中青年脑卒中患者术后心理社会适应变化轨迹潜在类别及其对康复锻炼依从性的影响OA
Latent Classes of Postoperative Psychosocial Adjustment Trajectories and Their Impact on Rehabilita-tion Exercise Adherence in Young and Middle-Aged Stroke Patients
目的 探讨中青年脑卒中患者术后心理社会适应变化轨迹的潜在类别及其对自主康复行为的影响,旨在识别不同适应轨迹类型的特征,为制定分阶段、个性化的护理干预措施提供理论依据.方法 2021年10月至2024年10月,采用方便抽样方法选取至九江市第一人民医院接受治疗的中青年脑卒中患者242例作为研究对象.采用疾病心理社会适应量表(PAIS-SR)评估患者术后72 h内、术后1个月、术后3个月、术后6个月的心理社会适应水平,通过增长混合模型分析轨迹类别的最优数量并进行命名.采用康复锻炼依从性问卷(EAQ)、疲劳严重程度量表(FSS)、视觉模拟评分法(VAS)、汉密尔顿抑郁量表(HAMD)、脑卒中康复动机量表(SRMS)分别评估患者的康复锻炼依从性、疲劳、疼痛、抑郁及康复动机水平;使用一般资料调查表及医院电子病历系统收集患者的临床资料.通过相关性分析、单因素分析及多元线性回归分析康复锻炼依从性的独立影响因素.结果 242例患者的心理社会适应发展可分为3个潜在类别:韧性适应型(86例,35.54%)、波动缓降型(116例,47.93%)、适应不良型(40例,16.53%).多元线性回归分析结果显示,文化程度、术后心理社会适应轨迹类别、FSS评分、HAMD评分及SRMS评分是患者康复锻炼依从性的独立影响因素(均P<0.05).结论 中青年脑卒中患者术后心理社会适应轨迹呈现明显的分类特征.文化程度、术后心理社会适应轨迹类别、FSS评分、HAMD评分及SRMS评分构成康复锻炼依从性的预测框架,提示临床需针对不同适应轨迹人群制定分层干预策略,以提升康复效能.
Objective To explore the latent classes of postoperative psychosocial adjustment trajectories and their impact on autonomous rehabilitation behaviors in young and middle-aged stroke patients,aiming to iden-tify characteristics of different trajectory classes and provide theoretical evidence for developing staged,per-sonalized nursing interventions.Methods From October 2021 to October 2024,242 young and middle-aged stroke patients treated at Jiujiang No.1 People's Hospital were selected by convenience sampling.They were assessed for psychosocial adjustment levels using the Psychosocial Adjustment to Illness Scale-Self-Report(PAIS-SR)within 72 h postoperatively and at 1 month,3 months and 6 months postoperatively.A growth mix-ture model was applied to identify the optimal number of trajectory classes and name the classes.They were al-so assessed for rehabilitation exercise adherence,fatigue,pain,depression and rehabilitation motivation us-ing the Exercise Adherence Questionnaire(EAQ),Fatigue Severity Scale(FSS),Visual Analogue Scale(VAS),Hamilton Rating Scale for Depression(HAMD)and Stroke Rehabilitation Motivation Scale(SRMS).Their clinical data were collected using the General Information Questionnaire and the hospital's elec-tronic medical record system.Correlation analysis,univariate analysis and multivariate linear regression were conducted to analyze the independent factors influ-encing rehabilitation exercise adherence.Results Psychosocial adjustment trajectories of the 242 patients were categorized into three latent classes:resilient adjustment type(86 subjects,35.54%),fluctuating gradu-al decline(116 subjects,47.93%),and maladjustment(40 subjects,16.53%).Multivariate linear regression analysis showed that education level,postoperative psychosocial adjustment trajectory class,FSS score,HAMD score and SRMS score were independent factors influencing patients'rehabilitation exercise adherence(P<0.05 for all).Conclusion The postoperative psychosocial adjustment trajectories of young and middle-aged stroke patients exhibit distinct characteristics across classes.Educational level,postoperative psychoso-cial adjustment trajectory class,FSS score,HAMD score and SRMS score constitute a predictive framework for rehabilitation exercise adherence.This indicates that stratified interventions targeting individuals with dif-ferent adjustment trajectories are needed in clinical practice to enhance rehabilitation efficacy.
张依;程芳;苏婉茜;洪佳莹
九江市第一人民医院,江西 九江 332000九江市第一人民医院,江西 九江 332000九江市第一人民医院,江西 九江 332000九江市第一人民医院,江西 九江 332000
医药卫生
中青年脑卒中心理社会适应康复锻炼依从性轨迹影响因素
Young and middle-agedStrokePsychosocial adjustmentRehabilitation exercise adherenceTrajectoryInfluencing factor
《上海护理》 2026 (6)
46-52,7
江西省卫生健康委科技计划项目(202211793).
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