张瑶瑶 苏晴晴

【摘 要】目的：探讨信息-动机-行为技巧模型指导的康复锻炼方案在全膝关节置换术患者功能锻炼中的应用效果。方法：选取108例初次行单侧全膝关节置换术的患者，按照入院时间分为试验组和对照组，每组54例。对照组接受常规的功能锻炼指导和健康教育，试验组除常规功能锻炼的方式外，实施以信息-动机-行为技巧模型为基础的康复锻炼护理方案。比较2组患者干预前后膝关节HSS评分、功能锻炼依从性、一般自我效能和社会支持的差异。结果：术后4周、6周，试验组患者膝关节功能锻炼依从性评分、HSS评分、社会支持评分、一般自我效能均优于对照组，差异有统计学意义（P < 0.05）。重复测量结果显示，2组患者时间效应、组间效应、交互效应比较，差异均有统计学意义（P < 0.05）。结论：基于信息-动机-行为技巧模型的康复锻炼方案能提高患者功能锻炼依从性、自我效能水平、社会支持度，改善患者膝关节功能。

【关键词】 全膝关节置换术;信息-动机-行为技巧模型;功能康复;自我效能;社会支持

【ABSTRACT】Objective：To explore the effect of rehabilitation exercise program guided by information-motivation-behavioral skill model in functional exercise of patients undergoing total knee arthroplasty.Methods：One hundred and eight patients undergone unilateral total knee arthroplasty for the first time were divided into an experiment group and a control group，54 cases in each group.The control group was given routine functional exercise guidance and health education，and the experiment group was given rehabilitation exercise nursing scheme based on information-motivation-behavioral skill model in addition to routine functional exercise.The differences of knee HSS，functional exercise compliance，general self-efficacy and social support between the two groups before and after intervention were compared.Results：At 4 and 6 weeks after operation，the knee function exercise compliance score，HSS，social support score and general self-efficacy of the experiment group were better than those of the control group（P < 0.05）.The repeated measurement results showed that there were significant differences in time effect，inter group effect and interaction effect between the two groups（P < 0.05）.Conclusion：The rehabilitation exercise program based on information-motivation-behavioral skill model can improve patients' functional exercise compliance，self-efficacy level，social support and knee function.

【Keywords】 total knee arthroplasty;information-motivation-behavioral skill model;functional rehabilitation;self efficacy;social support

全膝关节置换术（total knee replacement，TKA）是终末期膝骨关节炎患者最有效的治疗方式，能够缓解慢性疼痛，改善膝关节功能，提高患者术后生活质量[1-2]。近年来，随着手术技术的成熟和植入假体材料的发展，TKA术后康复训练的好坏成为患者预后的关键因素，能够影响患者关节周围肌肉力量、膝关节活动度及功能独立性的恢复[3]。据调查，我国TKA患者术后康复锻炼依从性仅为60%～80%，患者康复行为缺乏自主性，导致术后康复效果不佳[4-5]。信息-动机-行为技巧模型（IMB）是FISHER等[6]提出的一种被广泛应用的行为改变模式，能帮助患者进行自发的持续的行为转变，目前已被运用到慢性心力衰竭、脑出血、乳腺癌患者术后功能锻炼中，对患者术后功能锻炼依从性改善较为显著[7-9]。……