School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Nursing, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
J Adv Nurs. 2023 May;79(5):1926-1938. doi: 10.1111/jan.15421. Epub 2022 Aug 16.
To identify the different classes of total knee arthroplasty patients according to the heterogenous trajectories of psychological resilience and investigate the predictors for different patterns of resilience.
A prospective cohort study.
A total of 210 patients with total knee arthroplasty from March to December 2021 were included. Baseline assessment (T0) data were collected before surgery and included demographic, biological (clinical characteristics), psychological (psychological resilience, self-efficacy, psychological distress, hope, medical coping mode) and social (social support) factors. Resilience measurements were repeated at 3 days after surgery (T1), the date of discharge (T2), and 1 month (T3) and 3 months (T4) after discharge. Latent growth mixture modelling was employed to define different resilience trajectories. Predictors of class membership were identified using multinomial logistic regression.
Data from 198 patients were analysed. Three latent classes were identified with similar patterns in different intercepts, showing a significant decrease in resilience from admission (T0) to 3 days after surgery (T1) followed by an increase from T1 to T4. The three trajectories of psychological resilience were named the stable-resilience class (65.66%), high-resilience class (17.68%), and low-resilience class (16.66%). Multinomial logistic regression showed that compared with the stable-resilience class, the high-resilience class was predicted by having a higher level of hope, having higher education, living in urban areas and having more children, while the low-resilience class was predicted by having lower levels of self-efficacy and hope, living in semirural areas, and having more children.
The three trajectories indicated that surgery was the major stressor influencing patients' psychological resilience and that patients in the low-resilience class needed to be intervened.
Predictors of patients in different classes provide evidence for the identification of vulnerable populations and lay a foundation for future research contributing to the development of targeted interventions for improving patients' psychological resilience. No patient or public contribution but the time points of investigation were decided based on our interviews with 12 total knee arthroplasty patients.
根据心理弹性的异质轨迹确定全膝关节置换术患者的不同类别，并探讨不同弹性模式的预测因素。
前瞻性队列研究。
共纳入 2021 年 3 月至 12 月期间的 210 例全膝关节置换术患者。基线评估（T0）数据在术前采集，包括人口统计学、生物学（临床特征）、心理学（心理弹性、自我效能、心理困扰、希望、医学应对模式）和社会（社会支持）因素。术后 3 天（T1）、出院日（T2）、出院后 1 个月（T3）和 3 个月（T4）时重复进行弹性测量。采用潜在增长混合模型定义不同的弹性轨迹。使用多项逻辑回归确定类别的预测因素。
对 198 例患者的数据进行了分析。根据不同截距的相似模式确定了三个潜在类别，显示从入院（T0）到术后 3 天（T1）的弹性显著下降，然后从 T1 增加到 T4。心理弹性的三个轨迹分别命名为稳定弹性类（65.66%）、高弹性类（17.68%）和低弹性类（16.66%）。多项逻辑回归显示，与稳定弹性类相比，高弹性类由希望水平较高、受教育程度较高、居住在城市地区和子女较多预测，而低弹性类由自我效能和希望水平较低、居住在半农村地区和子女较多预测。
这三个轨迹表明手术是影响患者心理弹性的主要应激源，低弹性类患者需要干预。
不同类别的预测因素为识别脆弱人群提供了依据，并为未来研究奠定了基础，有助于制定针对提高患者心理弹性的靶向干预措施。没有患者或公众的贡献，但调查的时间点是根据我们对 12 名全膝关节置换术患者的访谈决定的。
