摘要
目的探讨老年膝骨关节炎(KOA)患者康复训练依从性的影响因素,并构建预测模型。方法选取2023年2月—2025年2月首都医科大学附属北京朝阳医院骨科收治的行关节镜手术的237例老年KOA患者为研究对象。根据术后3个月患者康复训练依从性分为低依从性组(n=96)和高依从性组(n=141)。比较2组患者一般资料及西安大略和麦克马斯特大学骨关节炎指数量表(WOMAC)、运动恐惧症量表(TSK-17)、家庭关怀度指数问卷(APGAR)评分。使用多因素logistic回归分析探讨老年KOA患者康复训练依从性低的独立影响因素,并绘制列线图构建老年KOA患者康复训练依从性低的预测模型。结果2组患者在居住方式、家庭人均月收入、医疗保险类型、Kellgren-Lawrence分级、发病位置、WOMAC评分、屈曲角度、伸直受限角度、TSK-17评分、APGAR评分方面比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,独居(OR:67.318,95%CI:1.859~2437.699)、医疗自费(OR:34.541,95%CI:1.295~921.494)、WOMAC评分高(OR:1.768,95%CI:1.388~2.252)、伸直受限角度大(OR:2.311,95%CI:1.247~4.283)、TSK-17评分高(OR:1.204,95%CI:1.067~1.360)是老年KOA患者康复训练依从性低的独立危险因素(P<0.05)。以7项独立影响因素构建列线图预测模型并进行验证,模型受试者工作特征(ROC)曲线的曲线下面积(AUC)为0.952(95%CI:0.916~0.975),敏感度为93.75%,特异度为82.98%,提示区分度良好。校准曲线显示预测模型校准度良好。绘制决策曲线(DCA)显示预测模型具有较高的临床应用价值。结论居住方式、医疗保险类型、WOMAC评分、屈曲角度、伸直受限角度、TSK-17评分、APGAR评分是影响老年KOA患者康复训练依从性的相关风险变量。本研究构建的风险预测模型能够较为准确地识别老年KOA患者康复训练依从性低的发生风险,具有临床应用价值。
Objective To explore the factors influencing rehabilitation training compliance in elderly patients with knee osteoarthritis(KOA)and construct a prediction model.Methods A total of 237 elderly KOA patients who underwent arthroscopic surgery at the Department of Orthopedics,Beijing Chao-Yang Hospital,Capital Medical University,from February 2023 to February 2025 were selected for the study.Based on rehabilitation training compliance 3 months after surgery,the patients were assigned to a low compliance group(n=96)and a high compliance group(n=141).General data and scores from the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Tampa Scale of Kinesiophobia-17(TSK-17),and the Family Adaptation,Partnership,Growth,Affection,and Resolve Index Scale(APGAR)were compared between the two groups.Multivariate logistic regression analysis was used to identify independent factors associated with low rehabilitation training compliance in elderly KOA patients,and a nomogram was drawn to construct a prediction model for low rehabilitation training compliance in elderly KOA patients.Results There were statistically significant differences between the two groups in living arrangements,monthly household income per capita,type of medical insurance,Kellgren-Lawrence grading,disease location,WOMAC score,flexion angle,extension limitation angle,TSK-17 score,and APGAR score(P<0.05).Multivariate logistic regression analysis showed that living alone(OR:67.318,95%CI:1.859-2437.699),self-paid medical expenses(OR:34.541,95%CI:1.295-921.494),high WOMAC score(OR:1.768,95%CI:1.388-2.252),large extension limitation angle(OR:2.311,95%CI:1.247-4.283),and high TSK-17 score(OR:1.204,95%CI:1.067-1.360)were independent risk factors for low rehabilitation training compliance in elderly KOA patients(P<0.05).A nomogram prediction model was constructed based on seven independent factors and validated.The area under the receiver operating characteristic curve(AUC)of the model was 0.952(95%CI:0.916-0.975),with a sensitivity of 93.75%and specificity of 82.98%,indicating good discriminatory ability.The calibration curve showed good calibration of the prediction model.The decision curve analysis(DCA)suggested that the prediction model has high clinical application value.Conclusion Living arrangement,type of medical insurance,WOMAC score,flexion angle,extension limitation angle,TSK-17 score,and APGAR score are relevant risk factors influencing rehabilitation training compliance in elderly KOA patients.The risk prediction model developed in this study can accurately identify the risk of low rehabilitation training compliance in elderly KOA patients and has clinical application value.
作者
张巧红
许倩
李晶
许丽平
藏磊
洪钢
张乐
钱雅楠
Zhang Qiaohong;Xu Qian;Li Jing;Xu Liping;Zang Lei;Hong Gang;Zhang Le;Qian Yanan(Department of Orthopedics,Beijing Chao-Yang Hospital(Shijingshan Branch),Capital Medical University,Beijing 100043,China)
出处
《保健医学研究与实践》
2025年第9期109-116,共8页
Health Medicine Research and Practice
基金
北京市自然科学基金面上项目(7242059)。
关键词
老年
膝骨关节炎
康复训练依从性
影响因素
预测模型
Elderly
Knee osteoarthritis
Rehabilitation training compliance
Influencing factors
Prediction model
