| Objective:(1)To investigate the general status,fatigue,medication compliance,anxiety and depression,disease activity and quality of life of patients with systemic lupus erythematosus(SLE).(2)To constructe the structural equation of quality of life based on the Wilson-Cleary health-related quality of life model in patients with systemic lupus erythematosus,and analyze the pathways of influencing factors of quality of life in patients with systemic lupus erythematosus.(3)Based on the establishment of structural equation model,health education and intervention of the Thought of Preventive Treatment of disease are carried out for SLE patients’ quality of life and its influencing factors,so as to prevent and prevent the decline of patients’ quality of life in advance,so as to achieve the purpose of preventing disease before disease and preventing disease after disease change in SLE patients’ quality of life.Subsequently,the effects of both on SLE quality of life and their applicability in clinical practice were comprehensively discussed.It provides some reference for the application of structural equation model and the Thought of Preventive Treatment of disease in nursing clinical practice in the future.Methods:(1)Cross-sectional investigation.A total of 216 SLE patients admitted to the Department of Rheumatology and Immunology of a third-class A hospital in Yunnan Province from December 2021 to March 2022 were selected by convenience sampling method.The survey was conducted using the General Situation Questionnaire,the Chinese version of the Chronic Disease Function Evaluation-Fatigue Scale,the Morisky Medication Compliance Scale,the hospital Anxiety and Depression Scale,the SF-12 Health Status Survey Brief Form,and the SLEDAI-2000 Disease Activity Score for Systemic Lupus erythematosus.Based on Wilson-Cleary health-related quality of life model,the structural equation of SLE patients’ quality of life was constructed.(2)Controlled intervention study.According to the inclusion and exclusion criteria,116 inpatients with SLE admitted to the rheumatology and immunology department of a Grade-III hospital in Yunnan Province from March to September 2022 were selected for non-concurrent control study.58 patients in the control group were given routine care,on the basis of routine nursing,58 patients in the intervention group focused on the influencing factors of quality of life of SLE patients shown in the structural equation model,and implemented nursing and health education on the Thought of Preventive Treatment of disease of traditional Chinese medicine for patients in the intervention group,and selected the influencing factors related to the quality of life of SLE patients in the structural equation model as the outcome index.In the actual study,6 cases fell off,4 cases in the control group and 2 cases in the intervention group,among which 2 cases had serious disease changes and 4 cases voluntarily withdrew from the study.In the end,110 cases were completed,55 cases in each group.The duration of intervention was one month.After the intervention,statistical analysis was conducted using SPSS software to compare the SLEDAI-2000 score,medication compliance score,fatigue score,anxiety depression and quality of life of the two groups of patients.Results:(1)A total of 216 questionnaires were sent out in the research investigation stage,and 207 were effectively received,with effective recovery of 95.8%.Univariate analysis showed that except age,there was no statistical difference in the quality of life of SLE patients under different demographic characteristics(P > 0.05).In terms of disease characteristics,there were statistical differences in quality of life scores among SLE patients with different disease course,self-care ability score,joint swelling and pain,and alopecia(P < 0.05).Except for elevated ESR,there was no statistical difference in the quality of life scores of SLE patients under different laboratory examination indicators(P > 0.05).(2)In the results of normality test,the scores of fatigue,anxiety,depression and quality of life were normally distributed,among which,the score of fatigue was(39.44±7.62),the score of anxiety was(5.43±3.64),the score of depression was(3.95±3.35),and the score of quality of life was(56.66 ± 19.33).SLEDAI-2000 score and medication compliance score were non-normal distribution M(P25,P75),7.00 and 7.75,respectively.