Mediating effect of coping mode and anxiety on the relationship between self-efficacy for exercise and kinesiophobia in patients with heart failure with preserved ejection fraction
-
摘要:
目的 探讨射血分数保留心衰(HFpEF)患者疾病应对方式及焦虑在运动自我效能与运动恐惧间的链式中介效应，以期为运动恐惧的管理及干预提供新视角。 方法 采用便利抽样法选取2022年3—10月于南京市某三甲医院就诊的156例HFpEF患者为研究对象，使用运动自我效能量表、医学应对方式量表、GAD-7焦虑障碍量表及慢性心衰患者运动恐惧量表进行调查，并进行链式中介效应检验。 结果 回收有效问卷147份，有效回收率为94.23%。HFpEF患者运动恐惧得分(40.347±10.523)分。HFpEF患者的运动自我效能、医学应对方式(屈服维度)、焦虑与运动恐惧之间两两相关(r=-0.211~0.611)，且差异均有统计学意义(P＜0.05)。屈服应对在运动自我效能与运动恐惧之间不仅存在单独中介效应(95% CI：-0.515~-0.031)，还与焦虑在运动自我效能与运动恐惧之间起链式中介作用(95% CI：-0.314~-0.013)，总中介效应占总效应的52.91%，链式中介占总中介效应的30.49%。 结论 HFpEF患者大多存在运动恐惧，运动自我效能可以通过屈服应对的单独中介作用或屈服应对与焦虑的链式中介作用间接影响其运动恐惧，提示医护人员可以从患者的医学应对方式及情绪出发，引导其采用积极的应对方式，同时缓解患者焦虑情绪，从而降低运动恐惧，提高运动依从性。 Abstract:Objective To examine the mediating effect of disease coping mode and anxiety on exercise self-efficacy and kinesiophobia in patients with heart failure with preserved ejection fraction (HFpEF). In order to provide new perspectives on the management and intervention of kinesiophobia. Methods A total of 156 patients diagnosed with HFpEF between March and October 2022 at a Grade A tertiary hospital in Nanjing were selected as the study subjects using the convenience sampling method. The questionnaire survey was conducted using the exercise self-efficacy scale (SEE), the medical coping mode questionnaire (MCMQ), the generalized anxiety disorder scale-7 (GAD-7), and the Chinese version of the fear of activity scale for patients with chronic heart failure (Fact-CHF). The results were analyzed to determine the chain mediation effect. Results A total of 147 valid questionnaires were collected, with an effective recovery rate of 94.23%. Fact-CHF score (40.347±10.523) in HFpEF patients. The results demonstrated a significant correlation between HFpEF patients' exercise self-efficacy, medical coping style (yield dimension), anxiety and kinesiophobia (r: -0.211 to 0.611). The medical coping style (yield dimension) exerts a dual mediating influence between exercise self-efficacy and kinesiophobia (95% CI: -0.515 to -0.031), as well as a chain mediating effect with anxiety between exercise self-efficacy and kinesiophobia (95% CI: -0.314 to -0.013). The cumulative mediation effect is 52.91%, with the chain mediation effect accounting for 30.49% of the total mediation effect. Conclusion The majority of patients with HFpEF exhibit kinesiophobia, and exercise self-efficacy can indirectly influence kinesiophobia through the single mediating effect of yielding coping or the chain mediating effect of yielding coping and anxiety. This suggests that medical staff can guide patients to adopt positive coping styles based on their medical coping style and emotions. Concurrently, the objective is to alleviate patient anxiety and mitigate kinesiophobia, thereby enhancing exercise adherence. -
图 1 射血分数保留的心衰患者运动自我效能对运动恐惧的中介效应模型
