认知行为理论视角下老年髋关节置换患者全周期康复运动需求的质性研究

瞿辉武; 真启云; 苏宙; 崔莉莉; 戴婷婷; 窦红梅

doi:10.16766/j.cnki.issn.1674-4152.004038

认知行为理论视角下老年髋关节置换患者全周期康复运动需求的质性研究

doi: 10.16766/j.cnki.issn.1674-4152.004038

瞿辉武^{1, 2},
真启云^1, ,,
苏宙¹,
崔莉莉¹,
戴婷婷¹,
窦红梅²

1.
江苏大学附属人民医院骨科, 江苏镇江 212000
2.
南京医科大学附属泰州人民医院手术室, 江苏泰州 225300

基金项目:

江苏省“六个一工程”拔尖人才科研项目 LGY2020064

详细信息

通讯作者:
真启云，E-mail：qicaixuan2002@163.com

中图分类号: R687.4
计量
- 文章访问数: 21
- HTML全文浏览量: 12
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2024-09-18
- 网络出版日期: 2025-09-04

A qualitative study on the rehabilitation exercise needs of elderly hip arthroplasty patients throughout the entire care continuum from the perspective of cognitive behavioral theory

QU Huiwu^{1, 2},
ZHEN Qiyun^{1
, ,},
SU Zhou¹,
CUI Lili¹,
DAI Tingting¹,
DOU Hongmei²

1.
Department of Orthopaedics, People′s Hospital Affiliated to Jiangsu University, Zhenjiang, Jiangsu 212000, China

摘要

摘要: 目的老年髋关节置换(THA)患者的关节活动功能受限、下肢深静脉血栓等血管并发症、焦虑抑郁不良情绪等的发生均与其康复运动息息相关，因此，做好老年THA患者的康复运动护理管理十分重要。本研究从认知行为理论视角进行访谈，通过探究老年THA患者康复运动过程中的差异化真实体验，为临床构建个体化、全周期的康复运动方案提供参考依据。方法采用目的抽样法，选取2023年3—4月在江苏大学附属人民医院接受治疗的老年THA患者为研究对象，对患者进行半结构式访谈，最终访谈患者18例。运用定向内容分析法对资料进行分析并提炼主题。结果老年THA患者全周期康复运动需求可提炼出3个主题，(1)手术前认知水平的偏差(自我认知的健康需求；家庭及情感支持需求；手术相关物品准备及使用需求；康复运动的信心和信念需求)。(2)手术后初期康复运动中的不同需求(多元化疾病康复知识获取需求；生活自理需求；运动锻炼需求)。(3)出院后居家康复运动中的不同需求(网络化延续性护理需求；外部环境支持需求)。结论老年THA患者在康复运动不同阶段存在多方面的问题和需求，医护人员应以认知行为理论为指导，开展个性化指导，重视其身心感受，构建“医护人员-同伴-家属”三方联动的老年THA患者康复运动支持体系，以适应患者疾病不同阶段的康复认知与需求，提高患者康复运动依从性。
- 髋关节置换 /
- 康复运动 /
- 认知行为 /
- 老年 /
- 质性研究
Abstract: Objective The occurrence of joint motor limitation, vascular complications such as deep vein thrombosis of the lower extremities, anxiety, depression and other negative emotions in elderly total hiparthroplasty (THA) patients are all closely related to their rehabilitation exercise. Therefore, it is very important to do a good job in managing the rehabilitation exercise nursing management of elderly THA patients. This study conducted interviews from the perspective of cognitive behavioral theory. By exploring the differentiated real experiences of elder THA patients in the process of rehabilitation exercise, it provided a reference for the clinical construction of individualized and full-cycle rehabilitation exercise programs. Methods Purposive sampling was used to select elderly THA patients treated at the People's Hospital Affiliated to Jiangsu University from March to April 2023 as research subjects. Semi-structured interviews were conducted with the patients, and 18 patients were eventually interviewed. Directed content analysis was used to analyze the data and refine the themes. Results Three themes could be deduced for the full cycle rehabilitation exercise needs of elderly THA patients, (1) bias of cognitive level before surgery (self-cognitive health needs; family and emotional support needs; preparation and use needs of surgery-related items; confidence and belief needs of rehabilitation exercise). (2) Different needs in the initial rehabilitation exercise after surgery (different needs in acquiring knowledge about disease rehabilitation; self-care needs in life; exercise needs). (3) Different needs in home rehabilitation exercise after discharge (networked continuous care needs; external environment support needs). Conclusion Elderly THA patients have different problems and needs at in different stages of rehabilitation exercise. Healthcare professionals should take the cognitive-behavioral theory as a guide, provide personalized guidance, pay attention to their physical and mental feelings, and build a tripartite "healthcare professionals-peers-family" rehabilitation exercise support system for elderly THA patients, so as to adapt to the rehabilitation cognition and needs at different stages of the disease, and improve patients' compliance of patients with rehabilitation exercise.
- Total hip arthroplasty /
- Rehabilitation exercise /
- Cognitive behavioral therapy /
- Elderly /
- Qualitative study

