Analysis of the Current Status and Influencing Factors of Self-management in Patients with Degenerative Spinal Deformity

doi:10.12114/j.issn.1007-9572.2023.0262

Abstract

Abstract:

Background

In recent years, the prevalence of degenerative spinal deformity (DSD) has been increasing annually. Patients have to live with DSD for a long time from the onset of disease until surgical intervention is required, and self-management during this period is crucial for the development and progression of DSD. However, the current status and influencing factors of self-management in DSD patients remain unclear, making it difficult to tailor effective intervention measures.

Objective

To investigate the current status and influencing factors of self-management in patients with DSD, so as to provide a clinical reference for the development of targeted intervention programs.

Methods

A total of 200 patients with DSD who attended the Department of Orthopedics in the First Affiliated Hospital of Army Medical University from June 2020 to December 2022 using a convenience sampling method to conduct questionnaire survey. The demographic information, Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score, Medical Outcomes Study Social Support Survey (MOS-SSS) score, and Chronic Disease Self-management Behavior Scale score were collected. Multiple linear regression were used to analyze the influencing factors of chronic disease self-management behaviors of patients.

Results

A total of 191 (95.5%) valid questionnaires were recovered. The average age of the patients was (62.6±11.6) years, including 144 cases (75.4%) of scoliosis, 37 cases (19.4%) of kyphosis and 10 cases (5.2%) of lateral kyphosis. The total score of self-management behaviors was (22.94±11.97). The standardized scores for each dimension of self-management behaviors were cognitive symptom management (26.27±15.83), doctor-patient communication (23.53±16.27) and exercise (18.42±11.00) in descending order. The results of correlation analysis showed that age, BMI, monthly per capita household income, education level, smoking history, function disorder and medical social support were significantly correlated with the scores of each dimension and total score of Chronic Disease Self-management Behavior Scale (P<0.05). The multiple linear regression analysis results showed that medical social support, education level, monthly per capita household income, and bone mineral density were influencing factors of Chronic Disease Self-management Behavior Scale scores (P<0.05) .

Conclusion

The level of self-management behavior in patients with DSD is low. Medical social support, education level, economic level, and bone mineral density are the main influencing factors of self-management behaviors. Healthcare providers should improve self-management behaviors of DSD patients in clinical practice to help them manage their diseases effectively by strengthening education and enhancing social support.

Key words: Spinal diseases, Degenerative spinal deformity, Self-management, Root cause analysis, Multiple linear regression

摘要： 背景近年来，退行性脊柱畸形（DSD）的患病率逐年上升，从疾病发生到需手术干预之前，患者将与疾病长期共存，期间自我管理对DSD的发展及转归至关重要。然而，DSD患者的自我管理现状及影响因素尚不明确，无法针对性地制订有效的干预措施。目的研究DSD患者的自我管理现状并分析其影响因素，为制订针对性的干预方案提供临床参考。方法采用便利抽样法对2020年6月—2022年12月于陆军军医大学第一附属医院骨科就诊的200例DSD患者进行问卷调查，收集患者的人口统计学资料、视觉模拟评分、Oswestry功能障碍指数问卷（ODI）评分、医疗社会支持量表（MOS-SSS）评分以及慢病自我管理行为量表评分。构建多元线性回归模型分析患者慢病自我管理行为量表评分的影响因素。结果共回收有效问卷191份（95.5%），患者的平均年龄为（62.6±11.6）岁，其中脊柱侧弯144例（75.4%），后凸37例（19.4%），侧后凸10例（5.2%）。慢病自我管理行为量表总分为（22.94±11.97）分，各维度标准化得分由高到低依次为认知症状管理（26.27±15.83）分、医患交流（23.53±16.27）分和运动锻炼（18.42±11.00）分。相关性分析结果显示，年龄、BMI、家庭人均月收入、受教育程度、吸烟史、ODI评分、MOS-SSS评分与慢病自我管理行为量表各维度评分和总分显著相关（P<0.05）。多元线性回归分析模型结果显示，MOS-SSS评分、受教育程度、家庭人均月收入和骨密度是DSD患者慢病自我管理行为量表评分的影响因素（P<0.05）。结论 DSD患者的自我管理行为水平较低，MOS-SSS评分、受教育程度、经济水平和骨密度是DSD患者自我管理的影响因素，医护人员在临床实践中应从加强教育、提升社会支持等方面增强患者的自我管理行为，帮助患者有效管理疾病。

