| ObjectiveTo take the patients with coronary heart disease after stent implantation as the research object,the cognitive behavior intervention scheme is established according to their kinesiophobia;The differences between cognitive behavior intervention and routine nursing intervention in kinesiophobia,knowledge mastery,anxiety and depression and self-management behavior;This paper comprehensively expounds the application value of cognitive behavioral intervention in rehabilitation exercise after coronary heart disease stent implantation,and provides evidence-based basis for further developing and perfecting the intervention methods of kinesiophobia of patients after coronary heart disease stent implantation.MethodsThis topic includes two aspects:1.The construction of cognitive behavioral intervention program of kinesiophobia for patients with coronary heart disease after stent implantation.Refer to relevant theory and literature,formed after coronary stent implantation in patients with cognitive behavioral intervention plan draft movement fear,selected 12 experts through panel meeting,eight patients through an experiment,the revised of the intervention program,movement formed after coronary stent implantation patients fear cognitive behavior intervention plan implementation.2.Evaluation of the effect of cognitive behavioral intervention on kinesiophobia in patients with coronary heart disease after stent implantation.According to the inclusion criteria of this study,80 patients with exercise phobia scale(The Tampa Scale for Kinesiophobia Heart,TSK-SV Heart)score ≥ 37 were selected from the cardiology ward of a third-class hospital in Henan Province from September 2020 to February 2021.After signing the informed consent form,the cardiology ward was randomly divided into the control group and the intervention group,and the control group received routine intervention.The main contents include:establishing electronic files after admission,explaining the relevant knowledge of the disease before operation,routine postural guidance,monitoring patients’ vital signs,clinical symptoms,diet and behavior guidance after operation.health education was carried out before discharge and telephone follow-up was carried out once a month.The intervention group increased cognitive behavior intervention on the basis of routine intervention.Wechat group intervention,individual intervention or telephone follow-up were used once a week on the first day after operation,the second day after operation,the day of discharge and 1 to 4 weeks after discharge.Cognitive behavior intervention mainly includes relationship building and trust acquisition,cognitive reconstruction and arousing patients’ self-management responsibility,behavior change and so on.After the vital signs of all patients were stable on the day after operation,the TSK-SV Heart scale was used to evaluate whether the patients had fear of exercise.If the score was ≥ 37,combined with the medical records and asking for their general data,the coronary heart disease knowledge questionnaire((Perceived Knowledge Scale for CHD,PKS-CHD),self-rating anxiety scale(Self-Rating Anxiety Scale,SAS)and self-rating depression scale(Self-rating depression scale)were used.SDS)and coronary stent implantation self-management scale(self-management scale for coronary artery stent implantation,SMS-CASI)were used to evaluate the effect of exercise fear on knowledge mastery,anxiety,depression and self-management behavior,and the above indexes were measured repeatedly on the same day,1 month and 3 months after operation.Statistical analysis:Demographic sociology and clinical characteristics mainly carried out descriptive statistical analysis in this study.Kolmogorov-Smirnov method was used to test the normal distribution of numerical variables,which accorded with the normal distribution,M(P25,P75)was used to express the non-conformance,and frequency(constituent ratio)was used to represent the discrete variables.By using the method of repeated measurement analysis of variance,the main effects and interaction effects of intervention factors and test time factors were analyzed,and the changes of scale scores of the two groups with test time were compared.ResultsConstruction of cognitive behavioral intervention program for kinesiophobia in patients with coronary heart disease after stenting.Through literature research,constructing the library about 2020 movement after coronary stent implantation patients fear cognitive behavioral intervention in both Chinese and English literature retrieval,from "the title,author,year,the purpose of the study,sample size,main outcome indicators,intervention,intervention cycle method,the results of the study,the research conclusion" to sum up,A total of 7articles that finally met the inclusion criteria were used as the basis of the program.A preliminary draft of the kinesiophobia intervention program for patients with coronary heart disease after stent implantation was constructed.The intervention program was revised through the expert group meeting and pre-experiment.Finally,the implementation draft of kinesiophobia intervention plan for patients with coronary heart disease after stent implantation was formed.Evaluation of the effect of cognitive behavioral intervention on kinesiophobia in patients with coronary heart disease after stent implantation.A total of 80 patients with TSK-SVHeart ≥ 37 after stent implantation were included,including 40 patients in the intervention group with an