HTML全文

表 1 18例老年THA患者一般资料

Table 1. General data of 18 elderly patients with THA

受访者编码	性别	年龄(岁)	BMI	文化程度	居住状态	婚姻状况	费用支付
N1	男性	64	25.8	小学	与子女同住	离异	医保
N2	女性	72	24.2	小学	夫妻同住	已婚	农保
N3	女性	70	23.3	文盲	与子女同住	已婚	自费
N4	女性	68	24.5	小学	夫妻同住	已婚	医保
N5	男性	75	32.1	小学	夫妻同住	已婚	医保
N6	女性	69	24.9	初中	与子女同住	已婚	医保
N7	男性	74	29.7	小学	与子女同住	已婚	医保
N8	女性	76	23.2	小学以下	与子女同住	已婚	医保
N9	女性	75	26.6	小学	夫妻同住	已婚	自费
N10	男性	78	31.1	小学	与子女同住	已婚	农保
N11	男性	80	25.9	初中	与子女同住	丧偶	医保
N12	女性	78	30.6	小学	与子女同住	已婚	医保
N13	男性	77	29.8	文盲	与子女同住	已婚	医保
N14	女性	79	26.4	小学以下	与子女同住	丧偶	医保
N15	女性	65	24.3	高中	夫妻同住	已婚	医保
N16	女性	62	25.7	高中	夫妻同住	已婚	医保
N17	男性	75	28.8	小学	夫妻同住	已婚	农保
N18	男性	76	30.2	小学	夫妻同住	已婚	医保

下载: 导出CSV

参考文献(21)