关键词: 脊柱疾病, 退行性脊柱畸形, 自我管理, 影响因素分析, 多元线性回归

ZHANG Zhao,ZHENG Tingting,WANG Yushu, et al. Analysis of the Current Status and Influencing Factors of Self-management in Patients with Degenerative Spinal Deformity[J]. Chinese General Practice, 2024, 27(15): 1867-1872. DOI: 10.12114/j.issn.1007-9572.2023.0262.
张曌,郑婷婷,王钰姝等. 退行性脊柱畸形患者的自我管理现状及影响因素研究[J]. 中国全科医学, 2024, 27(15): 1867-1872. DOI: 10.12114/j.issn.1007-9572.2023.0262.

Figures/Tables 4

References 31

[1]	DIEBO B G, SHAH N V, BOACHIE-ADJEI O，et al. Adult spinal deformity[J]. Lancet，2019，394(10193):160-172. DOI：10.1016/S0140-6736(19)31125-0.
[2]	GUM J L, CARREON L Y, GLASSMAN S D. State-of-the-art：outcome assessment in adult spinal deformity[J]. Spine Deform，2021，9(1):1-11. DOI：10.1007/s43390-020-00220-3.
[3]	CRISTANTE A F, SILVA R T E, COSTA G H R D，et al. Adult degenerative scoliosis[J]. Rev Bras Ortop，2021，56(1):1-8. DOI：10.1055/s-0040-1709736.
[4]	GLASSMAN S D, CARREON L Y, SHAFFREY C I，et al. Cost-effectiveness of adult lumbar scoliosis surgery：an as-treated analysis from the adult symptomatic scoliosis surgery trial with 5-year follow-up[J]. Spine Deform，2020，8(6):1333-1339. DOI：10.1007/s43390-020-00154-w.
[5]	LI X, SHEN J, LIANG J P，et al. Effect of core-based exercise in people with scoliosis：a systematic review and meta-analysis[J]. Clin Rehabil，2021，35(5):669-680. DOI：10.1177/0269215520975105.
[6]	ZHOU Z W, LIU F, LI R，et al. The effects of exercise therapy on adolescent idiopathic scoliosis：an overview of systematic reviews and meta-analyses[J]. Complement Ther Med，2021，58:102697. DOI：10.1016/j.ctim.2021.102697.
[7]	PONZANO M, TIBERT N, BANSAL S，et al. Exercise for improving age-related hyperkyphosis：a systematic review and meta-analysis with GRADE assessment[J]. Arch Osteoporos，2021，16(1):140. DOI：10.1007/s11657-021-00998-3.
[8]	MANN S J, LAM J C, SINGH P. McKenzie back exercises[J]. StatPearls，2023.
[9]	SCHOUTENS C, CUSHMAN D M, MCCORMICK Z L，et al. Outcomes of nonsurgical treatments for symptomatic adult degenerative scoliosis：a systematic review[J]. Pain Med，2020，21(6):1263-1275. DOI：10.1093/pm/pnz253.
[10]	GOU Y Y, LEI H W, ZENG Y，et al. The effect of Pilates exercise training for scoliosis on improving spinal deformity and quality of life：Meta-analysis of randomized controlled trials[J]. Medicine，2021，100(39):e27254. DOI：10.1097/MD.0000000000027254.
[11]	AILON T, SMITH J S, SHAFFREY C I，et al. Degenerative spinal deformity [J]. Neurosurgery，2015，77:S75-91. DOI：10.1227/neu.0000000000000938.
[12]	WANG W R, ZHENG X M, HE H G，et al. Psychometric testing of the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey in patients with coronary heart disease in mainland China[J]. Qual Life Res，2013，22(8):1965-1971. DOI：10.1007/s11136-012-0345-x.
[13]	傅东波，丁永明，杨柯君，等. 高血压自我管理健康教育项目效果评价[J]. 复旦学报（医学版），2005，32(3):284-288,294. DOI：10.3969/j.issn.1672-8467.2005.03.008.
[14]	HUDON É, HUDON C, LAMBERT M，et al. Generic self-reported questionnaires measuring self-management：a scoping review[J]. Clin Nurs Res，2021，30(6):855-865. DOI：10.1177/1054773820974149.
