运动恐惧与功能锻炼依从性对腰椎间盘突出症保守治疗患者复发风险的预测价值  

The predictive value of kinesiophobia and functional exercise adherence on recurrence risk in patients with lumbar disc herniation undergoing conservative treatment

作　　者：黄雪燕 王宝玉[1] 王睿[1] 徐星星[1] 冯莺[1] Huang Xueyan;Wang Baoyu;Wang Rui;Xu Xingxing;Feng Ying(Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou Zhejiang 310007,China)

机构地区：[1]杭州市中医院,浙江杭州310007

出　　处：《护理与康复》2025年第4期8-14,共7页Journal of Nursing and Rehabilitation

基　　金：浙江省医药卫生科技计划项目,编号2021KY919;杭州市医学重点学科建设项目,编号2020SJZDXK07。

摘　　要：目的探讨腰椎间盘突出症患者经保守治疗1年后的复发情况和影响因素及运动恐惧与功能锻炼依从性对复发的预测价值。方法选取2020年1月至2021年12月杭州市中医院推拿科收治的240例腰椎间盘突出症保守治疗患者为研究对象,收集患者的一般资料、运动恐惧和功能锻炼依从性,并根据随访1年内复发情况,将患者分为复发组和非复发组,对影响因素进行多因素logistic回归分析,并绘制受试者工作特征曲线分析多因素联合预测以及运动恐惧、功能锻炼依从性单独预测的效能,并对联合预测模型进行校准度和临床决策曲线的验证。结果240例患者随访过程中22例失访,最终纳入复发组46例、未复发组172例,复发率为21.10%。两组患者在年龄、职业性质、BMI、疼痛评分、糖尿病病史、吸烟史、运动恐惧和功能锻炼依从性之间的差异均有统计学意义(P<0.05);运动恐惧与复发呈正相关(r=0.220,P=0.001),功能锻炼依从性与复发呈负相关(r=-0.352,P<0.001);多因素logistic回归分析显示,年龄(>47岁)、职业性质(负重)、BMI(≥24 kg/m^(2))、疼痛评分(>1分)、运动恐惧(>37分)和功能锻炼依从性(≤63分)是复发的独立危险因素(P<0.05);受试者工作特征曲线分析结果显示,多因素联合预测、运动恐惧和功能锻炼依从性单独预测复发的曲线下面积分别为0.944、0.765和0.769。联合预测模型的敏感度为0.935,特异度为0.986,预测模型具有良好的校准度(P=0.484),净获益率为18%~92%,临床净获益水平较高。结论腰椎间盘突出症保守治疗患者复发率较高,运动恐惧和功能锻炼依从性可单独预测复发率,而与年龄、职业性质、BMI、疼痛评分联合预测复发的效能更高,可为临床早期识别复发风险和针对性干预提供参考。Objective To investigate the recurrence rate and influencing factors in patients with lumbar disc herniation(LDH)after one year conservative treatment and to evaluate the predictive value of kinesiophobia and functional exercise adherence on recurrence.Methods A total of 240 patients with LDH undergoing conservative treatment in the Department of Tuina at Hangzhou Hospital of Traditional Chinese Medicine were enrolled from January 2020 to December 2021.General information,Tampa Scale of Kinesiophobia-17,and functional exercise adherence were collected.Based on recurrence within one year of follow-up,patients were divided into recurrence and non-recurrence groups.Multivariate logistic regression analysis was performed to identify influencing factors.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive performance of combined factors,kinesiophobia alone,and functional exercise adherence alone.The combined prediction model was validated by calibration and clinical decision curve analysis.Results Among the 240 patients,22 were lost to follow-up,leaving 46 patients in the recurrence group and 172 patients in the non-recurrence group,with a recurrence rate of 21.10%.Significant differences were observed between the two groups in age,occupation,BMI,Visual Analogue Scale(VAS),diabetes comorbidity,smoking history,kinesiophobia,and functional exercise adherence(P<0.05).Kinesiophobia was positively correlated with recurrence(r=0.220,P=0.001),while functional exercise adherence was negatively correlated(r=-0.352,P<0.001).Multivariate logistic regression analysis identified age(>47 years),occupation(manual labor),BMI(≥24 kg/m 2),VAS(>1 point),kinesiophobia(>37 points),functional exercise adherence(≤63 points),and as independent risk factors for recurrence(P<0.05).ROC curve analysis showed that the areas under the curve(AUC)for combined prediction,kinesiophobia alone,and functional exercise adherence alone were 0.944,0.765,and 0.769,respectively.The combined prediction model had a sensitivity

关 键 词：腰椎间盘突出症 运动恐惧 功能锻炼 复发 预测价值 

分 类 号：R473.6[医药卫生—护理学]