Application Of Acceptance And Commitment Therapy In Middle-aged Diabetic Patients With Overactive Bladder

ObjectivesTo understand the current situation and influencing factors of disease perception in middleaged patients with overactive bladder disease(OAB),to analyze the relationship between disease perception,stigma and quality of life.To develop an intervention program based on acceptance and commitment therapy(ACT),and to explore the effect of its application in middle-aged diabetic patients with OAB,in order to reduce the level of disease perception and stigma and improve the quality of life.Methods1.Cross-sectional survey.A total of 220 middle-aged diabetic OAB patients who met the inclusion and exclusion criteria in a Grade 3A hospital in Jiangsu Province from October 2020 to November 2021 were selected as subjects.General information questionnaire,simplified disease perception questionnaire(B-IPQ),bladder overactivity symptom scale(OABSS),chronic disease shame scale(SSCI),bladder overactivity and health-related quality of life(OAB-q SF)were used to investigate.To understand the status quo of disease perception,stigma and quality of life in middle-aged diabetic patients with OAB,and to analyze the influencing factors of disease perception and its correlation with stigma and quality of life.2.Intervention research.A total of 76 middle-aged diabetic patients with OAB who met the met the inclusion and ranking criteria in a tertiary hospital in Jiangsu Province were randomly selected and randomly divided into experimental group and control group.The control group received usual treatment and care,and the experimental group applied an intervention based on acceptance and commitment therapy in addition to the control group.Disease perception,stigma and quality of life were assessed in both groups before and after the intervention.Results1.A total of 214 diabetic patients with OAB were included in the cross-sectional survey.The results showed that the total score of disease perception level of middle-aged diabetic patients with OAB was(50.46±5.76);The stigma score was(68.80±4.53),the internal stigma score of each dimension was(42.18±3.82),and the external stigma score was(26.62±2.66);The score of the disease distress subscale was(39.97±6.31)and the score of the HRQOL subscale was(72.16±6.03).2.Analysis of influencing factors: the education level of patients,Payment method of medical expenses,the per capita monthly income of family,the type of occupation,the course of diabetes,the number of diabetic complications and the severity of OAB symptoms were the influencing factors of disease perception in middle-aged diabetic patients with OAB(P<0.05).3.Correlation analysis: Disease perception was positively correlated with stigma(r=0.81,P<0.05)and symptom distress(r=0.96,P<0.01)in middle-aged diabetic patients with OAB,while negatively correlated with HRQOL(r=-0.98,P<0.01).4.Intervention study results: after 8 weeks of intervention in 76 middle-aged diabetic patients with OAB,75 subjects participated in the complete intervention program,while one subject in the control group withdrew from the study for personal reasons.There was no significant difference in the baseline scores of general data,disease perception,stigma and quality of life between the two groups(P>0.05).(1)Comparison of disease perception before and after intervention: the total score of disease perception and the scores of emotion,cognition and comprehension ability dimension after intervention in the experimental group were significantly lower than those before intervention(P<0.05).There was no significant difference in the total score of disease perception and the scores of emotion,cognitive dimension and understanding ability dimension between the control group before and after intervention(P>0.05).After intervention,the total score of disease perception and the scores of emotion,cognition and comprehension ability dimension in the experimental group were lower than those in the control group(P>0.05).(2)Comparison of stigma before and after intervention: the total score of stigma,the scores of internal stigma and external stigma in the experimental group after intervention were significantly lower than those before intervention(P<0.05).There was no significant difference in the total score of shame and the two dimensions of internal shame and external shame in the control group before and after intervention(P>0.05).After intervention,the total score of stigma,the scores of internal stigma and external stigma in the experimental group were lower than those in the control group(P<0.05).(3)Comparison of quality of life before and after intervention: After intervention,the scores of disease disturbance subscale in the experimental group was significantly lower than that before intervention,and the difference was statistically significant(P<0.05).The scores of HRQOL and coping,sleep and social / emotional scores in the experimental group were higher than those before intervention,and the difference was statistically significant(P<0.05).After intervention,the score of disease disturbance subscale in the control group was higher than that before intervention,and there was no significant difference(P>0.05).The total score of HRQOL subscale and the dimensions of coping and sleep in the control group were significantly higher than those before intervention,and the difference was statistically significant(P<0.05),and he score of social / emotional dimension was lower than that before intervention,and the difference was not statistically significant(P>0.05).After intervention,the score of disease disturbance subscale in the experimental group was lower than that in the control group(P<0.05),and the scores of HRQOL subscale and all dimensions in the experimental group were higher than those in the control group(P<0.05).Conclusions1.The disease perception and stigma of middle-aged diabetic patients with OAB are in the middle-high level,and the quality of life is relatively low.The influencing factors include:patient’s education level,medica insurance type,family per capita monthly income,occupation type,diabetes course,the number of diabetic complications and the severity of OAB symptoms.The higher the disease perception,the higher the sense of shame and the lower the quality of life in middle-aged diabetic patients with OAB.2.The intervention program based on acceptance and commitment therapy can reduce the disease perception and stigma of middle-aged diabetic patients with OAB,and improve the quality of life.