[15]	LAN X Y, LU X Y, YI B L，et al. Factors associated with self-management behaviors of patients with chronic obstructive pulmonary disease[J]. Jpn J Nurs Sci，2022，19(1):e12450. DOI：10.1111/jjns.12450.
[16]	黄雪，李辰瑶，郑萍. 老年慢性疼痛病人自我感受负担、疼痛恐惧及自我管理行为的相关性[J]. 护理研究，2021，35(15):2675-2681. DOI：10.12102/j.issn.1009-6493.2021.15.009.
[17]	李朵朵，黄俊婷，姚晚侠. 癌因性疲乏病人社会支持与自我管理能力的相关性研究[J]. 护理研究，2020，34(2):299-302. DOI：10.12102/j.issn.1009-6493.2020.02.024.
[18]	KONG L N, ZHU W F, LI L，et al. Self-management behaviors in adults with chronic hepatitis B：a structural equation model[J]. Int J Nurs Stud，2021，116:103382. DOI：10.1016/j.ijnurstu.2019.06.013.
[19]	李婷婷，梁桃云，刘宇，等. 慢性心力衰竭病人运动自我管理研究进展[J]. 护理研究，2022，36(12):2196-2200. DOI：10.12102/j.issn.1009-6493.2022.12.024.
[20]	刘菲，尹小兵，朱晓萍. 慢性腰痛恐动症患者对康复运动的心理体验[J]. 中国护理管理，2021，21(12):1796-1800. DOI：10.3969/j.issn.1672-1756.2021.12.008.
[21]	NIKIPHOROU E, SANTOS E J F, MARQUES A，et al. 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis[J]. Ann Rheum Dis，2021，80(10):1278-1285. DOI：10.1136/annrheumdis-2021-220249.
[22]	SCHRIJVER J, LENFERINK A, BRUSSE-KEIZER M，et al. Self-management interventions for people with chronic obstructive pulmonary disease[J]. Cochrane Database Syst Rev，2022，1(1):CD002990. DOI：10.1002/14651858.CD002990.pub4.
[23]	李涤凡，尹德荣，黄文伶，等. 老年慢性心力衰竭患者自我管理现况调查和影响因素的研究[J]. 中国护理管理，2020，20(3):360-366. DOI：10.3969/j.issn.1672-1756.2020.03.010.
[24]	张妍欣，杨丽，李家燕，等. 鼻咽癌患者同步放化疗后自我管理积极度现状及影响因素分析[J]. 中华护理杂志，2022，57(15):1853-1859. DOI：10.3761/j.issn.0254-1769.2022.15.009.
[25]	MO X Y, ZHAO S L, WEN Z X，et al. High prevalence of osteoporosis in patients undergoing spine surgery in China[J]. BMC Geriatr，2021，21(1):361. DOI：10.1186/s12877-021-02313-8.
[26]	WOODS G N, HUANG M H, LEE J H，et al. Factors associated with kyphosis and kyphosis progression in older men：the MrOS study[J]. J Bone Miner Res，2020，35(11):2193-2198. DOI：10.1002/jbmr.4123.
[27]	GUO R, LI B, ZENG Z L，et al. Thoracolumbar kyphosis in postmenopausal osteoporosis patients without vertebral compression fractures[J]. Ann Transl Med，2022，10(2):52. DOI：10.21037/atm-21-6285.
[28]	WANG H, ZOU D, SUN Z R，et al. Hounsfield unit for assessing vertebral bone quality and asymmetrical vertebral degeneration in degenerative lumbar scoliosis[J]. Spine，2020，45(22):1559-1566. DOI：10.1097/BRS.0000000000003639.
[29]	LIM K E, KIM S R, SUNG Y H，et al. Factors influencing self-management in Parkinson's disease：a cross-sectional study[J]. Geriatr Nurs，2020，41(3):254-260. DOI：10.1016/j.gerinurse.2019.10.005.
[30]	ÇERGEL Y, TOPUZ O, ALKAN H，et al. The effects of short-term back extensor strength training in postmenopausal osteoporotic women with vertebral fractures：comparison of supervised and home exercise program[J]. Arch Osteoporos，2019，14(1):82. DOI：10.1007/s11657-019-0632-z.
[31]	KONGSTED A, RIS I, KJAER P，et al. Self-management at the core of back pain care：10 key points for clinicians[J]. Braz J Phys Ther，2021，25(4):396-406. DOI：10.1016/j.bjpt.2021.05.002.

