Research On Nursing Intervention For Patients With CLBP To Improve Self-management Ability

Because of long rehabilitation period patients with chronic low back pain (CLBP)，inaddition to long-term pain, the patients are associated with various psycho-physicalproblems such as dysfunction, anxiety, fear and over-reliance on medical treatment,moreover, being short of proper understanding of chronic pain itself and rehabilitation,which lead to tardy jobs and low quality of life. It has been defined as a kind of disease bythe International Association for the Study of Pain（IASP）, not a kind of acute paincontinuation. At present, the rehabilitation management of patients with chronic low backpain is limited to physical therapy and drug therapy, only achieving temporary pain relief,which has been proved to have no obvious effect for long-term pain scale relief andphysiological-psychological-social function improvement. Recurrence or aggravation ofpain symptoms appears in most of the patients after acute treatment for the lack of self-management consolidating clinical curative effect, which make the physical and spiritualdiscomfort caused by pain more complex. According to Low Back Pain Self-ManagementHandbook, the patient needs to undertake self-nursing (management) responsibility, reducedependence on health care providers。Studies have shown that self-management cansignificantly reduce the pain and dysfunction, enhance self-efficacy, improve the patient’shealth status and reduce medical costs. Recent years, researches were mainly focused onhealth education, cognitive-behavioral intervention and different exercise methods.However, the self-management for CLBP can be summarized as follows:①self-management consciousness is lacking②management mode is the single mode, effectimproved incompletely③many relaxation training and systematic exercise of painmanagement need the guidance of a doctor, not fit for the patients self-operation④self-management behavior need continuous nursing intervention, to improve the long-termcompliance, the recent research is limited to follow-up observation. Based on the research literature analysis, to improve the patient self-management consciousness and ability,selecting effective nursing intervention methods such as construction of pain managementskills, cognitive education and yoga exercise, and designing exercise prescription,movement, and intervention method and time in accordance with analysis of and applyingyoga in the patients. Directed by nurses, to improve self-management awareness, skills andbehavior compliance for patients. And many randomized controlled trial tests are adoptedto test the application effects.First part Construction of Nursing Intervention Project for Patients with CLBPto Improve Self-Management Ability1. Method(1) Relevant documents about management and nursing intervention CLBP arestudied, systematical evaluation method is found and effective and suitable self-management style for research population is built.(2) With the domestic and international research and application status of each method,the suitable content of nursing intervention for research population is formulated, and thescheme and framework are constructed.(3) Sub schemes are established respectively, including cognitive-behavioral interv-ention scheme and exercise intervention scheme.2. Results(1) Effctive and scientic nursing ways of patients with CLBP are attained fromresearchs,include cognitive-exercise combined intervention projects are selected, such aseducation, training and promoting compliance behavior intervention.(2) The cognitive intervetion includes education, skill instruction and yoga training.compliance behavior intervention includes group communication, target detection, familymembers’ participation, telephone support and records management.(3) Two yoga sketch are designed for patients with prolapsed lumbar intervertebral discand chronic lumbar muscle strain，according to the characteristics of two kinds of diseasesand the difference in the cognitive education and yoga training content, a multidisciplinaryteam, including rehabilitation doctor, physiotherapist, nurse, psychotherapist and senioryogis, is built to support instruction. The design of the yoga exercise is carried on in manyaspects such as exercise content, sequence, time and safety management, to meet the demand of patients self-management.