average age of(60.28 ± 10.12)years,26.3% in primary school and illiteracy,20.0% in junior middle school,27.5% in technical secondary school and senior high school,26.3% in university and above,and 20% in coronary heart disease.Those with 1-3 years accounted for 32.5%,those with more than 3 years accounted for 47.5%,those with family history of coronary heart disease accounted for 28.8%,and those with other underlying diseases accounted for 53.8%.The general demographic data and indicators of the subjects in the intervention group were compared before intervention,and the difference was not statistically significant.Kinesiophobia: Repeated measure ANOVA showed that over time,the total TSK-SV Heart score of patients in the two groups decreased gradually(F=314.58,P<0.05),and the total TSK-SV Heart score of patients in the intervention group was significantly lower than that in the control group(F=86.22,P<0.05).There was a significant interaction between the grouping intervention factors and the time factors that affected the total TSK-SV Heart score(F=93.75,P<0.05).In addition: the total TSK-SV Heart score of patients in both groups decreased gradually over time.Except on the day after surgery,the total TSK-SV Heart scores of patients in the intervention group were significantly lower than those in the control group at different test times,and the differences were statistically significant after analysis(P< 0.05).Knowledge mastery: the analysis of variance of repeated measurements showed that the scores of knowledge mastery in the two groups gradually increased with the passage of time on the day after operation,1 month and 3 months after operation(F=212.88,P<0.05),and significantly higher than those in the control group(F=9.00,P<0.05).There was a significant interaction between the intervention factors and time factors affecting the score of knowledge mastery(F=20.95,P<0.05).In addition,with the passage of time,the score of knowledge mastery in the intervention group increased gradually,but there was no significant difference in the score of knowledge mastery in the control group at 1 month and 3 months after operation(t=1.67,P=0.10).The score of knowledge mastery of patients in the intervention group increased gradually with the passage of time,but there was no significant difference between the patients in the control group at 1 month and 3 months after operation.Except on the day after operation,the scores of knowledge mastery in the intervention group were significantly higher than those in the control group(P<0.05).Anxiety and depression: after repeated measurement and analysis of variance,the SAS scores of the two groups decreased continuously on the day after operation,1month and 3 months after operation,and the anxiety score of the intervention group was significantly lower than that of the control group(F=18.50,P<0.05).There was significant interaction between intervention factors and time factors affecting anxiety score(F=9.06,P<0.05).In addition,with the passage of time,the anxiety score of patients in the intervention group decreased gradually,while that of patients in the control group had no significant change.Except for the day after operation,the anxiety scores of patients in the intervention group were significantly lower than those in the control group.With the passage of time,the depression score of the included patients decreased gradually(F=11.36,P<0.05),but there was no significant difference between the two groups(F=0.77,P=0.40).There was significant interaction between intervention factors and time factors affecting depression score(F=7.25,P<0.05).In addition,with the passage of time,the depression scores of patients in the intervention group and the control group had no significant change.There was no significant difference in depression scores between the two groups under different test time.Self-management behavior: the analysis of variance of repeated measurements showed that the total score of self-management behavior of the two groups increased gradually with the passage of time on the postoperative day,1 month and 3 months after operation(F=328.26,P<0.05).The total score of self-management behavior in the intervention group was significantly higher than that in the control group(F=143.49,P<0.05).There was a significant interaction between the intervention factors and time factors affecting the total score of self-management behavior(F=40.36,P<0.05).In addition,with the passage of time,the total score of self-management behavior in the two groups increased gradually,except on the day after operation,the total score of self-management behavior in the intervention group was significantly higher than that in the control group.Incidence of adverse events: The total incidence of adverse events in the intervention group was 15% after statistics from 1 day after operation to 3 months after discharge.After 1 month and 3 months after operation,it can be found that the intervention group has a relatively lower incidence of adverse events.ConclusionsCognitive behavior intervention can reduce kinesiophobia,anxiety and depression and improve knowledge mastery in patients with coronary heart disease after stent implantation.Cognitive behavior intervention can improve the self-management ability of patients with coronary heart disease after stent implantation.The incidence of adverse events had been significantly reduced,which benefit to improve the quality of life. |
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