Application Of Case Management Scheme Based On Transtheoretical Model In Vocal Cord Polyp Patient Voice Training

Objective:To explore the effects of case management intervention based on cross-theoretical model on voice training compliance,voice function recovery,quality of life and self-efficacy of patients with vocal cord polyps.Methods:By reviewing the literature at home and abroad,systematically reviewing the case management model and cross-theoretical studies,and combining with the characteristics of vocal cord polyp disease,forming the first draft of case management intervention plan based on cross-theoretical model.The first draft of the scheme was modified through expert meetings and preliminary tests to ensure that the contents of the case management were comprehensive and reasonable,and finally the intervention scheme was formed.A total of 78 patients diagnosed with “vocal cord polyp” and meeting surgical treatment standards in the otolaryngology department of a Grade-III hospital in Shanxi Province from April 2022 to September 2022 were selected as subjects by convenience sampling method.In order to avoid mutual infection and influence between the two groups of patients,patients were randomly grouped according to the ward,and the first ward of otolaryngology was finally determined as the intervention group(40 cases)and the second ward of otolaryngology as the control group(38 cases)by coin toss method.The control group was given routine nursing and perioperative voice training,while the intervention group was given case management intervention based on transtheoretical model in the process of perioperative voice training,and the intervention time was 3months.At the follow-up before intervention,1 month after surgery and 3 months after surgery,the differences of voice training behavior change stage,voice objective acoustic parameters,VHI scale score and other related indicators were collected and analyzed between the two groups to evaluate the effect of intervention.SPSS 26.0 was used for statistical analysis.For quantitative data conforming to normal distribution,t test of two independent samples was used,Chi-square test was used for qualitative data,rank sum test was used for rank data,and generalized estimation equation or repeated measure analysis of variance was used to evaluate the change trend of each clinical outcome index at different time points.P<0.05 was considered statistically significant.Results:1.Comparison of general data: Baseline data such as age,gender,education level,marital status and course of disease were compared between the two groups,showing no statistical significance(P>0.05).2.Comparison of voice training behavior change stage between the two groups: the behavior change stage of the intervention group was significantly better than that of the control group at 1 month and 3 months after surgery,and the difference was statistically significant(P<0.05).Generalized estimating equation analysis showed that the intergroup effect,time main effect and interaction were statistically significant(P<0.05).At 1 month and 3 months after operation,the number of behavior change stage progression in the intervention group was significantly more than that in the control group,and the difference was statistically significant(P<0.05).3.Comparison of objective acoustic parameters of voice between the two groups:jitter and MPT scores in the intervention group were significantly better than those in the control group at 1 month and 3 months after operation,and the differences were statistically significant(P<0.05).There was no significant difference in shimmer and DSI scores between the two groups at 1 month after surgery(P>0.05),but the scores of the intervention group were significantly better than those of the control group at 3 months after surgery(P<0.05).Repeated measurement analysis of variance showed that the main effect of time was statistically significant(P<0.05),the effect between the two groups of jitter and MPT values was statistically significant(P<0.05),and only the interaction effect of jitter value was statistically significant(P<0.05).4.There was no significant difference in VHI-T,VHI-P,VHI-F and VHI-E scores between the two groups at 1 month after operation(P>0.05),but the intervention group was significantly better than the control group at 3 months after operation,and the difference was statistically significant(P<0.05).Repeated measurement ANOVA showed that the main effect of time was statistically significant(P<0.05),the effect of VHI-T,VHI-P and VHI-E values between the two groups was statistically significant(P<0.05),and the interaction was not statistically significant(P>0.05).5.The self-efficacy scores of the two groups were compared: at 1 month and 3months after surgery,the self-efficacy scores of the intervention group were significantly higher than those of the control group,and the difference was statistically significant(P<0.05).Repeated measures analysis of variance showed that the intergroup effect,time main effect and interaction were statistically significant(P<0.01).6.Comparison of the results of dynamic laryngoscopy between the two groups:there was no significant difference between the two groups at 1 month after surgery(P>0.05),but the recovery of vocal cords in the intervention group was significantly better than that in the control group at 3 months after surgery,and the difference was statistically significant(P<0.01).Conclusion:1.Cross-theoretical case management can effectively improve the voice training compliance of patients with vocal polyps,improve the objective acoustic parameters of the voice,and promote the recovery of vocal cord function.2.Cross-theoretical case management can improve the quality of life and self-efficacy of patients with vocal cord polyps.