(3)Correlation analysis showed that there was a low positive correlation between disease duration and age(r=0.284,P < 0.01).There was a low positive correlation between complications and course of disease(r=0.315,P < 0.01).Self-care ability had a low positive correlation with family monthly income(r=0.193,P < 0.01).Depression and anxiety were moderately positively correlated(r=0.683,P < 0.01).Fatigue was negatively correlated with anxiety and depression(r=-0.424,-0.333,P < 0.01).SLADAI-2000 score was negatively correlated with age and fatigue(r=-0.201,-0.231,P < 0.01),and positively correlated with complications(r=0.351,P < 0.01).Medication compliance was positively correlated with age(r=0.205,P < 0.01)and negatively correlated with SLEDAI-2000 score(r=-0.225,P < 0.01).Quality of life scores were negatively correlated with disease duration,anxiety,depression and SLEDAI-2000 scores(r=-0.019,-0.481,-0.448,-0.183,P < 0.01).It was positively correlated with self-care ability score and fatigue(r=0.229,0.711,P <0.01).(4)The results of structural equation model showed that age had a direct negative effect on quality of life(β=-0.154,P < 0.05),but medication compliance,SLEDAI-2000 and fatigue as remote mediating variables had an indirect positive effect on quality of life(β=0.066,P < 0.05).Fatigue positively predicted the quality of life(β=1.496,P < 0.05).Depression had a direct negative predictive effect on quality of life(β=-1.058,P < 0.05).SLEDAI-2000 had no direct effect on quality of life,but fatigue had indirect negative effect on quality of life(β=-0.505,P < 0.05).Anxiety had no direct effect on quality of life,but fatigue and depression as mediating variables had indirect negative effect on quality of life(β=-1.102、-0.651,P < 0.05).Medication compliance had no direct predictive effect on quality of life,but SLEDAI-2000 score and fatigue as remote mediating variables had indirect positive predictive effect on quality of life(β=1.554,P < 0.05).Disease course had no direct effect on quality of life,but medication compliance,SLEDAI-2000 score and fatigue as remote mediating variables had indirect negative effect on quality of life(β=-0.096,P< 0.05).(5)The total number of patients who completed the intervention study was 110,with 55 patients in each group.The T-test results of two independent samples showed that there was no significant difference in baseline data between the two groups(P> 0.05),which was comparable.(6)Before intervention,the data of the two groups were normally distributed,and there was no statistical significance between the two groups(P>0.05),indicating that the data were comparable.After intervention,the outcome index scores of the two groups were normally distributed,and the variance of disease activity and anxiety and depression scores was not uniform.After the intervention,the disease activity level and anxiety and depression scores decreased in both groups,but the intervention group decreased more than the control group,and the difference was statistically significant(P< 0.05).After intervention,the scores of fatigue scale,medication compliance scale and quality of life scale were increased in both groups,and the increase degree in the intervention group was greater than that in the control group,the difference was statistically significant(P < 0.05).Conclusions: In the first part of this study,the structural equation of influencing factors of SLE patients’ quality of life was established based on the Wilson-Cleary health-related quality of life model.According to the results of the study,individual factors,such as age,disease course,hair loss,self-care score,joint swelling and pain,and elevated ESR,will have a certain impact on the quality of life of SLE patients.The biophysical variable,SLEDAI-2000 score,was the primary improvement indicator for improving the quality of life of SLE patients.Good control of symptom state variables is an important indicator to improve the overall quality of life,among which fatigue and depression are the most important indicators for improving the quality of life of SLE patients,and anxiety is the second important indicator.Although medication compliance is a functional state variable,it can be seen from structural equation results that improvement of medication compliance is a prerequisite for alleviating disease activity,alleviating fatigue symptoms and improving quality of life in SLE patients.In the second part of the study,traditional Chinese medicine health education the Thought of Preventive Treatment of disease was carried out for SLE patients,and according to the results of the structural equation of the factors influencing the quality of life in the early stage of the study,patients’ medication compliance,anxiety,depression and fatigue state were taken as the intervention focus for health education.The results showed that the health education intervention program guided by the Thought of Preventive Treatment of disease of traditional Chinese medicine and focusing on the elements shown in the structural equation model had better effects on the improvement of the quality of life,anxiety and depression,fatigue and medication compliance of SLE patients than the clinical routine nursing,and had a significant effect on improving the quality of life of SLE patients. |
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