| BackgroundLumbar interbody fusion has become an important therapeutic method for lumbar degenerative disease (LDD). There are more and more LDD patients who have had this procedure internationally. Lumbar interbody fusion can provide the LDD patients with biomechanical stable lumber intervertebral segments. The treatment with interbody cage can prevent such complications as migration and collapses due to displacement of the bone graft. As a result, the patients are more likely to have early rehabilitation training and early off bed exercises after operation and reduce the long term sickbed related complications. Compared with the rapid spread and development of posterior lumbar interbody fusion, the postoperative rehabilitation nursing care is legging behind. Usually the process of fusion requires a relatively long period. All these factors raise special requirement on post- lumbar-interbody-fusion-surgery nursing. There are about 20 to 30 per cent patients who still exhibit lower back pain (LBP) after the surgery. Post surgery malfunction also affects their daily activity. Besides such causes as disease and surgery themselves, one important cause is the lack of reasonable rehabilitation nursing after operation. Enduring chronicle pain is usually accompanied with some negative emotions like depression, anxiety, etc.Early rehabilitation exercise is especially important after lumbar interbody fusion surgery, which can prevent nerve sticky and make back and abdominal muscle strong. In mainland China, most hospitals do not have any specialized rehabilitation or physiotherapy staff and early rehabilitation nursing is always inadequate in both depth and breath, and the surgery and rehabilitation are not integrated to provide a comprehensive care. Lumbar interbody fusion patients usually have a low ratio of return visit after operation due to their inconvenience of activity. However, the community health centers cannot provide the required rehabilitation instructions, so postoperation early rehabilitation nursing is especially important after lumbar interbody fusion surgery.In some foreign countries, the hospitals pay great attention to the LDD patients'postoperation rehabilitation, their postoperation exercise is very comprehensive and detailed. However a search of domestic literature shows in recovery nursing study, there is a composite lack of rehabilitation philosophy, rehabilitation technique and educational tools. Most papers on early rehabilitation nursing are empirical conclusion. No report was found to be controlled study for the integrated nursing intervention of LDD patients.This paper is based on the ideology of psychological-physiological comprehensive recovery and tries to study the rehabilitation nursing of patients who have undergone lumbar interbody fusion with a nonrandom controlled manner. We have designed a continuous integrated nursing intervention program in and out of the hospital. Within the program, we have designed a detailed rehabilitation training program with focus on rehabilitation exercise and psychological intervention. To guide the LDD patient's postoperation recovery, we have composed self-made DV and handbooks with illustrative graphs, and have arranged rehabilitation exercise for the patients.We also arranged audio and visual interventions, individual instruction at bedside and telephone visits. The result shows that early rehabilitation can facilitate patients' post surgery recovery, improve their life quality, promote employment and also provide the theoretical evidence to reduce the economic loss. It also gives the related department professional reference to design integrated in-hospital and in-community physiological-psychological recovery programs. Objective To evaluate the impact of early rehabilitation nursing intervention on lumbar degenerative disease (LDD) patients undergoing lumbar interbody fusion surgery.Methods 72 LDD patients undergoing operation of lumbar interbody fusion meeting the inclusion criterion were divided into intervention group (n=32) and control group (n=40). Patients in control group received routine care. The patients in intervention group received early rehabilitation nursing intervention. They were provided with audiovisual DV and Handbook for LDD rehabilitation, pre-operative education with PPT, individual instruction, pre-operative adaptive exercise and post-operative early active exercise, psychologic intervention, they also received telephone consultation and outpatients visiting for three months. Their physical functioning and pain were assessed with Oswestry disability index (ODI) and visual analogue scale (VAS) respectively. Activities of daily living were assessed with Barthel Index. Their psychological condition was assessed with self-rating depression scale (SDS). Both groups were assessed upon admission,10 days after operation, 1 month after operation and 3 months after operation.Results①There were no significant differences between the intervention group and the control group in age, gender, educational background, economic status, diagnosis, segment, duration of disease, and complication (P >0.05).②The difference of the total score of ODI score was significant between the intervention group and the control group (P<0.001). The intervention group was much lower than the control group. The results indicated that the intervention group had better physical function than the control group. Through the comparison of different dimensions of ODI score, there were statistical significances between the intervention group and the control group in score of self-care, walk, sit, stand, sleep and social activity (P<0.05). There was no significant interactive effect on total score and each score of the above dimensions between groups or different sampling instants (P<0.05).③The Barthel Index score were significantly higher in the intervention group than the control group (P <0.001). The results indicated that the intervention group has better activities of daily living than the control group. There was significant interactive effect on Barthel Index score between groups or different sampling instants (P<0.001).④Both VAS score of leg pain and VAS score of lumbar pain score were significantly less in the intervention group than the control group, which indicated the intervention group has better improvement in pain intensity. There was no significant interactive effect on VAS scores between groups or different sampling instants (P >0.05).⑤SDS score was significantly lower in the intervention group than the control group (P<0.05).ConclusionThis study shows that early rehabilitation nursing intervention could acquire better improvements in disability score, activities of daily living, pain intensity, and psychological state than the traditional nursing intervention. Therefore early rehabilitation nursing intervention is an effective approach in improving the physiology and psychology of LDD patients undergoing lumbar interbody fusion surgery. |
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