[1]	代志新, 杜鹏, 董隽含. 中国老年抚养比再估计与人口老龄化趋势再审视[J]. 人口研究, 2023, 47(3): 94-107. DAI Z X, DU P, DONG J H. Re-examining the old-age dependency ratio and ageing population in China[J]. Population Research, 2023, 47(3): 94-107.
[2]	叶赛赛, 陈可英, 周黎辉. 行走与站立平衡训练方案对全髋关节置换术患者术后早期康复的影响[J]. 军事护理, 2022, 39(10): 25-28. doi: 10.3969/j.issn.2097-1826.2022.10.007 YE S S, CHEN K Y, ZHOU L H. Effect of walking and standing balance training program on the early rehabilitation of patients undergoing total hip arthroplasty[J]. Military Nursing, 2022, 39(10): 25-28. doi: 10.3969/j.issn.2097-1826.2022.10.007
[3]	罗春林, 苏之盟, 钟远鸣, 等. 微创前方入路与传统外侧入路人工全髋关节置换术治疗股骨头缺血性坏死早期临床疗效分析[J]. 中华全科医学, 2024, 22(1): 55-58, 162. doi: 10.16766/j.cnki.issn.1674-4152.003330 LUO C L, SU Z M, ZHONG Y M, et al. Early clinical outcomes of total hip arthroplasty with minimally invasive direct anterior approach and traditional posterolateral approache for femoral head avascular necrosis[J]. Chinese Journal of General Practice, 2024, 22(1): 55-58, 162. doi: 10.16766/j.cnki.issn.1674-4152.003330
[4]	吕永慧, 陈立红, 许华亮. 住院髋关节置换术后患者心理一致感现状及其影响因素分析[J]. 军事护理, 2022, 39(11): 65-68. LYU Y H, CHEN L H, XU H L. Status quo of sense of coherence among inpatients after hip arthroplasty and its influencing factors[J]. Military Nursing, 2022, 39(11): 65-68.
[5]	吴弦光, 陈迪, 荀芳, 等. 发展康复事业促进实现"健康中国2030"目标[J]. 中国康复理论与实践, 2022, 28(1): 6-14. doi: 10.3969/j.issn.1006-9771.2022.01.002 WU X G, CHEN D, XUN F, et al. Development of rehabilitation undertakings to achieve the "Healthy China 2030" goals[J]. Chinese Journal of Rehabilitation Theory and Practice, 2022, 28(1): 6-14. doi: 10.3969/j.issn.1006-9771.2022.01.002
[6]	THOMA N, PILECKI B, MCKAY D. Contemporary cognitive behavior therapy: a review of theory, history, and evidence[J]. Psychodyn Psychiatry, 2015, 43(3): 423-461. doi: 10.1521/pdps.2015.43.3.423
[7]	肖煌怡, 袁建坤, 严梓予, 等. 认知行为疗法预防老年髋部骨折术后患者认知功能障碍的Meta分析[J]. 中国老年保健医学, 2022, 20(4): 60-65. doi: 10.3969/j.issn.1672-2671.2022.04.014 XIAO H Y, YUAN J K, YAN Z Y, et al. Meta analysis of cognitive behavioral therapy in preventing cognitive dysfunction in elderly patients after hip fracture surgery[J]. Chinese Journal of Geriatric Care, 2022, 20(4): 60-65. doi: 10.3969/j.issn.1672-2671.2022.04.014
[8]	SUDAK D M, BECK J S, WRIGHT J. Cognitive behavioral therapy: a blueprint for attaining and assessing psychiatry resident competency[J]. Academic Psychiatry, 2003, 27(3): 154-159. doi: 10.1176/appi.ap.27.3.154
[9]	WITKIEWITZ K, MARLATT A. Behavioral therapy across the spectrum[J]. Alcohol Res Health, 2011, 33(4): 313-319.
[10]	童培建. 髋膝关节置换围手术期加速康复专家共识[J]. 实用骨科杂志, 2021, 27(11): 961-965. TONG P J. Perioperative accelerated rehabilitation of hip and knee replacement[J]. Journal of practical Orthopaedics, 2021, 27(11): 961-965.
[11]	北京护理学会骨科专业委员会, 中华医学会骨科学分会护理学组, 中华医学会创伤学分会护理学组. 中国老年髋部骨折围手术期护理专家共识(2023)[J]. 中华创伤骨科杂志, 2023, 25(5): 369-379. doi: 10.3760/cma.j.cn115530-20230104-00004 Professional Committee of Orthopedic Nursing, Beijing Nursing Association, Nursing Group, Society of Orthopaedics, Chinese Medical Association, Nursing Group, Society of Traumatology, Chinese Medical Association. Expert consensus on perioperative nursing of geriatric hip fractures (2023)[J]. China Journal Orthopaedic Trauma, 2023, 25(5): 369-379. doi: 10.3760/cma.j.cn115530-20230104-00004
[12]	刘明. Colaizzi七个步骤在现象学研究资料分析中的应用[J]. 护理学杂志, 2019, 34(11): 90-92. LIU M. Using an example to illustrate Colaizzi' s phenomenological data analysis method[J]. Journal of Nursing Science, 2019, 34(11): 90-92.
[13]	邓杨清, 潘岑, 王庆兰, 等. 乳腺癌患者运动体验质性研究的Meta整合[J]. 护理学报, 2021, 28(13): 34-39. DENG Y Q, PAN C, WANG Q L, et al. Qualitative research on exercise experience of patients with breast cancer: a meta-synthesis[J]. Journal of Nursing(China), 2021, 28(13): 34-39.
[14]	KITZMAN D W, WHELLAN D J, DUNCAN P, et al. Physical rehabilitation for older patients hospitalized for heart failure[J]. N Engl J Med, 2021, 385(3): 203-216. doi: 10.1056/NEJMoa2026141
[15]	邓莹, 潘卫宇, 左珊珊, 等. 基于行动研究法的健康教育对全髋关节置换术患者术后康复的影响[J]. 中华全科医学, 2023, 21(1): 100-103. doi: 10.16766/j.cnki.issn.1674-4152.002822 DENG Y, PAN W Y, ZUO S S, et al. Effects of health education based on action research method on the postoperative rehabilitation of patients with total hip replacement[J]. Chinese Journal of General Practice, 2023, 21(1): 100-103. doi: 10.16766/j.cnki.issn.1674-4152.002822
[16]	陈建静, 谢幸尔, 储红梅, 等. 老年慢性心力衰竭患者积极运动体验的质性研究[J]. 中华护理杂志, 2023, 58(4): 421-425. doi: 10.3761/j.issn.0254-1769.2023.04.005 CHEN J J, XIE X E, CHU H M, et al. The active exercise experience in elderly patients with chronic heart failure: a qualitative research[J]. Chinese Journal of Nursing, 2023, 58(4): 421-425. doi: 10.3761/j.issn.0254-1769.2023.04.005
[17]	DI LORITO C, LONG A, BYRNE A, et al. Exercise interventions for older adults: a systematic review of meta-analyses[J]. Sport Health Sci, 2021, 10(1): 29-47.
[18]	中华人民共和国国家卫生健康委员会医政司. 老年髋部骨折诊疗与管理指南(2022年版)[J]. 骨科临床与研究杂志, 2023, 8(2): 77-83. Medical Administration Bureau, National Health Commission of the Peoples Republic of China. Guidelines for treatment and management of hip fractures in the elderly (2022 version)[J]. Journal of Orthopaedic Clinical and Research, 2023, 8(2): 77-83.
[19]	BIRTWISTLE S B, JONES I, MURPHY R, et al. Family support for physical activity post-myocardial infarction: a qualitative study exploring the perceptions of cardiac rehabilitation practitioners[J]. Nurs Health Sci, 2021, 23(1): 227-236.
[20]	YUAN Y, XU H W, ZHANG S, et al. The mediating effect of self-efficacy on the relationship between family functioning and quality of life among elders with chronic diseases[J]. Nurs Open, 2021, 8(6): 3566-3574.
[21]	余静, 谢幸尔, 钱湘云, 等. 艾滋病患者积极应对疾病的真实体验研究[J]. 中华护理杂志, 2021, 56(3): 399-403. YU J, XIE X E, QIAN X Y, et al. AIDS patients using internal and external strength resources to cope with the disease: a qualitative research[J]. Chinese Journal of Nursing, 2021, 56(3): 399-403.