(4)5series continuous nursing interventions are established in12weeks, such as3training and2compliance intervention,to promote self-management efficiency andbehavior.3. ConclusionThe determination of intervention methods and contents is based on sufficientliterature analysis and research, combining with nursing science, cognitive science,management science, yoga theory, motor function and anatomic theory, to ensure scientificcharacter in intervention project, applied to research objects with different disease,improving feedback, squeezing more suitable self-management for research population, toensure the feasibility of intervention project. And the combined training interventionscheme is constructed.5series continuous nursing interventions are established in12weekspromote self-management efficiency and behavior.Second Part Experimental Research and Evaluation on Nursing InterventionProject for Patients with CLBP1. MethodRandom control experiments are adopted to verify the research project. Based on theinclusion and exclusion criteria of two disease groups, research projects are selected.Patients with prolapsed lumbar intervertebral disc are divided into the experiment group (84cases) and the control group (63cases). Patients with lumbar muscle strain are divided intothe experiment group (36cases) and the control group (33cases). The experimental groupreceives the intervention activities. The prolapsed group gets physical and drug therapy andself-management after hospital discharge for three weeks. Self-management is implementedin the control group with lumbar muscle strain. The effect evaluation includes①pain anddysfunction score②pain coping strategies score and pain stage conversion③health status④second outpatient visit rate in three months. The prolapsed group collects data in the0,3,6and12week. The group with lumbar muscle strain collects data in the0,6and12week.Applying the professional statistics software (SAS8.2)to calculate and analyze the data, themeasurement data of two groups are compared with independent sample T-test, thedifference of the count data between two groups was evaluated by chi-square test, varianceanalysis of repeated measurement data is adopted to evaluate the time index change of two group patients at different times, the relationship between research findings and generalinformation was tested by Spearman’s Rank Correlation Analysis method. The studyinclude two interviews, the first is investigating patients’ troubles in self-management atthe third weekend, the second is investigating experience for different participants at theend of12weeks. And improving scheme according this results.2. Results(1) Pain degree：①In the prolapsed experiment group, scores of the slightest, the worst,the majority and the current pain, decrease significantly（P＜0.05）after12weeks,meanwhile, the majority pain intensity have statistical significance as compared with thecontrol group（P=0.046、0.029、0.013）in the3,6and12week, the worst pain intensitybegin to decrease （P=0.044）in the third week, the current pain intensity begin to decrease（P=0.044）in the sixth week.②In the lumbar muscle strain experiment group, scores ofthe slightest, the worst, the majority and the current pain, decrease significantly（P＜0.05）after12weeks, meanwhile, the majority and the worst pain intensity decrease significantlyas compared with the control group（P=0.032、0.038）in the sixth week.(2) Dysfunction：Scores of the prolapsed group decrease significantly as comparedwith the control group（P=0.071、0.026）in the sixth and twelfth week. Scores of the lumbarmuscle strain group decrease significantly（P=0.037）in the twelfth week.(3) Pain coping：Scores of the prolapsed group increase significantly（P＜0.05）in thesixth and twelfth week. Scores of the lumbar muscle strain group increase significantly（P＜0.01）in the sixth and twelfth week. And scores of two groups increase continuously from0-12week.(4) Pain stage：①The distribution variation of the prolapsed group has statisticalsignificance（P＜0.05）during the thinking prophase, thinking metaphase and action stage in3-12week, the difference is most significant（P＜0.01）in the sixth and twelfth week, thedistribution variation of maintenance period have statistical significance（P=0.042）in thetwelfth week.②The distribution variation of the lumbar muscle strain group has statisticalsignificance（P＜0.05）during the thinking prophase and action stage in the sixth week, thedifference（P=0.000、0.034）appears during the thinking metaphase and maintenance periodin the twelfth week.(5) Health Status：The statistical changes is observed in the total scores of two groups in the twelfth week（P=0.015、0.017）. The prolapsed group is associated with poorer physicalhealth as compared with the lumbar muscle strain group. In addition to intervention resultsanalysis of pain and dysfunction, the spirit and social situations effect is further comparedin the prolapsed group, the scores of patients vitality(VT), social functioning(SF),motional role(RE) and mental health(MH) have statistical significance（P＜0.05）after12weeks, the scores of the four indexes increase continuously from0-12week.