摘要
目的 探讨慢性肌肉骨骼疼痛(CMP)患者恐动的影响因素,依据影响因素构建列线图预测模型并进行验证.方法 前瞻性选取2021年3月至2023年10月入上海市第八人民医院的CMP患者419例为研究对象,按照随机数字表法将其分为模型组(n=319)和验证组(n=100).调查影响CMP患者发生恐动的影响因素,依据影响因素建立列线图模型,并使用受试者操作特征(ROC)曲线验证模型的预测效果.结果 模型组319例CMP患者中恐动患者113例,占比41.69％;非恐动患者186例,占比58.31％.多因素Logistic回归分析结果显示,年龄、合并症数量(2种及以上)、疼痛部位数量(3个及以上)、疼痛干扰(重度)、TSK～11量表得分、心理弹性得分、疼痛程度得分、疼痛灾难化得分和一般自我效能得分为CMP恐动的影响因素(P＜0.05).预测CMP患者恐动发生的一致性指数为0.853,95％CI:0.819～0.946;校准曲线显示,CMP患者恐动列线图预测模型预测恐动的效能较好;ROC曲线分析结果显示,曲线下面积为0.971,95％CI:0.903～0.939,敏感度为91.75％,特异度为87.43％,约登指数为0.796.验证组Hosmer-Lemeshow检验结果显示,该模型对恐动的预测值与实际值之间差异无统计学意义(P＞0.05),模型具有较好的拟合度.结论 年龄、合并症数量、疼痛部位数量、疼痛干扰、心理弹性、疼痛程度、疼痛灾难化和一般自我效能得分是CMP恐动的影响因素,据此构建的CMP患者恐动的列线图预测模型具有较好的区分度和拟合度.
Abstract
Objective To explore and analyze the influencing factors of kinetophobia in patients with chronic musculoskeletal pain(CMP),and build a nomogram prediction model based on the influencing factors and verify it.Methods A total of 419 patients with CMP admit-ted to Shanghai Eighth People's Hospital from March 2021 to October 2023 were selected as the study subjects,and they were randomly divided into the model group(n=319)and the verification group(n=100)by random number table method.To investigate the influencing factors of kine-tophobia in patients with CMP,and a nomogram model according to the influencing factors was established,and the predictive effect was validated using the receiver operating characteristic(ROC)curve.Results Among 319 patients with CMP in the model group,113 cases(41.69％)were kinetophobia and 186 were non-motile patients,accounting for 58.31％.The results of multivariate Logistic regression analysis showed that Age,number of complications(2 or more),number of pain sites(3 or more),pain interference(severe),TSK-11 scale score,mental resilience score,pain degree score,pain catastrophization score and general self-efficacy score were the influencing factors of motility in chronic musculo-skeletal pain(P＜0.05).The index consistency for predicting movement in patients with CMP was 0.853,95％CI:0.819-0.946.Calibra-tion curve showed that the predictive model of kinetophobia in patients with chronic musculoskeletal pain was effective.ROC curve analysis results showed that the area under the curve was 0.971,95％CI:0.903-0.939,sensitivity was 91.75％,specificity was 87.43％,and Yoden index was 0.796,which proved that the model had good differentiation.The results of the Hosmer-Lemeshow test in the validation group showed that there was no statistically significant difference between the predicted and actual values of the model for fear(P＞0.05),indicating a good fit of the model.Conclusion Age,number of comorbidities,number of pain sites,pain interference,mental resilience,pain degree,pain catastroph-ization and general self-efficacy score are the influencing factors of CMP,and the nomogram prediction model of CMP patients has a good degree of differentiation and fit.
基金项目
上海市健康促进委员会基金课题(JKKPZX-2021-B14)
NETL
NSTL
万方数据