Figure 1. The mediating effect model of exercise self-efficacy on kinesiophobia in patients with heart failure with ejection fraction
表 1 147例HFpEF患者运动自我效能、医学应对方式、焦虑与运动恐惧的相关性分析(r值)
Table 1. Correlation analysis of exercise self-efficacy, medical coping style, anxiety, and exercise fear in 147 patients with HFpEF (r value)
变量 运动自我效能 面对 回避 屈服 焦虑 运动自我效能 1 面对 0.122 1 回避 0.007 0.264a 1 屈服 -0.250a -0.072 -0.078 1 焦虑 -0.225a -0.003 -0.046 0.611a 1 运动恐惧 -0.211a 0.082 -0.076 0.404a 0.398a 注：aP＜0.01。 
下载: 导出CSV
表 2 模型中变量关系的回归分析(n=147)
Table 2. Regression analysis of variable relationship in the model (n=147)
结果变量 预测变量 整体拟合指数 回归系数显著性 调整R2 F值 β t值 P值 运动恐惧 运动自我效能 0.038 6.725 -0.843 -2.593 0.010 屈服应对 运动自我效能 0.056 9.641 -0.261 -3.105 0.002 焦虑 运动自我效能 0.370 43.923 -0.167 -1.145 0.254 屈服应对 1.211 8.722 ＜0.001 运动恐惧 运动自我效能 0.192 12.579 -0.397 -1.284 0.201 屈服应对 0.912 2.510 0.013 焦虑 0.430 2.439 0.016
下载: 导出CSV
表 3 屈服应对方式、焦虑在射血分数保留的147例心衰患者运动自我效能及运动恐惧间的中介效应分析
Table 3. The mediating effect of yieldly coping and anxiety on exercise self-efficacy and kinesiophobia in heart failure patients with preserved ejection fraction
项目 Effect Boot SE BootLLCI BootULCI 效应占比(%) 总效应 -0.843 0.325 -1.486 -0.201 直接效应 -0.397 0.309 -1.008 0.214 47.09 间接效应 -0.446 0.175 -0.812 -0.130 52.91 间接效应1 -0.238 0.125 -0.515 -0.031 28.23 间接效应2 -0.072 0.068 -0.224 0.047 8.54 间接效应3 -0.136 0.077 -0.314 -0.013 16.13
下载: 导出CSV
-
[1] 周京敏, 王华, 黎励文. 射血分数保留的心力衰竭诊断与治疗中国专家共识2023[J]. 中国循环杂志, 2023, 38(4): 375-393. doi: 10.3969/j.issn.1000-3614.2023.04.001ZHOU J M, WANG H, LI L W. Diagnosis and Treatment of Heart Failure With Preserved Ejection Fraction: Chinese Expert Consensus 2023[J]. Chinese Circulation Journal, 2023, 38(4): 375-393. doi: 10.3969/j.issn.1000-3614.2023.04.001 [2] 周冰洁, 李玉梅, 罗向卫, 等. 运动康复训练对射血分数保留的心力衰竭患者预后改善的研究[J]. 中国医药科学, 2021, 11(20): 182-185, 193.ZHOU B J, LI Y M, LUO X W, et al. Study on the effect of exercise rehabilitation training on prognosis improvement of patients with heart failure with preserved ejection fraction[J]. China Medicine and Pharmacy, 2021, 11(20): 182-185, 193. [3] 刘瑞, 鲁燕, 贾永平, 等. 运动诱导的心脏保护作用及相关分子机制[J]. 中华全科医学, 2023, 21(6): 1021-1025. doi: 10.16766/j.cnki.issn.1674-4152.003040LIU R, LU Y, JIA Y P, et al. Exercise induced cardioprotective effects and related molecular mechanisms[J]. Chinese Journal of General Practice, 2023, 21(6): 1021-1025. doi: 10.16766/j.cnki.issn.1674-4152.003040 [4] OKWOSE N C, O'BRIEN N, CHARMAN S, et al. Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study[J]. BMJ Open, 2020, 10(9): e036382. DOI: 10.1136/bmjopen-2019-036382. [5] 高敏, 孙国珍, 王倩怡, 等. 慢性心力衰竭患者运动康复行为影响因素的质性研究[J]. 护理学杂志, 2021, 36(20): 88-92.GAO M, SUN G Z, WANG Q Y, et al. Factors influencing exercise rehabilitation among patients with chronic heart failure: a qualitative study[J]. Journal of Nursing Science, 2021, 36(20): 88-92. [6] 秦静雯, 熊娟娟, 潘鑫, 等. 老年慢性心力衰竭患者运动恐惧现状及影响因素分析[J]. 中华护理杂志, 2022, 57(4): 408-414.QIN J W, XIONG J J, PAN X, et al. The status and influencing factors of kinesiophobia in elderly patients with chronic heart failure[J]. Chinese Journal of Nursing, 2022, 57(4): 408-414. [7] 张秀婷. 