下肢创伤骨折患者康复自我效能与运动恐惧的关系:基于交叉滞后模型的纵向研究-东南大学学报医学版

下肢创伤骨折患者康复自我效能与运动恐惧的关系:基于交叉滞后模型的纵向研究

单位：徐州医科大学附属淮安医院/淮安市第二人民医院, 江苏淮安 223003

分类号：R473.6;R683.42

出版年·卷·期（页码）：2025·44·第六期（879-888）

摘要：

目的: 探讨下肢创伤骨折患者康复自我效能与运动恐惧的变化趋势,构建交叉滞后模型分析二者随时间变化的交互作用。方法: 便利抽样法选取2023年1月至2024年8月本院收治的下肢创伤骨折患者。采用中文版康复自我效能感量表(SER)、恐动症Tampa评分量表(TSK)调查患者术后首次功能锻炼时(T1)、术后3个月(T2)、术后6个月(T3)的康复自我效能与运动恐惧水平。不同时间点康复自我效能、运动恐惧比较采用重复测量方差分析;康复自我效能与运动恐惧的相关性采用Pearson相关分析;Mplus 8.3软件构建交叉滞后模型分析康复自我效能与运动恐惧的纵向作用关系。结果: 231例患者完成研究。T1~T3时,康复自我效能评分依次为(70.74±5.44)、(85.94±6.27)、(91.60±6.07)分,运动恐惧评分依次为(42.39±5.05)、(34.11±3.96)、(31.64±4.12)分,康复自我效能评分总体呈增高趋势,运动恐惧评分总体呈降低趋势,不同时点成对比较均差异有统计学意义(均P<0.05)。Pearson相关分析显示,T1、T2、T3时点的康复自我效能与T1、T2、T3时点的运动恐惧均呈负相关(均P<0.01),变量间存在同步相关性;各变量交叉时点的评分结果也具有相关性(均P<0.01)。交叉滞后模型(控制了性别、年龄、致伤原因、下肢骨折部位、疼痛程度)显示,模型拟合参数卡方/自由度(χ²/df)=1.250,近似误差均方根(RMSEA)=0.033,比较拟合指数(CFI)=0.995,塔克-刘易斯指数(TLI)=0.949,标准化残差均方根(SRMR)=0.017;T2运动恐惧随着T1康复自我效能水平升高而降低(β=-0.232,P=0.001),T3运动恐惧随着T2康复自我效能水平升高而降低(β=-0.249,P<0.001);而T2康复自我效能随着T1运动恐惧水平升高而降低(β=-0.237,P<0.001),T3康复自我效能随着T2运动恐惧水平升高而降低(β=-0.188,P=0.004)。结论: 下肢创伤骨折患者术后6个月内康复自我效能与运动恐惧水平呈动态变化,二者存在纵向交互预测关系。医护人员应该关注其动态变化特征,结合交互预测关系优化阶段性的干预策略,提高康复自我效能,降低运动恐惧水平,实现良性循环。

Objective: To explore the changing trends of rehabilitation self-efficacy and kinesiophobia in patients with lower extremity traumatic fractures, and to construct a cross-lagged model to analyze the interaction between the two over time. Methods: The patients with lower extremity traumatic fractures admitted to our hospital from January 2023 to August 2024 were selected by convenience sampling. The Chinese version of the Self-efficacy for Rehabilitation Outcome Scale(SER) and Trampa Scale for Kinesiophobia(TSK) were used to investigate the levels of rehabilitation self-efficacy and kinesiophobia of the patients at the first functional exercise after surgery(T1), 3 months after surgery(T2), and 6 months after surgery(T3). Repeated measures analysis of variance was used to compare rehabilitation self-efficacy and kinesiophobia at different time points. The correlation between rehabilitation self-efficacy and kinesiophobia was analyzed by Pearson correlation analysis. The Mplus 8.3 software was used to construct a cross-lagged model to analyze the longitudinal relationship between rehabilitation self-efficacy and kinesiophobia. Results: 231 patients completed the study. From T1 to T3, the scores of rehabilitation self-efficacy were(70.74±5.44) points,(85.94±6.27) points, and(91.60±6.07) points respectively, and the scores of kinesiophobia were(42.39±5.05) points,(34.11±3.96) points, and(31.64±4.12) points respectively. The scores of rehabilitation self-efficacy generally showed an increasing trend, while the scores of kinesiophobia generally showed a decreasing trend. There were statistically significant differences in pairwise comparisons at different time points(all P<0.05). Pearson correlation analysis showed that the rehabilitation self-efficacy at time points T1, T2, and T3 was negatively correlated with kinesiophobia at time points T1, T2, and T3(all P<0.01), and there was a synchronous correlation among the variables. The scoring results at the intersection time points of each variable were also correlated(all P<0.01). The cross-lagged model(controlling for gender, age, cause of injury, location of lower extremity fracture, and degree of pain) showed that the model fitting parameters chi-square/degree of freedom(χ²/df)=1.250, root mean square error of approximation(RMSEA)=0.033, comparative fit index(CFI)=0.995, tucker-lewis index(TLI)=0.949, and standardized root mean square residual(SRMR)=0.017; T2 kinesiophobia decreased with the increase of T1 rehabilitation self-efficacy level(β=-0.232, P=0.001), and T3 kinesiophobia decreased with the increase of T2 rehabilitation self-efficacy level(β=-0.249, P<0.001). However, the T2 rehabilitation self-efficacy decreased with the increase of the T1 kinesiophobia level(β=-0.237,P<0.001), and the T3 rehabilitation self-efficacy decreased with the increase of the T2 kinesiophobia level(β=-0.188, P=0.004). Conclusion: The rehabilitation self-efficacy and the level of kinesiophobia in patients with lower extremity traumatic fractures within 6 months after surgery show dynamic changes, and there is a longitudinal interactive predictive relationship between the two. Medical staff should focus on the dynamic change characteristics, combine the interactive prediction relationship to optimize the phased intervention strategies, improve the rehabilitation self-efficacy, reduce the level of kinesiophobia, and achieve a virtuous cycle.

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