| Objecti ve1、To investigate anxiety of Hip/Knee arthroplasty patients.2、To explore the effect of cognitive therapy、music therapy and guided imagery on anxiety and postoperative pain of patients undergoing Hip/Knee arthroplasty.3、To evaluate the different effects of cognitive therapy、music therapy and guided imagery on anxiety and postoperative pain of patients undergoing Hip/Knee arthroplasty.MethodsFrom November2010to November2011,120Patients with hip and knee arthroplasty in Tianjin Hospital were analyzed using convenient sampling.The patients were randomly assigned into cognitive group(n=30),music group(n=30),guided to imagine group(n=30) and the control group(n=30).The patients in the control group received the orthopaedics routine care.The patients in cognitive group,music group,guided to imagine group received respectively cognitive therapy、music therapy and guided imagery on the basis of routine care.The general survey、Chinese-state anxiety inventory(C-SAI) and Changhai pain rating scale were applied to assess anxiety level and degree of postoperative pain.The blood pressure and heart rate were selected as objective index of physiological stress.The four groups of patients were measured objective indicators and subjective indicators at the time of admission,preoperative night,6h,12h,24h,48h,72h of postoperation and one week of postoperative.Analyze dates using statistical software.Results1、The SAI scores of general patients at the time of admission were47.66±5.89,which were higher than national norm(P<0.01).Patients with low and moderate anxiety accounted for95%.2、Repeated measures analysis of variance showed that SAI scores of four groups of patients in using different interventions were statistically significant difference (P<0.05),the main effects of time on SAI were statistical significant differences (P<0.05),there were significant interactions between intervention and time on SAI(P<0.05);The comparison between groups showed that:SAI scores of the patients in cognitive group, music group, guided to imagine group were lower than that in control group at preoperative night,12hours after operation and one week after of operation(P<0.01),meanwhile SAI scores of the patients in the music group and guided to imagine group were lower than that in cognitive group(P<0.05),but SAI scores between music group and guided imagery group were no statistically significant differences (P>0.05).3、At the time of preoperative night, the decreasing range of SAI scores in cognitive group was mostly<5points,which was5～10points in music group and guided to imagine group, but the control group rised gradually.At the time of12hours after operation, the decreasing range of SAI scores in cognitive group,music group and guided imagery group was5～10points,which was no change in control group.At the time of one week after operation, the decreasing range of SAI scores in cognitive group and music group was in5～10points mostly,which was>10point in guided to imagine group.While the decreasing range also declined in control group,but which was inferior to the intervention groups by and large.4、Repeated measures analysis of variance showed that systolic blood pressure and heart rate of four groups of patients in using different intervention were statistically significant difference (P<0.05),the main effects of time on systolic blood pressure and heart rate were statistical significant differences (P<0.05),there were significant interactions between time and intervention on the systolic blood pressure and heart rate (P<0.05); The comparison between groups showed that systolic blood pressure and heart rate of the patients in the cognitive group, music group and guided to imagine group were lower than that in control group at preoperative night,12hours after operation and one week after operation(P<0.01); meanwhile systolic blood pressure and heart rate of the patients in the music group and guided to imagine group were lower than in cognitive group(P<0.05), but systolic blood pressure and heart rate between music group and guided to imagine group were no statistically significant differences (P>0.05).5、Repeated measures analysis of variance showed that the pain scores of four groups of patients in using different interventions were statistically significant differences (P<0.05),the main effects of time on pain were statistically significant differences (P<0.05),there were significant interactions between time and intervention on pain (P<0.05);The comparison between groups showed that pain scores of four groups were no statistically significant difference at the time of6h,12h after operation(P>0.05);the pain scores of the patients in guided to imagine group were lower compared to the control group at24h of postoperation(P<0.05);The pain scores of the patients in cognitive group,music group and guided to imagine group were lower compared to control group at24h,72h,one week after operation(P<0.01),meanwhile the pain scores of the patients in guided imagery group were lower than that in cognitive group and music group(P<0.05),but pain scores between music group and cognitive group were no statistically significant differences(P>0.05).Conclusion1、State anxiety level of four groups of patients were higher than domestic norm after admission, indi eating that the Hip/Knee arthroplasty patients were obvious anxiety status after admission.2、Cognitive therapy, music therapy and guided imagination could effectively improve the anxiety level of the Hip/Knee arthroplasty patients; Guided imagination was more effective than music therapy on improving the anxiety of Hip/Knee arthroplasty patients, but music therapy was superior to cognitive therapy.3、Cognitive therapy, music therapy and guided imagination could effectively reduce the pain level of Hip/Knee arthroplasty paitents; Guided imagination was better than cognitive therapy and music therapy,but the effect between cognitive therapy and music therapy was undifferentiated on improving postoperative pain of Hip/Knee arthroplasty patients. |
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