康复锻炼依从性评分比较(±s)

Table 4 Comparison of rehabilitation exercise compliance scores before and after intervention between two groups

组别Groups	例数Case number	锻炼依从Exercise compliance
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	13.3±2.3	17.5±1.1	10.498	<0.001
对照组Control group	36	13.1±2.1	15.4±1.9	7.051	<0.001
t值		0.372	5.901
P值		0.711	<0.001
组别Groups	例数Case number	主动寻求意见依从Actively seeking opinions and compliance
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	5.9±1.3	9.9±1.3	17.278	<0.001
对照组Control group	36	6.3±1.3	8.0±1.5	9.950	<0.001
t值		0.996	5.514
P值		0.323	<0.001
组别Groups	例数Case number	锻炼监督依从Exercise supervision compliance
组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	6.7±1.3	10.3±1.2	12.081	<0.001
对照组Control group	36	6.8±1.4	8.7±1.3	8.774	<0.001
t值		0.433	5.304
P值		0.666	<0.001

表5 两组患者干预前后HSS评分比较(±s)

Table 5 Comparison of HSS scores before and after intervention between two groups

组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	51±4	83±6	24.257	<0.001
对照组Control group	36	52±4	78±4	26.406	<0.001
t值		0.696	4.183
P值		0.489	<0.001

表5 两组患者干预前后HSS评分比较(±s)

Table 5 Comparison of HSS scores before and after intervention between two groups

组别Groups	例数Case number	干预前Before intervention	干预后After intervention	t值	P值
实验组Experimental group	36	51±4	83±6	24.257	<0.001
对照组Control group	36	52±4	78±4	26.406	<0.001
t值		0.696	4.183
P值		0.489	<0.001

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Application of health education based on protective motivation theory in rehabilitation exercise after total knee arthroplasty

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Application of health education based on protective motivation theory in rehabilitation exercise after total knee arthroplasty