Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture

The incidence and risk factors of phobic movement disorder after hip fracture internal fixation surgery

OBJECTIVE

This study aims to analyze the cumulative incidence and associated risk factors of phobic movement disorder (PMD) after hip fracture internal fixation surgery, with the goal of optimizing postoperative rehabilitation management and improving the quality of life in elderly patients.

METHODS

A total of 269 patients who underwent hip fracture internal fixation surgery at our hospital from June 2022 to June 2024 were retrospectively included. Clinical data, including age, sex, BMI, underlying diseases, psychological status, postoperative hip joint function, and self-efficacy, were collected. PMD was assessed using the Tampa Scale for Kinesiophobia (TSK), pain acceptance was evaluated using the Chronic Pain Acceptance Questionnaire (CPAQ-8), anxiety and depression status were assessed with the Hospital Anxiety and Depression Scale (HADS), hip joint function was measured using the Harris Hip Score, and self-efficacy was evaluated using the General Self-Efficacy Scale (GSE). Univariate analysis and multivariate binary logistic regression analysis were used to identify independent risk factors for PMD. The variance inflation factor (VIF) was calculated to assess multicollinearity.

RESULTS

The cumulative incidence of PMD was 34.9%. Univariate analysis revealed that BMI ≥ 30 kg/m², low pain acceptance, anxiety and depression, poor postoperative hip joint function, and low self-efficacy were significantly associated with PMD (P < 0.001). Multivariate logistic regression analysis further confirmed that BMI ≥ 30 kg/m² (OR = 4.07, 95% CI [2.39, 6.94]), low pain acceptance (OR = 4.67, 95% CI [2.69, 8.10]), anxiety and depression (OR = 4.14, 95% CI [2.44, 7.04]), poor postoperative hip joint function (OR = 10.61, 95% CI [5.67, 19.87]), and low self-efficacy (OR = 4.19, 95% CI [2.44, 7.18]) were independent risk factors for PMD. All VIF values were < 5, indicating no significant multicollinearity.

CONCLUSION

PMD is common after hip fracture internal fixation surgery and is closely associated with high BMI, low pain acceptance, anxiety and depression, poor postoperative hip joint function, and low self-efficacy. The VIF analysis showed no significant multicollinearity, indicating stable results. Comprehensive interventions targeting high-risk factors may help reduce the incidence of PMD and improve postoperative recovery.

Effect of extended nursing based on self-efficacy theory on the anxiety of patients with intertrochanteric fracture

BACKGROUND

Extended care based on self-efficacy theory to elderly patients with intertrochanteric fractures will provide data reference to optimize the care plan of these patients, reduce patients' concurrent mental diseases, and improve prognosis.

AIM

To analyze the value of extended nursing based on the self-efficacy theory in older patients with intertrochanteric fractures.

METHODS

Older patients with intertrochanteric fractures (n = 88) admitted to our hospital between January 2021 and December 2024 were randomly divided into two groups - the control group (n = 44, routine nursing) and the observation group (n = 44, extended nursing) - via balloting and treated for 12 weeks. The mental state, pain severity, limb function, and self-nursing ability of all patients before and after nursing were analyzed.

RESULTS

After nursing, the Hamilton Anxiety Scale and General Self-Efficacy Scale scores of patients in the two groups improved. Notably, Hamilton Anxiety Scale and General Self-Efficacy Scale scores in the observation group were lower and higher, respectively, than those in the control group (P < 0.05). The pain severity in the observation group (2.64 ± 0.22) was lower than that in the control group (2.85 ± 0.41) (P < 0.05). The recovery rate of limb function was higher in the observation group than in the control group (P < 0.05). In addition, the self-nursing ability scores of the patients in both groups increased, with a significantly higher score in the observation group (P < 0.05).

CONCLUSION

Extended nursing based on the self-efficacy theory can significantly improve mental state, relieve pain, and promote the recovery of limb function and self-nursing ability in older patients with intertrochanteric fractures.

Effect of trans-theoretical model-based nursing intervention on emotion and fear in post-liver cancer surgery patients

OBJECTIVE

To investigate the efficacy of nursing interventions grounded in the trans-theoretical model on emotion and fear among patients undergoing surgery for hepatocellular carcinoma (HCC).

METHODS

The study included 188 surgical patients from the Second People's Hospital of Lanzhou City who underwent HCC intervention between March 2020 and May 2022. The control group comprised 81 patients receiving standard postoperative care, while the observation group included 107 patients who received nursing interventions based on the trans-theoretical model. We assessed outcomes using the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), Quality of Life Questionnaire Core 30 (QLQ-C30), Gastrointestinal Comfort Questionnaire (GCQ), Self-Rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) before and after the intervention. Logistic regression was used to identify factors influencing post-intervention fear.

RESULTS

Both groups showed improvement in FOP-Q-SF, QLQ-C30, GCQ, SAS, and SDS scores after the intervention. However, the observation group demonstrated significantly greater improvements (P < 0.05). There was a positive correlation between FOP-Q-SF scores and both SAS and SDS scores (all P < 0.05), and a negative correlation with QLQ-C30 and GCQ scores (both P < 0.05). Multifactorial logistic regression revealed that age (P < 0.001, OR: 8.328), gender (P < 0.001, OR: 0.181), literacy level (P < 0.001, OR: 0.354), and nursing care regimen (P < 0.001, OR: 0.078) were significant independent risk factors for persistence of fearpost-intervention.

CONCLUSION

The implementation of nursing interventions based on the trans-theoretical model significantly reduces postoperative fear and anxiety, improves pain perception, and enhances overall comfort in patients after liver cancer surgery.