衰弱与抑郁在老年慢性腰背痛患者功能障碍与疼痛灾难化间的链式中介作用  

Chain mediating effect of frailty and depression between dysfunction and pain catastrophizing in older patients with chronic low back pain

作　　者：刘菲[1] 罗海萍 黄渝婷 朱晓萍[1] LIU Fei;LUO Haiping;HUANG Yuting;ZHU Xiaoping(Department of Nursing,Tenth People's Hospital Affiliated to Tongji University,Shanghai,200072,China)

机构地区：[1]同济大学附属第十人民医院护理部,上海市200072

出　　处：《中国护理管理》2024年第11期1635-1640,共6页Chinese Nursing Management

基　　金：国家自然科学基金青年项目(72304210);上海申康医院发展中心第二轮《促进市级医院临床技能与临床创新三年行动计划》研究型医师创新转化能力培训项目(SHDC2023CRS024);上海市护理学会2022年优秀青年人才育苗项目。

摘　　要：目的:分析衰弱、抑郁在老年慢性腰背痛患者功能障碍与疼痛灾难化之间的链式中介作用,以期为老年慢性腰背痛患者疼痛干预管理提供建议与指引。方法:采用横断面研究方法,便利抽取2023年2月—11月上海市某三级甲等医院收治的253例老年慢性腰背痛患者为研究对象。采用一般资料调查问卷、功能障碍指数量表、FRAIL衰弱量表、患者健康问卷抑郁量表、疼痛灾难化量表对患者进行调查。采用Process 3.3宏程序分析衰弱和抑郁在患者功能障碍与疼痛灾难化之间的链式中介作用,并采用Amos 28.0软件构建结构方程模型。结果:Pearson相关分析结果显示,功能障碍指数、衰弱、抑郁、疼痛灾难化得分两两呈正相关(r=0.496~0.741,P<0.01)。功能障碍指数可正向影响衰弱(β=0.496,P<0.001);功能障碍指数和衰弱可正向影响抑郁(β=0.508、0.355,P<0.001),功能障碍指数、衰弱和抑郁可正向影响疼痛灾难化(β=0.355、0.244、0.351,P<0.001)。患者功能障碍指数对疼痛灾难化的直接效应为0.330,占总效应的49.1%;衰弱和抑郁在患者功能障碍与疼痛灾难化间的总间接效应为0.342,占总效应的50.9%。衰弱在功能障碍与疼痛灾难化之间的间接效应、抑郁在功能障碍与疼痛灾难化之间的间接效应、衰弱和抑郁在功能障碍与疼痛灾难化之间的间接效应分别为0.114、0.169、0.059。结论:老年慢性腰背痛患者的功能障碍不仅可直接影响疼痛灾难化,还可以通过衰弱、抑郁的中介作用,以及衰弱和抑郁的链式中介作用间接影响疼痛灾难化。Objective:To explore the chain mediating effect of frailty and depression between dysfunction and pain catastrophizing in older patients with chronic low back pain.Methods:The study used a cross-sectional study design.A total of 253 older patients with chronic low back pain were recruited by convenience sampling in tertiary grade A hospital in Shanghai from February 2023 to November 2023.Patients were investigated by the Oswestry Disability Index,the FRAIL Frailty Scale,the Patient Health Questionnaire-9,and the Pain Catastrophizing Scale.The Process3.3 macro program was used to analyze the chain mediating effect of frailty and depression between patient dysfunction and pain catastrophizing.The Amos 28.0 was used to construct a structural equation model.Results:Disability index,frailty,depression and pain catastrophizing scores were positively correlated(r was from 0.496 to 0.741,P<0.01).Disability index had a positive effect on frailty(β=0.496,P<0.001).Disability index and frailty had a positive impact on depression(β=0.508 and 0.355,P<0.001).Disability index,frailty and depression had positive effects on pain catastrophizing(β=0.355,0.244 and 0.351,P<0.001).The direct effect of disability index on pain catastrophizing was 0.330,accounting for 49.1%of the total effects.The total indirect effect of frailty and depression between disability and pain catastrophizing was 0.342,accounting for 50.9%of the total effects.The indirect effects of the frailty between dysfunction and pain catastrophizing,the depression between dysfunction and pain catastrophizing,and the frailty and depression between dysfunction and pain catastrophizing were 0.114,0.169,and 0.059,respectively.Conclusion:The dysfunction of older patients with chronic low back pain can not only directly affect pain catastrophizing,but also indirectly affect pain catastrophizing through the mediating effect of frailty,depression,and the chain mediating effect of frailty and depression.

关 键 词：衰弱 抑郁 慢性疼痛 疼痛灾难化 中介作用 老年 慢性腰背痛 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]