【摘要】：背景:全膝關(guān)節(jié)置換術(shù)(Total Knee Arthroplasty,TKA)是治療嚴重膝關(guān)節(jié)骨性關(guān)節(jié)炎的最佳措施,手術(shù)成功率高,但患者術(shù)后仍需進行康復(fù)治療以減輕功能障礙,促進康復(fù)。術(shù)后3～6個月是患者康復(fù)的關(guān)鍵時期,然而TKA患者居家功能鍛煉依從性低,導致其喪失了功能恢復(fù)的最佳時機,康復(fù)未達到預(yù)期效果。微信集文字、語音、視頻等為一體,具有即時化、操作簡單、成本低等特點,已被作為一種健康傳播手段廣泛運用于不同健康領(lǐng)域。本研究擬借助微信的功能優(yōu)勢,探索基于微信的干預(yù)對提高全膝關(guān)節(jié)置換術(shù)患者居家功能鍛煉依從性的效果。目的:探討基于微信的干預(yù)對全膝關(guān)節(jié)置換術(shù)患者居家功能鍛煉依從性及康復(fù)效果的影響。方法:采用便利取樣的方法,于2016年9月至2017年3月,選取于北京市某三甲醫(yī)院行TKA術(shù),術(shù)后轉(zhuǎn)往醫(yī)聯(lián)體內(nèi)康復(fù)機構(gòu)接受康復(fù)治療,符合納入排除標準的患者72例,入組后隨機分為干預(yù)組(37例)和對照組(35例)。干預(yù)組研究對象在出院前掌握微信平臺使用方法,按照出院時的居家運動計劃,在微信干預(yù)下進行居家功能鍛煉;對照組根據(jù)與干預(yù)組鍛煉內(nèi)容相同的功能鍛煉手冊和居家運動計劃,進行居家功能鍛煉。在干預(yù)前、術(shù)后1個月和術(shù)后3個月,采用居家功能鍛煉依從性問卷、醫(yī)用量角器、AKS膝關(guān)節(jié)功能評分量表和SF-36簡明健康調(diào)查量表分別調(diào)查及測量兩組研究對象的居家功能鍛煉依從性、膝關(guān)節(jié)活動度、膝關(guān)節(jié)功能和生活質(zhì)量。術(shù)后3個月時對微信干預(yù)方式進行評價。結(jié)果:共完成63例研究對象的資料收集(干預(yù)組33例,對照組30例)。結(jié)果顯示(1)基于微信干預(yù)后,干預(yù)組研究對象術(shù)后1個月和3個月的功能鍛煉依從率分別為45.71%和71.47%,對照組研究對象的功能鍛煉依從率分別為44.86%和54.73%,術(shù)后3個月時干預(yù)組研究對象功能鍛煉依從率顯著高于同期對照組(P0.001)。干預(yù)組研究對象AKS評分的癥狀維度及活動維度得分,SF-36量表的總平均分、生理功能維度得分及軀體疼痛維度得分,在術(shù)后1個月及3個月時顯著高于同期對照組,AKS評分總平均分、滿意度維度得分及期望維度得分在術(shù)后3個月時顯著高于同期對照組(P0.05)。兩組研究對象其他指標差異無統(tǒng)計學意義(P0.05)。(2)研究對象對微信干預(yù)方式表現(xiàn)出較高的接受度和滿意度。結(jié)論:基于微信的干預(yù)可提高TKA患者居家功能鍛煉依從性,改善患者的膝關(guān)節(jié)功能,提高生活質(zhì)量,促進患者康復(fù)。
[Abstract]:Background: total knee arthroplasty (Total Knee Arthroplasty,TKA) is the best method for the treatment of severe osteoarthritis of the knee. 3 ~ 6 months after operation is the key period of patients' rehabilitation. However, the compliance of TKA patients with family functional exercise is low, which leads to the loss of the best time of functional recovery, and the recovery does not reach the expected results. WeChat, which integrates text, voice and video, has the characteristics of instant, simple operation and low cost. It has been widely used in different health fields as a means of health communication. The purpose of this study was to explore the effect of WeChat based intervention on improving the compliance of family functional exercise in patients with total knee arthroplasty by virtue of WeChat's functional advantages. Objective: to investigate the effect of WeChat-based intervention on family function exercise compliance and rehabilitation effect of total knee arthroplasty patients. Methods: from September 2016 to March 2017, 72 patients who were selected from September 2016 to March 2017 to receive TKA operation were transferred to the rehabilitation organization in vivo. After entering the group, they were randomly divided into intervention group (37 cases) and control group (35 cases). The subjects of the intervention group mastered the method of using WeChat platform before leaving hospital, and carried on the exercise of home function under the intervention of WeChat according to the home movement plan when discharged from hospital. Control group according to the same exercise content as the intervention group functional exercise manual and home exercise plan, the home function exercise. Before intervention, 1 month after operation and 3 months after operation, the compliance questionnaire of home function exercise was used, and the medical protractor was used. AKS knee function scale and SF-36 brief health survey scale were used to investigate and measure the compliance of home function exercise, knee motion, knee joint function and quality of life of the two groups. WeChat intervention was evaluated 3 months after operation. Results: a total of 63 subjects were collected (33 cases in the intervention group and 30 cases in the control group). The results showed that (1) based on WeChat intervention, the compliance rates of functional exercise were 45.71% and 71.47% in the intervention group 1 month and 3 months after the intervention, respectively. The compliance rate of the subjects in the control group was 44.86% and 54.73% respectively. The compliance rate of the intervention group was significantly higher than that of the control group 3 months after operation (P0.001). The scores of symptom dimension and activity dimension, total average score of SF-36 scale, physiological function dimension and somatic pain dimension of the subjects in the intervention group were significantly higher than those in the control group at 1 month and 3 months after operation. The total average score, satisfaction dimension score and expectation dimension score of AKS score were significantly higher than those of the control group 3 months after operation (P0.05). There was no significant difference in other indexes between the two groups (P0.05). (2). The subjects showed high acceptance and satisfaction with WeChat intervention. Conclusion: the intervention based on WeChat can improve the compliance of the patients with TKA, improve the knee joint function, improve the quality of life, and promote the rehabilitation of the patients.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.6

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