Research On The Status Of Kinesiophobia And Its Relationship With Resilience And Family Care In Elderly Patients Undergoing Total Knee Arthroplasty

【Objiective】To investigate the current situation of postoperative kinesiophobia in elderly patients undergoing total knee arthroplasty,to understand the level of kinesiophobia and its influencing factors,to analyze the correlation between psychological resilience,family care and kinesiophobia,to explore the mechanism of psychological resilience and family care on kinesiophobia in elderly patients undergoing total knee arthroplasty,and to further analyze the intermediary of psychological resilience between family care and kinesiophobia effect.In order to provide a theoretical basis for the clinical development and implementation of the intervention measures to effectively reduce the incidence of postoperative kinesiophobia in the elderly patients undergoing total knee arthroplasty.【Methods】According to the inclusion and exclusion criteria of this study,203elderly patients who received total knee arthroplasty from March 2019 to August 2019 in the orthopaedic ward of two general Grade-A hospitals were selected for questionnaire survey.The questionnaire includes general situation questionnaire,facial expression rating scale,kinesiophobia Tampa scale,family care index questionnaire and 10 items of Psychological Resilience Scale.Spss21.0 and amos23.0 statistical software were used to analyze the data,and descriptive statistical analysis was used for demographic data and variable scores;independent sample t-test or one-way ANOVA was used for the influence of demographic factors on kinesiophobia;Pearson correlation analysis was used for the correlation between the three variables;multiple linear analysis was used for the influence of psychological resilience and family care on kinesiophobia Stepwise regression analysis;the mediating effect of psychological resilience between kinesiophobia and family care was verified by structural equation model.P<0.05 means there is statistical significance.【Results】1.The average score of postoperative kinesiophobia in elderly TKA patients was(39.81±5.74),and 67.98%of them had kinesiophobia(TSK>37),with an average score of(42.54±4.50).The influence of general data on kinesiophobia showed that education level,marital status,main caregivers and the number of chronic diseases had statistical significance on the total score of kinesiophobia in elderly TKA patients(P<0.05).2.The average score of the elderly patients with TKA was(23.04±6.16).The influence of general data on psychological resilience showed that gender,education level,marital status,family per capita monthly income,whether to use analgesics for a long time had statistical significance(P<0.05).3.The average score of family care in elderly patients with TKA was(6.42±2.12).The influence of general data on family care showed that education level,current working condition,main caregivers,BMI index and the number of chronic diseases had statistical significance(P<0.05).4.The total score of kinesiophobia was negatively correlated with the total score of psychological resilience(r=-0.456,P<0.01),the total score of kinesiophobia was negatively correlated with the total score of family care(r=-0.469,P<0.01),and the total score of family care was positively correlated with the total score of psychological resilience(r=0.589,P<0.01).Multiple linear stepwise regression analysis showed that the total scores of psychological resilience and family care were the influencing factors of postoperative kinesiophobia in elderly TKA patients(P<0.01).5.Using structural equation model to analyze the mediating effect of psychological resilience,the fitting indexes of structural equation model in this study are:?~2(CMIN)=22.117,CMIN/DF=1.701,GFI=0.972,AGFI=0.939,RMSEA=0.059.Bootstrap gives a 95%confidence interval of(-0.253,-0.040)for indirect effects and(-0.648,-0.213)for direct effects.Family care indirectly affects kinesiophobia with the psychological resilience of elderly TKA patients as the mediating variable.The standardized path coefficient is0.67×(-0.19)=-0.13.The total effect of family care on kinesiophobia is(-0.41)+(-0.13)=-0.54.The mediating effect of psychological resilience accounts for 24.1%of the total effect.【Conclusion】1.In this study,the incidence of postoperative kinesiophobia in elderly patients with TKA is high,which needs to be paid more attention.The level of family care and psychological resilience is at a low level,and they are deficient in varying degrees.And there are differences in patients with different demographic characteristics and disease characteristics.2.In this study,psychological resilience,family care,education level,marital status,main caregivers and types of chronic diseases are all the factors influencing the level of kinesiophobia in elderly TKA patients.3.In this study,there was a correlation between kinesiophobia,resilience and family care in elderly patients with TKA.Psychological resilience and family care were negatively correlated with kinesiophobia,while psychological resilience was positively correlated with family care.4.In this study,the psychological resilience of middle-aged and old TKA patients played a part of intermediary role between family care and kinesiophobia.Family care not only directly affects the level of kinesiophobia in elderly TKA patients,but also indirectly affects the level of kinesiophobia through psychological resilience.