基于每日目标管理路径的全膝关节置换术患者运动干预方案的构建及初步验证OA
Formulation and initial validation of a daily goal-management-based exercise intervention for total knee arthro-plasty patients
目的 构建基于每日目标管理路径的全膝关节置换术患者运动干预方案,并初步验证其临床可行性和有效性. 方法 依据每日目标管理路径和希望理论,通过文献分析、质性访谈及专家咨询法构建干预方案.2025年9月至11月选取北京博爱医院骨科护士和患者,开展方案可行性评价.采取对照预试验,两组各纳入15例患者.对照组行常规康复护理,试验组实施该干预方案.比较两组美国特种外科医院膝关节评分(HSS)、膝关节活动度(ROM)、功能锻炼依从性评分、视觉模拟评分(VAS)和西安大略及麦克马斯特大学骨关节炎指数(WOMAC)评分. 结果 构建的干预方案围绕入院至术后3周康复周期,涵盖3个主题,包含7种训练方式(早期下床活动、助行器行走、肌力、拉伸、关节活动度、步态和日常活动能力训练)及32条具体建议.可行性结果显示,患者招募率100%,留存率93.75%,方案可接受性得分率为96.94%.21名骨科护士对方案4个维度评分均≥4.5分.干预后,试验组HSS和ROM均显著升高(|t|>6.205,P<0.001),WOMAC和VAS均明显降低(t=9.127,Z=-3.415,P<0.01);对照组VAS明显降低(Z=-3.122,P=0.002),ROM下降(t=-2.622,P=0.015),其余指标无明显改善(P>0.05);试验组所有指标均明显优于对照组(|t|>7.949,|Z|>2.990,P<0.01).试验组功能锻炼依从性优于对照组(t=-8.565,P<0.001). 结论 构建的基于每日目标管理路径的运动干预方案科学、可行,且预试验验证初步有效,能为全膝关节置换术患者在住院期间早期运动训练提供结构化、人性化护理.
Objective To develop an exercise intervention program for patients undergoing total knee arthroplasty based on the daily goal management pathway,and preliminarily verify its clinical feasibility and effectiveness. Methods The intervention program was formulated based on the daily goal management pathway and hope theory,com-bined with literature analysis,qualitative interviews and expert consultation.Feasibility evaluation was conduct-ed among orthopedic nurses and patients in Beijing Bo'ai Hospital from September to November,2025.A con-trolled pilot study was performed with 15 patients in each group:the control group received routine rehabilitation care,while the experimental group received the developed intervention program.The Hospital for Special Sur-gery Knee Score(HSS),range of motion(ROM)of knee,functional exercise compliance score,Visual Analogue Scale(VAS)and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)were compared be-tween two groups. Results The program covered three themes from admission to three weeks postoperatively,including seven training methods and 32 specific recommendations.Feasibility results showed 100%patient recruitment rate,93.75%re-tention rate and 96.94%program acceptance rate.A total of 21 orthopedic nurses scored≥4.5 on all four dimen-sions of the program.After intervention,HSS score and knee ROM significantly increased(|t|>6.205,P<0.001),while WOMAC and VAS score decreased(t=9.127,Z=-3.415,P<0.01)in the experimental group;in the control group,VAS score decreased(Z=-3.122,P=0.002),and knee ROM reduced(t=-2.622,P=0.015),with no significant improvement in other indicators(P>0.05);all the indexes were better in the experimental group than in the control group(|t|>7.949,|Z|>2.990,P<0.01),including the functional exercise compliance(t=-8.565,P<0.001). Conclusion The exercise intervention program based on the daily goal management pathway is scientific,feasible and preliminarily effective,which can provide a new structured and humanized nursing for early exercise training of patients during hospitalization for total knee arthroplasty.
田靖晓;艾佳茗;闵红巍;赵克聪;张宝翠;姜虹;杨威;刘均娥
首都医科大学护理学院,北京市 100069||中国康复研究中心北京博爱医院骨科,北京市 100068首都医科大学护理学院,北京市 100069中国康复研究中心北京博爱医院骨科,北京市 100068中国康复研究中心北京博爱医院骨科,北京市 100068中国康复研究中心北京博爱医院骨科,北京市 100068中国康复研究中心北京博爱医院骨科,北京市 100068中国康复研究中心北京博爱医院骨科,北京市 100068首都医科大学护理学院,北京市 100069
医药卫生
全膝关节置换运动康复每日目标管理路径护理
total knee arthroplastytrainingrehabilitationdaily goal management pathwaynursing
《中国康复理论与实践》 2026 (8)
959-967,9
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