中国全科医学2017，Vol.20Issue(35)：4397-4403,4411,8.DOI:10.3969/j.issn.1007-9572.2017.00.066
自我效能和恐惧-回避信念与应对方式对慢性腰背痛患者生命质量的影响路径研究
Mediated Routes for the Effects of Self-efficacy,Fear-avoidance Belief and Coping Styles on the Quality of Life among Patients with Chronic Low Back Pain
摘要
Abstract
Objective To explore the mediated routes of the effects of self-efficacy,fear-avoidance belief,coping styles on the quality of life (QOL)in community patients with chronic low back pain (CLBP). Methods This cross-sectional study was carried out from March to September 2016. By convenience sampling,from 11 communities in Nanjing and Changzhou, we enrolled 250 participants with CLBP and surveyed them by the Self-efficacy for Managing Chronic Disease 6-item Scale (SEM-CD),Chinese version of Fear-avoidance Beliefs Questionnaire (FABQ-CHI),Simplified Coping Style Questionnaire (SCSQ),and 36-item Short Form Health Survey (SF-36)for assessing the self-efficacy,fear-avoidance belief,coping style and QOL,respectively. Pearson correlation,multiple stepwise linear regression,and structural equation model were adopted for statistical analysis to explore the mechanism of mediated path of self-efficacy,fear-avoidance belief and coping styles on the QOL in the participants with CLBP. Results The survey achieved a response rate of 88. 4% (221 / 250). The average scores of PCS and MCS of SF-36 were (53. 96 ± 19. 93)and (60. 83 ± 22. 70),respectively. All the scores of the eight dimensions of the SF-36 of the CLBP patients were lower than those of the norm (P < 0. 01),indicating that CLBP patients were suffering poor QOL. Pearson correlation analysis showed that the total scores of SEM-CD for patients with CLBP were negatively related with those of FABQ-CHI,while they were positively related with the scores of active coping dimension of SCSQ and all the eight dimensions of SF-36 (P < 0. 05);the total scores of FABQ-CHI were positively related with the scores of negative coping dimension of SCSQ,whereas they were negatively related with the scores of all the eight dimensions of SF-36 (P < 0. 05). The scores of active coping dimension of SCSQ were positively related with the scores of PF,VT and MH dimensions of SF-36 (P <0. 05),while the scores of negative coping dimension of SCSQ were negatively related with the scores of PF,GH,SF and MH dimensions of SF-36 (P < 0. 05). Multiple linear regression analyses indicated that the scores of SEM-CD,FABQ-CHI,active coping and negative coping of SCSQ could be the predictors for the scores of PCS of SF-36;the scores of SEM-CD,FABQ-CHI, negative coping of SCSQ could predict the MCS scores of SF-36 (P < 0. 05). The analysis of structural equation model showed that self-efficacy played an direct and positive role in predicting QOL in patients with CLBP (b = 0. 35),and it also played an indirect and positive role in predicting QOL (b = 0. 19)through active coping styles (b = 0. 31);fear-avoidance belief played an direct and negative role in predicting QOL (b =-0. 33),and it also played an indirect and negative role in predicting QOL (b =-0. 32)through negative coping styles (b = 0. 32). Conclusion Self-efficacy and fear-avoidance belief may directly or indirectly influence the QOL of patients with CLBP through positive coping and negative coping,respectively. Health education strategies should be adopted by medical staff to improve CLBP patients′ self-efficacy,reduce pain fear-avoidance belief,and modify coping styles,so that patients′ QOL can be enhanced.关键词
背痛/生活质量/自我效能/恐惧-回避信念/应对方式/影响因素分析/结构方程模型Key words
Back pain/Quality of life/Self-efficacy/Fear-avoidance belief/Coping styles/Root cause analysis/Structural equation modeling分类
医药卫生引用本文复制引用
杜世正,胡玲莉,柏亚妹,董建树,金胜姬,张姮..自我效能和恐惧-回避信念与应对方式对慢性腰背痛患者生命质量的影响路径研究[J].中国全科医学,2017,20(35):4397-4403,4411,8.基金项目
教育部人文社会科学研究青年基金(14YJCZH024) （14YJCZH024）
江苏省高校"青蓝工程"(2016~2019年度)资助项目 （2016~2019年度）
江苏省优势学科二期项目南京中医药大学护理学一级学科指令性课题(YSHL2016-032) （YSHL2016-032）