量表	条目数	得分	标准化分数
VAS	1	4.03±1.98	40.30±19.80
ODI	10	41.71±19.37	41.71±19.37
MOS-SSS	19	49.50±15.34	52.11±16.15
有形支持维度	4	12.31±3.82	61.55±19.10
信息和情绪支持维度	8	18.65±6.59	46.63±16.48
积极的社会互动支持维度	4	10.85±3.58	54.25±17.90
情感支持维度	3	7.68±2.66	51.20±17.73
慢病自我管理行为量表	15	15.83±8.26	22.94±11.97
运动锻炼维度	6	4.42±2.64	18.42±11.00
认知症状管理维度	6	7.88±4.75	26.27±15.83
医患交流维度	3	3.53±2.44	23.53±16.27

量表	条目数	得分	标准化分数
VAS	1	4.03±1.98	40.30±19.80
ODI	10	41.71±19.37	41.71±19.37
MOS-SSS	19	49.50±15.34	52.11±16.15
有形支持维度	4	12.31±3.82	61.55±19.10
信息和情绪支持维度	8	18.65±6.59	46.63±16.48
积极的社会互动支持维度	4	10.85±3.58	54.25±17.90
情感支持维度	3	7.68±2.66	51.20±17.73
慢病自我管理行为量表	15	15.83±8.26	22.94±11.97
运动锻炼维度	6	4.42±2.64	18.42±11.00
认知症状管理维度	6	7.88±4.75	26.27±15.83
医患交流维度	3	3.53±2.44	23.53±16.27

项目	运动锻炼	认知症状管理	医患交流	慢病自我管理行为量表总分
年龄	-0.219^ab	-0.068	-0.249^ab	-0.182^ab
BMI	-0.043	-0.202^ab	-0.209^ab	-0.192^ab
家庭人均月收入	0.293^a	0.268^a	0.276^a	0.318^a
受教育程度	0.245^a	0.253^a	0.357^a	0.323^a
吸烟史	-0.147^a	-0.056	-0.202^a	-0.126^a
ODI评分	-0.151^ab	-0.122	-0.250^ab	-0.192^ab
MOS-SSS评分	0.486^ab	0.475^ab	0.575^ab	0.598^ab

项目	运动锻炼	认知症状管理	医患交流	慢病自我管理行为量表总分
年龄	-0.219^ab	-0.068	-0.249^ab	-0.182^ab
BMI	-0.043	-0.202^ab	-0.209^ab	-0.192^ab
家庭人均月收入	0.293^a	0.268^a	0.276^a	0.318^a
受教育程度	0.245^a	0.253^a	0.357^a	0.323^a
吸烟史	-0.147^a	-0.056	-0.202^a	-0.126^a
ODI评分	-0.151^ab	-0.122	-0.250^ab	-0.192^ab
MOS-SSS评分	0.486^ab	0.475^ab	0.575^ab	0.598^ab

项目	例数	得分	t（F）值	P值
年龄			1.488	0.224
<65岁	101	16.51±8.86
≥65岁	90	15.06±7.51
性别			0.103	0.749
男	41	16.20±7.27
女	150	15.73±8.53
BMI			4.558	0.034
<24 kg/m²	97	17.07±8.50
≥24 kg/m²	94	14.54±7.85
职业			0.936	0.335
无	97	15.26±7.55
有	94	16.41±8.94
婚姻状态			0.236	0.627
已婚	135	16.01±8.51
独身（含未婚、丧偶）	56	15.38±7.68
医疗付费方式			0.066	0.798
医保	154	15.90±8.29
自费	37	15.51±8.25
吸烟史			5.468	0.020
无	165	16.38±8.50
有	26	12.35±5.51
饮酒史			0.415	0.520
无	159	15.65±8.35
有	32	16.69±7.90
家庭人均月收入			11.186^a	<0.001
≤1 000元	19	10.26±7.06
1 001~3 000元	54	12.74±5.92
3 001~5 000元	62	16.77±7.63
>5 000元	56	19.64±9.24
受教育程度			18.538^a	<0.001
小学以下	25	9.84±3.45
小学	74	13.85±6.65
初中及以上	92	19.04±8.97
骨密度			16.608^a	<0.001
正常	55	20.80±9.14
骨量减少	62	13.24±5.54
骨质疏松	74	14.30±7.97
合并慢病数量			0.085^a	0.918
0种	131	15.69±8.47
1种	40	15.93±7.67
≥2种	20	16.50±8.36