基于远程 Teach-back 法的老年骨质疏松精准化管理


目的 探讨远程 Teach-back 法对老年骨质疏松症(osteoporosis,OP)患者精准化管理的应用效果。 方法 2016 年 6 月—9 月选择老年 OP 门诊患者,并随机分为 2 组:常规治疗组与远程 Teach-back 综合治疗组。远程 Teach-back 综合治疗组即在常规治疗基础上加上移动互联网(微信)对患者进行远程 OP 治疗管理指导。比较两组患者在治疗 12 个月后的 OP 知识、OP 自我效能、日常生活活动(activities of daily living,ADL)能力、骨密度值等指标。 结果 共纳入老年男性患者 80 例,每组各 40 例。远程 Teach-back 法综合治疗组患者在运动知识、钙知识、运动效能、ADL 能力及骨密度值方面的改善情况优于常规治疗组(P<0.05)。其中,远程 Teach-back 综合治疗组和常规治疗组的运动知识干预后改善值[均以中位数(下四分位数,上四分位数)表示]分别为 1.870(1.098,2.870)分和 0.670(0.043,1.283)分,钙知识干预后改善值分别为 2.495(1.860,3.455)分和 0.250(–0.810,0.705)分,运动效能干预后改善值分别为 15.015(10.490,26.175)分和 6.045(1.405,13.545)分,ADL 能力改善值分别为 13.565(4.053,23.768)分和 2.245(–4.953,7.872)分,腰 1-腰 4 骨密度值的改善值分别为 0.155(0.010,0.313)g/cm2 和 0.045(–0.095,0.160)g/cm2,髋部骨密度值的改善值分别为 0.130(–0.023,0.245)g/cm2 和 0.035(–0.043,0.165)g/cm2。而 OP 危险因素知识和摄钙效能在两种干预方式的改善差别无统计学意义(P>0.05)。 结论 远程 Teach-back 在线教育使 OP 管理更有疗效。应依托康复教育和康复训练的特色,建立优势化管理模式,以预防 OP 和脆性骨折的发生,提高患者生活质量。

Objective To investigate the application effect of remote Teach-back method on the precise management of elderly patients with osteoporosis (OP). Methods From June to September 2016, the elderly outpatients with OP were selected and randomly divided into the conventional treatment group and the remote Teach-back comprehensive treatment group. The remote Teach-back comprehensive treatment group was given the mobile Internet (WeChat) on the basis of conventional treatment to guide patients with remote OP treatment. The OP knowledge, OP self-efficacy, activities of daily living (ADL), bone mineral density (BMD) and other indicators were compared between the two groups after 12 months of treatment. Results A total of 80 elderly patients with OP were included, with 40 patients in each group. The comparison of the improvement values of the two groups showed that the remote Teach-back comprehensive treatment group was superior to the conventional treatment group in terms of exercise knowledge, calcium knowledge, exercise performance, ADL and BMD (P<0.05). Among them, the improvement in exercise knowledge intervention in the remote Teach-back group and the conventional treatment group were 1.870 (1.098, 2.870) and 0.670 (0.043, 1.283); the improvement values of calcium knowledge intervention in the two groups were 2.495 (1.860, 3.455) and 0.250 (–0.810, 0.705); the improvement values after exercise intervention in the two groups were 15.015 (10.490, 26.175) and 6.045 (1.405, 13.545); the improvement of ADL in the two groups were 13.565 (4.053, 23.768) and 2.245 (–4.953, 7.872); the improvement of lumbar 1-waist 4 BMD in the two groups were 0.155 (0.010, 0.313) g/cm2 and 0.045 (–0.095, 0.160) g/cm2; the hip BMD improvement values of the two groups were 0.130 (–0.023, 0.245) g/cm2 and 0.035 (–0.043, 0.165) g/cm2. There was no significant difference in OP knowledge between the two groups (P>0.05). Conclusions Remote Teach-back online education makes OP management more effective. Relying on the characteristics of rehabilitation education and rehabilitation training, we will establish an advantageous management model to prevent the occurrence of OP and fragility fractures and improve the quality of life.

关键词: 远程教育; Teach-back; 老年骨质疏松; 精准化管理

Key words: Remote education; Teach-back; Elderly with Osteoporosis; Precise management

引用本文: 刘思佳, 朱传美, 黄石书, 刘立岷, 梁邱, 马秀清, 何成奇. 基于远程 Teach-back 法的老年骨质疏松精准化管理. 华西医学, 2018, 33(10): 1267-1271. doi: 10.7507/1002-0179.201806174 复制

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