基于恐惧-回避模型的慢性心衰患者活动恐惧现状及影响因素研究[D]. 济南: 山东大学, 2020.ZHANG X T. The Fear of Movement and Associated Factors in Patientswith Chronic Heart Failure Using the Fear-Avoidance Model[D]. Jinan: Shandong University, 2020. [8] 王艳玲, 常淑莹, 李红, 等. 疾病感知控制、运动自我效能对心力衰竭患者运动恐惧影响的纵向研究[J]. 中国实用护理杂志, 2022, 38(23): 1782-1789.WANG Y L, CHANG S Y, LI H, et al. Effects of perceived disease control and exercise self-efficacy on kinesiophobia in patients with heart failure: a longitudinal study[J]. Chinese Journal of Practical Nursing, 2022, 38(23): 1782-1789. [9] 曹二凤, 王宇涛, 李鹏, 等. 急性心肌梗死PCI术后病人急性应激障碍现状及其与疾病感知和应对方式的相关性[J]. 护理研究, 2024, 38(1): 37-42.CAO R F, WANG Y T, LI P, et al. Current status of acute stress disorder in patients with acute myocardial infarction after PCl and its relationship with illness perception and coping strategies[J]. Chinese Nursing Research, 2024, 38(1): 37-42. [10] 徐娜, 高振宇. 冠心病病人应对方式在D型人格与负性情绪间的中介作用[J]. 护理研究, 2022, 36(15): 2760-2764.XU N, GAO Z Y. Mediating role of coping style between type D personality and negative emotions in patients with coronary heart disease[J]. Chinese Nursing Research, 2022, 36(15): 2760-2764. [11] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789.Heart Failure Group of Chinese Society of Cardiology of Chinese Medical Association, Chinese Heart Failure Association of Chinese Medical Doctor Association, Editorial Board of Chinese Journal of Cardiology. Chinese guidelines for the diagnosis and treatment of heart failure 2018[J]. Chinese Journal of Cardiology, 2018, 46(10): 760-789. [12] 高敏, 孙国珍, 王倩怡, 等. 慢性心力衰竭病人运动恐惧量表的修订及信效度检验[J]. 护理研究, 2023, 37(11): 1907-1913.GAO M, SUN G Z, WANG Q Y, et al. Chinese version of Fear of Activity in Patients with Chronic Heart Failure and its reliability and validity test[J]. Chinese Nursing Research, 2023, 37(11): 1907-1913. [13] OZYEMISCI-TASKIRAN O, DEMIRSOY N, ATAN T, et al. Development and validation of a scale to measure Fear of activity in patients with coronary artery disease (Fact-CAD)[J]. Arch Phys Med Rehabil, 2020, 101(3): 479-486. doi: 10.1016/j.apmr.2019.09.001 [14] RESNICK B, JENKINS L S. Testing the reliability and validity of the self-efficacy for exercise scale[J]. Nurs Res, 2000, 49(3): 154-159. doi: 10.1097/00006199-200005000-00007 [15] LEE L L, PERNG S J, HO C C, et al. A preliminary reliability and validity study of the Chinese version of the self-efficacy for exercise scale for older adults[J]. Int J Nurs Stud, 2009, 46(2): 230-238. [16] FEIFEL H, STRACK S, NAGY V T. Coping strategies and associated features of medically ill patients[J]. Psychosom Med, 1987, 49(6): 616. [17] 沈晓红, 姜乾金. 医学应对方式问卷中文版701例测试报告[J]. 中国行为医学科学, 2000(1): 22-24.SHEN X H, JIANG G J. Report on application of Chinese version of MCMQ in 701 patients[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2000(1): 22-24. [18] GARCÍA-CAMPAYO J, ZAMORANO E, RUIZ M A, et al. Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool[J]. Health Qual Life Outcomes, 2010, 8(1): 8. [19] 王历. 心血管疾病焦虑抑郁自评问卷以及急性冠脉综合征焦虑抑郁相关因素流行病学研究[D]. 重庆: 重庆医科大学, 2015.WANG L. Validation of anxiety-depression self-rating scales in cardiovascular patients and prevalence and factors associated anxiety-depression in acute coronary symptom patients[D]. Chongqing: Chongqing Medical University, 2015. [20] 姜梦凡, 王万霞, 高瑾, 等. 孤独感和社会支持在农村乳腺癌幸存者病耻感与社交回避间的中介调节作用[J]. 中华全科医学, 2023, 21(12): 2000-2004. doi: 10.16766/j.cnki.issn.1674-4152.003276JIANG M F, WANG W X, GAO J, et al. The mediating role of loneliness and social support between stigma and social avoidance in rural breast cancer survivors[J]. Chinese Journal of General Practice, 2023, 21(12): 2000-2004. doi: 10.16766/j.cnki.issn.1674-4152.003276 [21] 汤丹丹, 温忠麟. 共同方法偏差检验: 问题与建议[J]. 心理科学, 2020, 43(1): 215-223.TANG D D, WEN Z L. Statistical Approaches for Testing Common Method Bias: Problems and Suggestions[J]. Journal of Psychological Science, 2020, 43(1): 215-223. [22] 于甜栖, 孙国珍, 高敏, 等. 运动自我效能在慢性心力衰竭患者运动恐惧与运动康复依从性间的中介效应[J]. 现代预防医学, 2022, 49(22): 4163-4168.YU T X, SUN G Z, GAO M, et al. Mediation effect of self-efficacy for exercise on the relationship between kinesiophobia and exercise rehabilitation adherence in patients with heart failure[J]. Modern Preventive Medicine, 2022, 49(22): 4163-4168. [23] 任鹏娜, 张月, 丁琳, 等. 运动恐惧在急性心肌梗死经皮冠状动脉介入治疗术后患者自我效能与运动依从性间的中介效应[J]. 解放军护理杂志, 2022, 39(1): 21-24.REN P N, ZHANG Y, DING L, et al. The Mediating Effect of Kinesophobia on Self-Efficacy and Exerciseadherence in Patients with Acute Myocardial lnfarction after PCI[J]. Military Nursing, 2022, 39(1): 21-24. [24] 朱明元, 鲁才红, 林婉婷, 等. 领悟社会支持在恶性肿瘤患者性格优势与应对方式间的中介效应[J]. 护理学杂志, 2023, 38(8): 87-90, 94.ZHU M Y, LU C H, LIN W T, et al. Mediating effect of perceived social support between character strengths and coping style in patients with malignant tumor[J]. Journal of Nursing Science, 2023, 38(8): 87-90, 94. [25] 李英琦, 姜峰, 韩丹丹, 等. 应对方式在医学院校硕士新生自我效能感与抑郁间的多重中介作用[J]. 中国健康心理学杂志, 2019, 27(5): 773-777.LI Y Q, JIANG F, HAN D D, et al. Relationship between self-efficacy and depression of postgraduates in medical university: The multiple mediating effect of coping style[J]. China Journal of Health Psychology, 2019, 27(5): 773-777. [26] 厉姝岑, 陈慧婷, 张红梅, 等. 社会支持、应对方式在青年2型糖尿病患者自我效能与糖尿病痛苦间的链式中介效应[J]. 护理管理杂志, 2022, 22(10): 718-722.LI S C, CHEN H T, ZHANG H M, et al. Chain mediating effect of social support and coping style on the relationship between self-efficacy and diabetes distress in young patients with type 2 diabetes mellitus[J]. Journal of Nursing Administration, 2022, 22(10): 718-722. [27] 龚映雪, 李小保, 杨艺琳, 等. 未来时间洞察力对焦虑的影响: 自我效能感和应对方式的链式中介作用[J]. 心理研究, 2023, 16(5): 402-410.GONG Y X, LI X B, YANG Y L, et al. The impact of future time perspective on anxiety: A chain mediating model of self-efficacy and coping[J]. Psychological Research, 2023, 16(5): 402-410. -
点击查看大图
图(1) / 表(3)
计量
- 文章访问数: 30
- HTML全文浏览量: 14
- PDF下载量: 2
- 被引次数: 0
