發(fā)布時間：2018-10-24 08:24

【摘要】：目的探討自我效能、恐懼-回避信念和應(yīng)對方式對社區(qū)慢性腰背痛患者生命質(zhì)量的影響路徑。方法2016年3—9月,采用便利抽樣法選擇南京市和常州市11個社區(qū)的慢性腰背痛患者為調(diào)查對象。分別采用慢性病管理自我效能量表、中文版恐懼-回避信念問卷(FABQ-CHI)、簡易應(yīng)對方式問卷(SCSQ)和簡明健康狀況量表(SF-36)評價患者自我效能、恐懼-回避信念、應(yīng)對方式和生命質(zhì)量。采用Pearson相關(guān)、多元逐步線性回歸和結(jié)構(gòu)方程模型分析自我效能、恐懼-回避信念、應(yīng)對方式對生命質(zhì)量的影響機(jī)制。結(jié)果本研究共發(fā)放問卷250份,回收有效問卷221份,有效回收率為88.4%。SF-36生理健康領(lǐng)域(PCS)評分為(53.96±19.93)分,心理健康領(lǐng)域(MCS)評分為(60.83±22.70)分,各維度得分均低于常模(P0.01)。Pearson相關(guān)分析顯示,慢性病管理自我效能量表總分與FABQ-CHI總分呈負(fù)相關(guān),與SCSQ積極應(yīng)對維度評分呈正相關(guān),與SF-36各維度評分呈正相關(guān)(P0.05);FABQ-CHI總分與SCSQ消極應(yīng)對維度評分呈正相關(guān),與SF-36各維度評分呈負(fù)相關(guān)(P0.05);SCSQ積極應(yīng)對維度評分與SF-36生理功能(PF)維度、活力(VT)維度、精神健康(MH)維度評分呈正相關(guān)(P0.05);SCSQ消極應(yīng)對維度評分與SF-36 PF維度、總體健康(GH)維度、社會功能(SF)維度、MH維度評分呈負(fù)相關(guān)(P0.05)。多元線性回歸分析顯示,慢性病管理自我效能量表、FABQ-CHI、SCSQ的積極應(yīng)對維度和消極應(yīng)對維度評分均可預(yù)測SF-36 PCS評分,慢性病管理自我效能量表、FABQ-CHI、SCSQ的消極應(yīng)對維度評分可預(yù)測SF-36 MCS評分(P0.05)。結(jié)構(gòu)方程模型顯示,自我效能對生命質(zhì)量有直接正向預(yù)測作用(b=0.35),并通過中介變量積極應(yīng)對(b=0.31)間接正向影響生命質(zhì)量(b=0.19);恐懼-回避信念對生命質(zhì)量有直接負(fù)向預(yù)測作用(b=-0.33),并通過中介變量消極應(yīng)對(b=0.32)間接負(fù)向影響生命質(zhì)量(b=-0.32)。結(jié)論自我效能、恐懼-回避信念可直接及分別通過積極應(yīng)對、消極應(yīng)對間接影響慢性腰背痛患者生命質(zhì)量。醫(yī)護(hù)人員應(yīng)通過健康教育,提高患者的自我效能,降低恐懼-回避信念,改善應(yīng)對方式,提高其生命質(zhì)量水平。
[Abstract]:Objective to explore the influence of self-efficacy, fear-avoidance beliefs and coping styles on the quality of life of patients with chronic low back pain in community. Methods from March to September 2016, patients with chronic low back pain in 11 communities of Nanjing and Changzhou were selected by convenience sampling method. Chronic disease management self-efficacy scale, Chinese version fear avoidance belief questionnaire (FABQ-CHI), simple coping style questionnaire (SCSQ) and brief Health status scale (SF-36) were used to evaluate patients' self-efficacy, fear avoidance belief, coping style and quality of life. Pearson correlation, multiple stepwise linear regression and structural equation model were used to analyze the influence mechanism of self-efficacy, fear avoidance belief and coping style on quality of life. Results A total of 250 questionnaires were sent out and 221 valid questionnaires were collected. The effective recovery rate was (53.96 鹵19.93) in 88.4%.SF-36 physical health and (60.83 鹵22.70) in mental health. The scores of each dimension were lower than those of the norm (P0.01). Pearson correlation analysis showed that the recovery rate was (53.96 鹵19.93) and (60.83 鹵22.70) respectively). The total score of chronic disease management self-efficacy scale was negatively correlated with the total score of FABQ-CHI, positively correlated with the score of positive coping dimension of SCSQ, and positively correlated with the score of each dimension of SF-36 (P0.05); the total score of FABQ-CHI was positively correlated with the score of negative coping dimension of SCSQ. There was a negative correlation between the scores of each dimension of SF-36 (P0.05); SCSQ positive coping dimension score and SF-36 physiological function (PF) dimension, dynamic (VT) dimension, mental health (MH) dimension score positive correlation (P0.05); SCSQ negative coping dimension score and SF-36 PF dimension, overall health (GH) dimension; Social function (SF) dimension, MH dimension score was negatively correlated (P0.05). Multiple linear regression analysis showed that chronic disease management self-efficacy scale, FABQ-CHI,SCSQ positive coping dimension and negative coping dimension score can predict SF-36 PCS score, chronic disease management self-efficacy scale, FABQ-CHI,SCSQ negative coping dimension score can predict SF-36 MCS score (P0.05). The structural equation model shows that, Self-efficacy has direct positive predictive effect on quality of life (b.35), and indirect positive effect on quality of life through intermediate variable (bG0.31), fear avoidance belief has direct negative predictive effect on quality of life (b-0.33), and through intermediary change, it has indirect positive effect on quality of life (BQOL). The quantity of negative coping (bt0. 32) indirectly and negatively affected the quality of life (bPQ-0. 32). Conclusion Self-efficacy, fear-avoidance belief can directly and separately affect the quality of life of patients with chronic low back pain through positive coping and negative coping. Health care workers should improve their self-efficacy, reduce fear-avoidance beliefs, improve coping styles and improve their quality of life through health education.
【作者單位】： 南京中醫(yī)藥大學(xué)護(hù)理學(xué)院;南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院核醫(yī)學(xué)科;上海市健康促進(jìn)中心;
【基金】：教育部人文社會科學(xué)研究青年基金(14YJCZH024) 江蘇省高�！扒嗨{(lán)工程”(2016~2019年度)資助項目 江蘇省優(yōu)勢學(xué)科二期項目南京中醫(yī)藥大學(xué)護(hù)理學(xué)一級學(xué)科指令性課題(YSHL2016-032)
【分類號】：R681.55

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