Construction And Empirical Study Of Rehabilitation Education Program For Patients With Lumbar Disc Herniation With Sciatica

ObjectiveBased on the health action process approach theory(HAPA),the rehabilitation education program for patients with lumbar disc herniation with sciatica was constructed.The program focused on improving the separation of patients’ knowledge and action,and discussed the impact on patients’ rehabilitation compliance and effect,so as to achieve the goal of optimizing the rehabilitation education mode of such patients and improving the rehabilitation level.Methods1.Construct a rehabilitation education program for patients with lumbar disc herniation with sciatica based on HAPA theoryThe first draft of rehabilitation education program was prepared by means of literature review and panel discussion.The Delphi expert inquiry method was used to consult 18 experts who met the inclusion criteria and improve the first draft.The expert positive coefficient and authority coefficient were used to measure the consultation results to form the final rehabilitation education program for patients with lumbar disc herniation with sciatica.2.Application study of rehabilitation education program for patients with lumbar dis cherniation with sciatica based on HAPA theoryThis study was a clinical controlled trial.The 98 patients with lumbar disc herniation with sciatica,who met the inclusion criteria and exclusion criteria in a third class hospital in Linyi from August 2021 to January 2022,were selected as the study subjects.With the informed consent,the patients were divided into the control group and the intervention group by random number method.The control group was given nursing routine of pain rehabilitation department: including admission education(introduce the relevant rules and regulations and environment of the hospital,etc.);publicity and education on medication and rehabilitation training precautions during hospitalization;publicity and education on home rehabilitation exercise,return visit and follow-up after discharge.The intervention group was given the intervention of rehabilitation education program based on HAPA on the basis of nursing routine of pain rehabilitation department,assessed the patient’s behavioral stage,according to the behavioral stage of the patient to give the corresponding rehabilitation education measures.Using the Japanese Orthopaedic Association low back pain assessment questionnaire(JOA),self-efficacy scale,compliance scale and hospital anxiety and depression scale(HAD)as tools,the indexes of JOA,compliance,anxiety and depression and self-efficacy at admission,discharge and 30 days of intervention were compared.SPSS22.0 was used for data statistics and analysis.Results(1)The effective recovery rate(RR)of the three rounds of expert correspondence in this study was 94.44%,100% and 100%;judgment coefficient(Ca)0.912,0.924 and0.934;familiarity coefficient(Cs)0.953,0.9765 and 0.9765;authority coefficient(Cr)0.9325,0.95025 and 0.95445.The level of expert authority coefficient in the three rounds of expert inquiry was relatively high,which proved that the results of expert inquiry were highly credible.Targeted intervention for patients in the former intention stage,intention stage and action stage with the constructed rehabilitation education program could improve the separation of knowledge and action,improved their functional exercise compliance and self-efficacy,reduced patients’ anxiety and depression,and improved the rehabilitation level of patients.(2)A total of 98 cases were completed in this study,including 48 cases in the intervention group and 50 cases in the control group.There were no statistically significant differences between the two groups in baseline data such as age,gender,BMI,educational level,residence,primary caregivers,medical insurance mode and course of disease(P> 0.05).(3)Clinical index results:(1)At discharge,JOA total score,subjective symptoms,clinical signs and daily life restriction scores of the two groups were statistically significant differences(P <0.05),the intervention group was better than the control group,and the bladder function score was no statistically significant differences(P> 0.05).At 30 days of intervention,JOA total score,subjective symptoms and daily life restriction scores were statistically significant differences(P <0.05),the intervention group was better than the control group,and the clinical signs and bladder function scores were no statistically significant differences(P> 0.05).(2)The two groups of participants repeatedly measured ANOVA for JOA total score,subjective symptoms,clinical signs,daily life restriction scores: between-group factors(F=4.765～168.554,P<0.05),within-group factors(F=361.042～1035.933,P <0.05),interaction(F=15.172～74.62,P <0.05),were statistically significant differences,and the intervention group was better than the control group.(4)Self-efficacy results:(1)At discharge and 30 days of intervention,There were statistically significant differences in the total score of self-efficacy and the scores of each dimension between the two groups(P <0.05),and the intervention group was better than the control group.(2)The two groups of participants repeatedly measured ANOVA for the total score of self-efficacy and the scores of each dimension: between-group factors(F=60.11～160.484,P <0.05),within-group factors(F=1213.007～3171.109,P <0.05),interaction(F = 26.196-55.007,P <0.05),were statistically significant differences,and the intervention group was better than the control group.(5)Anxiety and depression results:(1)At discharge and 30 days of intervention,the anxiety and depression scores were statistically significant differences between the two groups(P <0.05),and the intervention group was lower than the control group.(2)The two groups of participants repeatedly measured ANOVA for anxiety and depression scores:between-group factors(F=79.538,P <0.05),within-group factors(F=335.591,P <0.05),interaction(F=16.615,P <0.05),were statistically significant differences,and the intervention group was lower than the control group.(6)Compliance results:(1)At discharge,There was no statistically significant differences in the scores of functional exercise compliance between the two groups(P>0.05);At 30 days of intervention,There was statistically significant differences in the scores of functional exercise compliance between the two groups(P <0.05),and the intervention group was better than the control group.(2)The two groups of participants repeatedly measured ANOVA for functional exercise compliance scores: between-group factors(F=10.886,P <0.05),within-group factors(F=1047.388,P <0.05),interaction(F=14.606,P <0.05),were statistically significant differences,and the intervention group was better than the control group.ConclusionThe rehabilitation education program for patients with lumbar disc herniation with sciatica could effectively improve the compliance of patients with functional exercise,reduce the level of anxiety and depression,improve self-efficacy,and achieve better rehabilitation effect for patients.