恐惧回避信念和疼痛作为腿部溃疡患者身体活动水平低的预测因素。

Fear-avoidance beliefs and pain as predictors for low physical activity in patients with leg ulcer.

作者信息

Roaldsen Kirsti Skavberg, Elfving Britt, Stanghelle Johan Kvalvik, Talme Toomas, Mattsson Eva

机构信息

Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.

出版信息

Physiother Res Int. 2009 Sep;14(3):167-80. doi: 10.1002/pri.433.

DOI:10.1002/pri.433

PMID:19194958

Abstract

BACKGROUND AND PURPOSE

Previous studies have shown that patients with chronic venous insufficiency are deconditioned and physically inactive. The present study aimed to examine the occurrence of fear-avoidance beliefs in patients with chronic venous insufficiency, and to investigate the role of fear-avoidance beliefs and pain severity in predicting the low level of physical activity in these patients.

METHOD

Data were collected by a postal questionnaire sent to 146 patients with chronic venous insufficiency and current or previous venous leg ulcer. Complete data were collected from 98 patients aged 60-85 years - 63% women - giving a response rate of 67%. Fear-avoidance beliefs were assessed by the Fear-Avoidance Beliefs Questionnaire, physical activity subscale. Pain and physical activity were assessed by the Six-point Verbal Rating Scale of Pain Assessment and the Physical Activity Questionnaire, respectively.

RESULTS

Fear-avoidance beliefs were present in 81 (83%) of the patients with chronic venous insufficiency (range 0-24, median 12). Forty patients (41%) had strong fear-avoidance beliefs. One-third of the patients with healed ulcers had strong fear-avoidance beliefs. Patients with low physical activity had significantly stronger fear-avoidance beliefs and more severe pain than patients with high physical activity. Multiple logistic regression showed that the odds ratio (OR) for low physical activity were about three times higher for patients with strong fear-avoidance beliefs (OR 3.1, 95% confidence interval 1.1-8.3; p = 0.027) than for patients with weak fear-avoidance beliefs.

CONCLUSIONS

Fear-avoidance beliefs were present in most patients with chronic venous insufficiency and were associated with low physical activity. Clinical implications ought to include a better recognition of fear-avoidance beliefs, early information about the negative consequences of such beliefs, and the importance of physical activity to counteract poor mobility.

摘要

背景与目的

既往研究表明，慢性静脉功能不全患者身体机能减退且缺乏运动。本研究旨在调查慢性静脉功能不全患者中恐惧回避信念的发生情况，并探讨恐惧回避信念和疼痛严重程度在预测这些患者低体力活动水平中的作用。

方法

通过邮寄问卷对146例慢性静脉功能不全且有当前或既往下肢静脉溃疡的患者进行数据收集。从98例年龄在60 - 85岁的患者中收集到完整数据，其中女性占63%，回复率为67%。采用恐惧回避信念问卷的身体活动分量表评估恐惧回避信念。分别采用疼痛评估六点言语评定量表和身体活动问卷评估疼痛和身体活动情况。

结果

81例（83%）慢性静脉功能不全患者存在恐惧回避信念（范围0 - 24，中位数12）。40例（41%）患者有强烈的恐惧回避信念。三分之一已愈合溃疡的患者有强烈的恐惧回避信念。与高体力活动患者相比，低体力活动患者的恐惧回避信念明显更强，疼痛更严重。多因素logistic回归显示，与恐惧回避信念较弱的患者相比，有强烈恐惧回避信念的患者低体力活动的优势比（OR）约高3倍（OR 3.1，95%置信区间1.1 - 8.3；p = 0.027）。