护士职业性肌肉骨骼疾病风险预测模型的构建与验证  

Construction and validation of a risk prediction model for work-related musculoskeletal disorders among nurses

作　　者：许娜[1] 杨春玲[1] 董栋[1] 谭丽丽 蒋爱争 秦丽宁 黄静[1] Xu Na;Yang Chunling;Dong Dong;Tan Lili;Jiang Aizheng;Qin Lining;Huang Jing(Operating Room,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院手术室,北京100020

出　　处：《中华现代护理杂志》2022年第14期1876-1883,共8页Chinese Journal of Modern Nursing

基　　金：北京市自然科学基金(7194270)。

摘　　要：目的构建护士群体职业性肌肉骨骼疾病(WMSDs)发生风险的预测模型并验证,以期对护士WMSDs高危人群的筛查提供科学和客观的参考工具。方法本研究为横断面研究。采用便利抽样法,于2021年3—7月选择北京市25所医院的1050名临床护士为研究对象,通过发放肌肉骨骼疾患调查表对WMSDs发生的风险因素进行研究。将所有调查对象按7︰3的比例随机分为训练集(n=715)和验证集(n=304),训练集建立模型;采用受试者工作特征曲线下面积(AUC)评价风险模型的预测能力,并用验证集验证。最终发放调查问卷1050份,回收有效问卷1019份,有效回收率为97.05%。结果1019名护士群体WMSDs的周发生率为84.0%(856/1019),年发生率为86.7%(883/1019);颈部是WMSDs发生率最高的部位,其周发生率与年发生率分别为70.3%(716/1019)和70.1%(714/1019)。多因素Logistic回归分析结果显示,年龄≥40岁(P<0.001)、紧张的工作氛围(P<0.001)、前倾的颈部姿势(P=0.002)、每日从事同样的工作(P=0.039)、需要常与患者打交道(P=0.012)、背部长时间保持同一姿势(P=0.002)是护士群体WMSDs周发生的风险因素;年龄≥40岁(P=0.001)、无安全防护培训(P=0.003)、高学历(P=0.041)、紧张的工作氛围(P=0.005)、大幅前倾的颈部姿势(P=0.008)、需要常与患者打交道(P=0.001)、工作涉及寒冷或气温变化(P=0.017)、休息时间不足(P=0.019)、经常替班(P=0.035)、工作中躯干经常重复同一动作(P=0.025)、手部弯曲(P=0.006)是护士群体WMSDs年发生的影响因素。基于以上筛选变量分别建立预测护士群体WMSDs周发生与年发生风险的列线图模型,结果显示,该模型在训练集中的AUC值分别为0.794(95%CI:0.750~0.838)与0.789(95%CI:0.718~0.860)。验证集进一步证实了列线图模型的预测能力,预测护士群体WMSDs周发生与年发生风险的AUC值分别为0.782(95%CI:0.729~0.835)与0.794(95%CI:0.721~0.868)。结论该列线图模型对护士群体WMObjective To construct and validate a risk prediction model for work-related musculoskeletal disorders(WMSDs)among nurses,so as to provide a scientific and objective reference tool for the screening of high-risk groups of WMSDs among nurses.Methods This study was a cross-sectional study.From March to July 2021,convenience sampling was used to select 1050 nurses from 25 hospitals in Beijing as the research subject.The risk factors for WMSDs were evaluated by issuing the Musculoskeletal Disease Questionnaire.All survey subjects were randomly divided into the training set(n=715)and the validation set(n=304)according to the ratio of 7∶3,and the training set was used to build the model.The predictive ability of the risk model was evaluated using the area under receiver operating characteristic curve(AUC)and the validation set was used for validation.A total of 1050 questionnaires were distributed and 1019 valid questionnaires were recovered,with a valid recovery rate of 97.05%.Results Among 1019 nurses,the weekly incidence of WMSDs was 84.0%(856/1019)and the annual incidence was 86.7%(883/1019).The neck was the site with the highest incidence of WMSDs,the weekly incidence and annual incidence were 70.3%(716/1019)and 70.1%(714/1019),respectively.The results of multivariate Logistic regression analysis showed that the risk factors of the weekly incidence of WMSDs among nurses included age≥40 years old(P<0.001),tense work atmosphere(P<0.001),forward neck posture(P=0.002),doing the same job daily(P=0.039),needing to dealing with patients(P=0.012)and keeping the back in the same posture for a long time(P=0.002),and the risk factors of the annual incidence of WMSDs among nurses included age≥40 years old(P=0.001),did not participation in safety protection training(P=0.003),high education(P=0.041),stressful work atmosphere(P=0.005),significantly forward neck posture(P=0.008),needing to dealing with patients frequently(P=0.001),work involving cold or temperature changes(P=0.017),insufficient rest time(P=0.019),frequent s

关 键 词：护士 职业性肌肉骨骼疾病 风险因素 列线图 预测模型 

分 类 号：R192.6[医药卫生—卫生事业管理]