Application effect of Precede-Proceed model nursing in postoperative anti-osteoporosis treatment of patients with osteoporotic thoracolumbar fracture
Objective To investigate the application effect of Precede-Proceed model nursing in postoperative anti-osteoporosis treatment of patients with osteoporotic thoracolumbar fracture(OTLF).Methods A retrospective cohort study was conducted to analyze the clinical data of 168 patients with OTLF admitted to the Second Affiliated Hospital of Soochow University from September 2021 to June 2022,including 32 males and 136 females,aged 56-81 years[(72.0±6.6)years].The fractured segments were T1-T10 in 29 patients,T11-L2 in 114 and L3-L5 in 25,all of whom were treated with percutaneous kyphoplasty(PKP).The 86 patients admitted from September 2021 to January 2022 were treated with conventional care(conventional nursing group)and the 82 patients admitted from February to June 2022 with Precede-Proceed model care(Precede-Proceed model nursing group).The compliance rates of anti-osteoporosis treatment at 1 and 6 months postoperatively and at the last follow-up were compared between the two groups,mainly including standardized medication,balanced diet,exercise and regular return visit.Chinese Osteoporosis Quality of Life(COQOL)questionnaire,including pain degree,physical function,social interaction ability,psychological and mental function,and total score were assessed before,at 6 months after surgery and at the last follow-up.Bone mineral density was measured preoperatively and at the last follow-up.Recurrence rate was recorded at the last follow-up.Results All the patients were followed up for 12-16 months[(13.2± 1.0)months].There were 3 patients in the conventional nursing group and 2 in the Precede-Proceed model nursing group who were lost to follow-up.The compliance rates of standardized medication and regular return visit at 1 month after surgery were 97.5％(78/80)and 98.8％(79/80)in the Precede-Proceed model nursing group,which had no significant difference compared with 90.3％(75/83)and 96.4％(80/83)in the conventional nursing group(P＞0.05).The compliance rates of balanced diet and exercise at 1 month after surgery were 92.5％(74/80)and 91.3％(73/80)in the Precede-Proceed model nursing group,which were higher than those in the conventional nursing group[78.3％(65/83)and 73.5％(61/83)](P＜0.05 or 0.01).The compliance rates of standardized medication,balanced diet,exercise and regular return visit at 6 months after surgery were 86.3％(69/80),83.8％(67/80),82.5％(66/80)and 90％(72/80)in the Precede-Proceed model nursing group,which were higher than those in the conventional nursing group[57.8％(48/83),60.2％(50/83),38.6％(32/83)and 37.3％(31/83)](P＜0.01).At the last follow-up,the compliance rates of all the aspects in the Precede-Proceed model nursing group were 80％(64/80),75％(60/80),70％(56/80)and 82.5％(66/80),which were all higher than those of the conventional nursing group[36.1％(30/83),54.2％(45/83),26.5％(22/83)and 27.7％(23/83)](P＜0.01).There were no statistical differences in COQOL scores including pain degree,physical function,social interaction ability,psychological and mental function and total scores between the two groups before surgery(P＞0.05).The pain degree,social interaction ability,psychological and mental function and total scores of COQOL in the Precede-Proceed model nursing group were lower than those in conventional nursing group at 6 months after surgery and at the last follow-up(P＜0.05 or 0.01).There was no statistical difference in the physical function of COQOL scores at 6 months after surgery(P＞0.05).The physical function of COQOL scores in the Precede-Proceed model nursing group were significantly lower than that of the conventional nursing group at the last follow-up(P＜0.05).There was no statistical difference in preoperative bone mineral density between the two groups(P＞0.05).Bone mineral density in the Precede-Proceed model nursing group was(-2.7±0.9)SD at the last follow-up,which was higher than that in the conventional nursing group[(-3.1±0.9)SD](P＜0.05).At the last follow-up,bone mineral density of the Precede-Proceed model nursing group was significantly improved compared with that before surgery(P＜0.01),while there was no significant difference in the conventional nursing group(P＞0.05).The incidence of refracture in the Precede-Proceed model nursing group was 3.8％(3/80),which was lower than that in conventional nursing group[13.3％(11/83)](P＜0.05).Conclusion Compared with the conventional nursing mode,the Precede-Proceed model nursing can significantly improve the compliance rate of OTLF patients with postoperative anti osteoporosis treatment,improve their quality of life and bone quality,and reduce the incidence of refracture.
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