The Construction And Application Study Of Collaborative Care Intervention Program For Patients With Abdominal Pedicle Flaps Transplantation

ObjectiveTo develop the collaborative care intervention program for patients with abdominal pedicle flaps transplantation and explore its effects of pain,anxiety status and upper limbs function,aiming to alleviate pain,relieve anxiety and promote recovery.Then provide clinical experience for hand surgery by collaborative care model.Method1.The construction of collaborative care intervention program for patients with abdominal pedicle flaps transplantation: The collaborative care model and International Classification of Functioning,Disability and Health were the theoretical framework in this study.Intervention program was initially established by the literature review and interview,then the intervention program was revised by 2 rounds of Delphi expert consultation;Finally,preliminary experiment was ued to modify the intervention program and the final version of intervention program was developed.2.The application of collaborative care intervention program:The convenience sampling procedures were used to choose 96 patients with abdominal pedicle flaps transplantation form the department of hand surgery in a tertiary comprehensive hospital in Qingdao from January 2019 to August 2019 according to the inclusion and exclusion criteria.The patients were divided into control group and intervention group according to the inpatient area,48 patients in each group.The control group was given routine care,and the intervention group was given collaborative care intervention program:Gather a collaborative intervention team,procedure files,give the individual intervention,group intervention and collaborative intervention in stages.The pain scores of two groups were compared at one day,two days and three days after the first-stage of pedicle flap operation.The shoulder joint function scores and the elbow joint function scores of two groups were compared at one day,three days,seven days and one month after the second-stage of pedicle flap operation.The anxiety scores and the hand function scores oftwo groups were compared at one month and 3 months after the second-stage of pedicle flap operation.SPSS 22.0 software was used for statistical analysis of the data.Results1.The construction of collaborative care intervention program:20 experts were investigated in two rounds of Delphi expert consultation,then 20 questionnaires were taken back,so response rates in the two rounds of consultation were 100%.Authoritative coefficients in the two rounds of experts' consultation were 0.840 and 0.859.The Kendall'W in the two rounds of experts' consultation were 0.286 and 0.322,the difference was statistically significant(P<0.01).The final intervention program consisted of 3 first-level items,9 second-level items,and 42 third-level items.2.The application of collaborative care intervention program:(1)There were no significant differences in general data between two groups(P>0.05);Before the intervention,there were no significant differences in pain score,anxiety score,shoulder joint function score,elbow joint function score and hand function score between two groups(P>0.05)(2)Pain: The pain score of the intervention group was less than the control group at one day,two days and three days after operation,the difference was statistically significant(P<0.01).ANOVA for repeated measurement showed that the difference was statistically significant in groups effect,time effect and interaction effect(P<0.05).(3)Psychological status: The anxiety score of the intervention group was less than the control group at one month and 3 months after operation,the difference was statistically significant(P<0.01).ANOVA for repeated measurement showed that the difference was statistically significant in groups effect,time effect and interaction effect(P<0.01).(4)Functional status: The shoulder joint function score of the intervention group was higher than the control group at one day,three days,seven days and one month after operation,the difference was statistically significant(P<0.01).ANOVA for repeated measurement showed that the difference was statistically significant in groups effect,time effect and interaction effect(P<0.01).The elbow joint function score of the intervention group was higher than the control group at one day,three days,seven days and one month after operation,the difference was statistically significant(P<0.01).ANOVA for repeated measurement showed that the difference was statistically significant in groups effect,time effect and interaction effect(P<0.01).The hand function score of the intervention group was higher than the control group at one month and 3 months after operation,the difference was statistically significant(P<0.01).ANOVA for repeated measurementshowed that the difference was statistically significant in groups effect,time effect and interaction effect(P<0.01).ConclusionThe collaborative care intervention program for patients with abdominal pedicle flaps transplantation has reliability and scientificity.The collaborative care intervention program for patients with abdominal pedicle flaps transplantation in this study can relieve pain and anxiety,promote the recovery of shoulder joint function,elbow joint function and hand function.