非特异性慢性腰背痛患者居家运动疗法依从性影响因素的质性研究

关键词：非特异性慢性腰背痛  居家运动疗法  依从性

Keywords:non-specific chronic low back pain  home-based exercise therapy  adherence

摘要：

      摘要 目的：探究非特异性慢性腰背痛患者居家运动疗法依从性的影响因素。 方法：采用质性研究方法，对32例在北京大学第三医院康复医学科门诊就诊、被诊断为“非特异性慢性腰背痛”且由医生开具了居家运动处方的患者进行深入访谈。以扎根理论为指导并借助质性分析软件NVivo进行三级编码，建立理论模型。 结果：开放式编码得到19个初始范畴；主轴式编码将19个初始范畴归纳为健康信念、自我效能、运动处方、自我管理和家庭支持5个主范畴；选择式编码将健康信念和自我效能归类为“内部环境”，将运动处方和家庭支持归类为“外部环境”，在此基础上建立两条理论：①患者的“自我管理”能力是依从行为的内源动机；②“内部环境”和“外部环境”对依从行为起调节作用。 结论：患者的依从行为受自我管理能力的直接影响并在良好的内部环境和外部环境的调节下趋于规范；定期随访、进行健康教育及调整运动处方的结构是提高患者依从性的必要措施。

Abstract:

      Abstract Objective： To explore the influencing factors on the adherence of home-based exercise therapy in patients with non-specific chronic low back pain. Method： Based on qualitative research， 32 patients who were diagnosed as ‘non-specific chronic low back pain’ and prescribed with home-based exercise program in the Department of rehabilitation medicine of Peking University Third Hospital， were deeply interviewed. Under the guidance of grounded theory， the three-level coding was programmed by using qualitative analysis software NVivo， the theoretical model is established by refining the categories. Result： The open coding got 19 initial categories； axial coding classified 19 initial categories into five main categories： health belief， self-efficacy， exercise prescription， self-management and family support； selective coding classified health belief and self-efficacy as ‘internal environment’ and， exercise prescription and family support as ‘external environment’. Based on this discovery， two theories are established： ①Patients' ‘self-management’ ability is the internal motivation of adherence behavior； ②The ‘internal environment’ and ‘external environment’ play a regulatory role in adherence behavior. Conclusion： Patients' adherence behavior is directly affected by the ability of self-management and tends to be standardized under the regulation of good internal and external environment. Regular follow-up，health education and adjusting the structure of exercise prescription are necessary measures to improve the patients' adherence.