确定影响神经性关节障碍手术患者走路的可修改因素:一项前性纵向研究
Suzanne McIlroy1,2, Lindsay Bearne3, John Weinman4
1Physiotherapy Department, King's College Hospital, London, UK. Suzanne.mcilroy@nhs.net.
Scientific reports
|February 10, 2025
概括
经过腰椎脊柱狭窄手术的老年人经常没有改善手术后的行走状况. 手术前的行走能力和手术后的跌倒和运动恐惧显著影响行走结果,这表明有针对性的康复是至关重要的.
科学领域:
- 整形外科和康复科学 整形外科和康复科学
- 老年医学 老年医学
- 行为医学是一种行为医学.
背景情况:
- 来自腰椎脊柱狭窄的神经性硬化是老年人中常见的手术指示.
- 手术的目的是改善疼痛和行走,但许多患者在手术后无法获得显著的行走效果.
- 确定可修改的因素对于优化康复策略至关重要.
研究的目的:
- 为了确定可修改的物理和心理社会因素影响手术后行走在老年人接受手术的神经性听.
- 探索手术前因素与步行结果之间的关联.
- 为了研究与手术后12周步行改善相关的因素.
主要方法:
- 对97名50岁以上的成年人进行前性纵向研究,这些成年人正在等待腰椎缩手术.
- 评估了手术前和手术后12周的步行测量 (六分钟的步行测试,每天的步骤,自我评估的距离).
- 利用混合效应回归模型来分析可修改的变量 (例如,跌倒,下肢表现,运动恐惧,疾病感知) 映射到COM-B模型.
主要成果:
- 所有步行测量都显示出统计学上显著的改善 (p < .001),但50%的患者没有达到临床上重要的最小差异.
- 术前行走能力是术后行走能力的最强相关性.
- 手术前,下肢表现,跌倒史,跌倒恐惧,运动恐惧,状况连贯性和感知控制与行走有关.
- 手术后 (6周),恐惧跌倒,恐惧移动和情绪反应与12周的步行改善较少有关.
结论:
- 虽然手术可以改善神经性听症的行走,但许多患者经历的收益有限.
- 手术前的诸如下肢表现和心理社会方面等因素会影响行走.
- 手术后的跌倒恐惧,运动恐惧和情绪反应会对走路的改善产生负面影响.
- 建议进行预康复和术后康复,以步行,平衡和心理社会因素为目标,以优化结果.
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