腰椎间盘突出症患者切除术后恐动症发生的相关因素分析及预测模型构建OA

Objective To explore the related factors of kinesiophobia in patients with lumbar disc herniation(LDH)after re-section,and to construct and verify a risk prediction model based on them.Methods The relevant data of 120 patients who underwent lumbar disc herniation resection in Jiangxi Jiayou Shuguang Hospital from February 2021 to October 2023 were retrospectively analyzed.According to the ratio of 7∶3,they were divided into the modeling set(n=84)and the validation set(n=36).The postoperative LDH patients with kinesiophobia during hospitalization and rehabilitation were divided into kine-siophobia group and non-kinesiophobia group.Univariate analysis and multivariate logistic regression analysis were used to screen the independent influencing factors of kinesiophobia in patients with LDH after resection,and a risk prediction model was constructed based on the above factors.The consistency of the model was evaluated by calibration chart.The ROC curve was used to evaluate the predictive value of the risk prediction model.The Hosmer-Lemeshow test was used to judge the goodness of fit of the model.Results Among 84 LDH patients in the modeling set,27 patients(32.14％)developed kinesio-phobia during in-hospital rehabilitation after resection and were included in the kinesiophobia group.The remaining 57 patients were included in the non-kinesiophobia group.U-nivariate analysis showed that there were statistically significant differences in age,postoperative pain(numerical rating scale[NRS]score),postoperative self-efficacy(general self-efficacy scale[GSES]score),intraoperative blood loss and lumbar disc degeneration between the two groups(P＜0.05).Multivariate logistic regression analysis showed that age(β=0.417,OR=1.517,95％CI:1.146-2.010),degree of postoperative pain(β=1.019,OR=2.772,95％CI:1.282-5.994),postop-erative self-efficacy(β=-0.233,OR=0.792,95％CI:0.674-0.931),degree of lumbar disc degeneration(β=1.656,OR=5.237,95％CI:1.012-27.113)were independent influencing factors of postoperative kinesiophobia in LDH patients(P＜0.05),and the risk prediction model was constructed based on the above four independent influencing factors.The AUC of ROC curve in the modeling set was 0.952,the sensitivity and specificity were 0.852 and 0.930,respectively.The calibration curve was close to the standard curve,and the mean absolute error(MAE)was 0.030,indicating that the model had good consis-tency.Hosmer-Lemeshow test results showed x2=4.645,P=0.795.In the validation set,there were 12 cases with kinesio-phobia and 24 cases without kinesiophobia.The AUC of external validation was 0.957,the sensitivity and specificity were 0.960 and 0.808,respectively.Conclusion Age,postoperative pain,postoperative self-efficacy,and the degree of lumbar disc degeneration are all independent influencing factors of postoperative kinesiophobia in LDH patients,and the risk prediction model constructed based on this has good clinical predictive value.