(6) Pain management：1）To study the implementation of the pain management situation, frequency andpercentage analysis is adopted. According to research requirements, one postural exerciseeach two days must be done.47.62%of the prolapsed can meet this requirement.54.54%ofthe lumbar muscle strain patients can meet this requirement. The Average amount ofexercise is zero for7.14%of the patients with prolapsed and8.33%of the patients withlumbar muscle strain. Application of pain management:22.22%excise two times each day,38.89%excise three times each day, in the prolapsed group.38.10%excise two times eachday,13.10%excise three times each day, in the lumbar muscle strain group.2) The impact of pain coping ability on the pain intensity and Dysfunction: Spearman’sRank Correlation Analysis method is applied to the prolapsed group with larger sample size.There is a negative correlation between the pain coping ability and two Symptoms, thehigher the score of pain coping ability, the lower the pain intensity and Dysfunction. It hasbeen proved that the intervention project is effective to improve the pain copingability.Spearman’s Rank Correlation Analysis method is applied to investigate therelationship among postural exercise, application of pain management, and health status inthe prolapsed group with larger sample size. Positive correlation is observed, especially thegreater relevance for the physiological role, general health, vitality and social functioning.The results show that the project is positive to health status of research project and ishelpful to improve the patient’s overall health status.3）The impact of research project general information on pain coping and pain self-management: Spearman’s Rank Correlation Analysis method is applied to investigate theimpact of research project general information on pain coping and pain self-management.The results show that the patients’ condition affects the implementation of pain management.There is a positive correlation among score of pain coping, usage frequency of pain management skills, disease course, number of pain sites, educational level, family modeland family income. And negative correlation is observed for the family history.（7）Barriers of self-management focus on the following aspects:1) lack of time;2)questioning the role of self-management measures;3)coping skills is maybe too difficult tomaster;4) they do not want to adhere to the physical discomfort;5) cognitive errors.(8) Comparative research on the outpatient rates for research projects within3months:The disease clinic rate (second visiting) for the research project, during the interventionperiod, is surveyed. The investigation discovers that, no matter what kind of patients,5.83%of two experiment groups appears recurrence rate of patients, lower than controlgroups, and that the prolapsed is higher than the lumbar muscle strain group.(9) Thinking about self-management1) Patients think pain decreased and mental improved, but hope getting more guidanceand encouragement.2) Patients’ family thinks their support play important role on patients’ rehabilitation,including their attitudes and behavior. But lacking knowledge, ability and sufficientpatience,3) Health care workers think it is necessary to establish hospital-community-homemanagement system for chronic disease,improve doctor-patient trust and workers’comprehensive ability.3. conclusion(1) cognitive-yoga united intervention can reduce pain and disability levels of CLBPpatients, yoga scheme formulated is more suitable for lumbar muscle strain.(2) Cognitive-yogaUnited intervention can significantly improve self-managementperception and pain coping ability of two CLBP patients. Yoga stretching and distractingare pain coping skills used by two group.(3) Cognitive-yoga United intervention can improve the health status of patients withCLBP, especially for psycho-social status of lumbar disc herniation improve patients’ fullhealth condition,their families play important roles,but more knowelges and skills aredemanded, in addition,a fluent way of hospital-community-family-patient is should beestabilished.(4) Follow-up intervention can promote CLBP patient’self-management behavior compliance and continuous improvement of health status.(5) Promoting factors of self-management include longer disease course, more painpositions, other medical histories, higher cultural level, and more families and main sourceof family income. Pain family history, lack of knowledge, confidence and support are thekey factors influencing the patient self-management. Pessimistic attitude leads to badbehavior compliance.（6）Sensitivity analysis on the related nursing intervention outcome evaluation tool:"one of the dimensions of health status scores in physical pain" is not suitable for painmeasurement;"RRMDQ low back pain scale" and "SF-36health survey scale" in thedimension of physiological function (PF) and physiological functions (RP) can functionevaluation patients, but SF-36evaluation of mental, emotional aspects of a morecomprehensive.In summary, nursing intervention activities of cognition and yoga exercise combinedimprove self-management consciousness and ability of patients with chronic low back pain,alleviate their pain and dysfunction, promote overall health, and reduce the rate ofinpatients. these results prove the research purposes are mainly attained,but long-termapplying is necessary to observe lumbar pathological changes and maintain the complianceof self management behavior. This study explores the nursing intervention of patients withchronic low back pain, the research results provide new ideas and practical basis for chronicdisease patients’ self management.