基于随机森林算法的腰椎间盘突出症保守治疗慢性疼痛患者恐动症影响因素分析  

Analysis of factors influencing kinesiophobia in patients with conservative treatment of chronic pain caused by lumbar disc herniation based on random forest algorithm

作　　者：许燕昕 黄丽珊[2] 陈静 王琳 任璇 霍佳雯 李瑞 罗翱翔 Xu Yanxin;Huang Lishan;Chen Jing;Wang Lin;Ren Xuan;Huo Jiawen;Li Rui;Luo Aoxiang(School of Nursing,Guangdong Pharmaceutical University,Guangzhou 510006,China;Department of Spinal Orthopedics,Guangdong Second Provincial General Hospital,Guangzhou 510317,China)

机构地区：[1]广东药科大学护理学院,广州510006 [2]广东省第二人民医院脊柱骨科,广州510317

出　　处：《中国实用护理杂志》2025年第7期506-514,共9页Chinese Journal of Practical Nursing

基　　金：广东省联合培养研究生示范基地(粤教研函[2024]1号-57);广东省继续教育质量提升工程建设类项目(JXJYGC2022GX164);广东省省级一流本科课程(粤教高函[2022]10号-190);广东省课程思政建设改革示范项目(粤教高函[2021]4号-154)。

摘　　要：目的探讨腰椎间盘突出症(LDH)保守治疗慢性疼痛患者恐动症现状及其影响因素,为降低该类患者恐动症的发生提供参考依据。方法采用横断面研究方法,于2023年5月至2024年1月便利抽样选取广东省第二人民医院LDH保守治疗慢性疼痛患者作为研究对象,采用一般资料调查表、数字评定量表、恐动症评估简表、疼痛患者心理灵活性量表、慢性疼痛自我效能感量表进行调查。构建随机森林模型并进行变量重要性排序,通过二元Logistic回归分析恐动症的影响因素。结果共发放问卷279份,有效回收问卷270份,有效回收率为96.8%(270/279)。270例LDH保守治疗慢性疼痛患者男139例,女131例,年龄18~40岁92例,41~60岁132例,>60岁46例,恐动症总分为(31.00±5.09)分,发生率为79.6%(215/270)。随机森林算法筛选的8个影响因素为疼痛自我效能感、心理灵活性、腰痛后体育锻炼情况、疼痛年限、疼痛状态、对LDH的了解程度、婚姻状况、疼痛程度。二元Logistic回归分析显示,腰痛后体育锻炼情况(OR=0.583,95%CI 0.344~0.986)、疼痛状态(OR=0.424,95%CI 0.206~0.873)、心理灵活性(OR=1.102,95%CI 1.052~1.155)、疼痛自我效能感(OR=0.923,95%CI 0.895~0.953)是LDH保守治疗慢性疼痛患者恐动症的影响因素(均P<0.05)。结论LDH保守治疗慢性疼痛患者恐动症发生率较高,腰痛后体育锻炼情况、疼痛状态、心理灵活性、疼痛自我效能感是LDH保守治疗慢性疼痛患者恐动症的影响因素。医护人员应加强对LDH保守治疗慢性疼痛患者恐动症的关注,有针对性地进行早期干预,以降低恐动症的发生率。Objective To investigate the prevalence and influencing factors of kinesiophobia in chronic pain patients undergoing conservative treatment for lumbar disc herniation(LDH),providing reference and basis for reducing the occurrence of kinesiophobia in this patient population.MethodsA cross-sectional study was conducted from May 2023 to January 2024.A convenience sample of chronic pain patients undergoing conservative treatment for LDH in Guangdong Second Provincial General Hospital was selected as the study population.Data were collected by the general information questionnaire,Numerical Rating Scale,Tampa Scale of Kinesiophobia-11,Psychological Inflexibility in Pain Scale,and Chronic Pain Self-efficacy Scale.A random forest model was constructed to rank variable importance,and binary Logistic regression was used to analyze the influencing factors of kinesiophobia.ResultsThe effective response rate of the questionnaire was 96.8%(270/279).Among 270 patients,there were 139 males and 131 females,92 patients aged 18-40 years,132 patients aged 41-60 years,and 46 patients aged>60 years old.The total kinesiophobia score for chronic pain patients undergoing conservative treatment for LDH was(31.00±5.09)points,with a kinesiophobia prevalence of 79.6%(215/270).The random forest algorithm identified eight influencing factors:pain self-efficacy,psychological flexibility,physical exercise after low back pain onset,duration of pain,pain status,understanding of LDH,marital status,and pain intensity.Binary Logistic regression analysis showed that physical exercise after low back pain onset(OR=0.583,95%CI 0.344-0.986),pain status(OR=0.424,95%CI 0.206-0.873),psychological flexibility(OR=1.102,95%CI 1.052-1.155),pain self-efficacy(OR=0.923,95%CI 0.895-0.953)were significant influencing factors of kinesiophobia in chronic pain patients undergoing conservative treatment for LDH(all P<0.05).ConclusionsThe prevalence of kinesiophobia is high among chronic pain patients undergoing conservative treatment for LDH.Physical exercise after lo

关 键 词：恐动症 慢性疼痛 保守治疗 随机森林 腰椎间盘突出症 影响因素 

分 类 号：R473.6[医药卫生—护理学]