健康促进模式教育在女性膀胱过度活动症患者中的应用

目的:评价健康促进模式教育对改善女性膀胱过度活动症患者生活行为和健康状况的效果。方法:选择我院2015年1月1日至6月30日期间收治的女性膀胱过度活动症患者为研究对象,按照随机数字法分为对照组(86例)和实验组(87例)。对照组采用膀胱过度活动症常规健康教育,实验组在此基础上,实施基于健康促进模式的健康教育。于患者入院时和干预3个月后分别应用健康促进生活方式问卷(HPLP)、膀胱过度活动症状评分量表(OABSS)和King’s健康问卷(KHQ)评估。结果 :干预3个月后,实验组健康责任、压力应对、运动、自我实现维度评分和总分均明显高于对照组(P0.05);干预前后实验组OABSS评分分别为(7.82±3.23)分和(3.10±2.24)分,差异有统计学意义(t=11.268,P0.001);干预后实验组KHQ评分量表的排尿症状严重程度、运动受限、社交受限、行为受限、症状应对和总体健康感受评分均低于对照组(P0.01)。结论 :健康促进模式教育可以有效帮助患者建立健康行为,改善症状和健康状况。     

行为疗法在膀胱过度活动症中的应用进展

膀胱过度活动症(OAB)因其严重影响生活质量,目前已经成为全世界严重的社会健康问题之一[1]。国际尿控协会(ICS)将OAB定义为尿急伴或不伴急迫性尿失禁(UI),通常有尿频和夜尿增多,而无泌尿系统感染或其他确切病变者[2]。行为疗法是建立在行为学习理论基础上的一种治疗方法,其     

盆底肌电刺激治疗老年女性患者膀胱过度活动症

膀胱过度活动症(overactive bladder,OAB)是指由于逼尿肌无抑制性收缩引起的尿急、尿频和/或急迫性尿失禁症状.     

感觉相关的排尿日记在社区女性膀胱过度活动症中的应用研究

目的 应用感觉相关的排尿日记评价40岁及以上的社区女性的膀胱过度活动症(OAB)发病情况.方法 620例女性(平均58岁)完成了3 d的感觉相关的排尿日记.膀胱感觉的定义:0级=膀胱没有感觉,1级=膀胱有涨满的感觉,但没有排尿的愿望,2级=有排尿愿望,3级=有强烈的排尿愿望,4级=有非常紧迫的排尿愿望,但没有急迫性尿失禁,5级=出现因尿急引起的漏尿.结果 96例(15.5%)有OAB症状,包括74例(11.9%)没有急迫性尿失禁(即干性OAB)和22例(3.5%)伴有急迫性尿失禁(即湿性OAB).在全部的11 418次排尿中,随着膀胱感觉等级的增加,排尿量显著增加.干性OAB受试者的24 h排尿量显著高于正常受试者.湿性OAB受试者的平均排尿量显著低于干性OAB受试者和正常受试者.无尿急感觉的正常组的膀胱感觉3级时平均排尿量显著高于其他各组.湿性OAB组的膀胱感觉4级和5级时排尿量显著低于正常组和干性OAB组.结论 感觉相关的排尿日记能有效地评价排尿感觉、尿失禁和排尿模式.正常组、干性OAB组和湿性OAB组中引起诸如尿急或尿频等症状的原因可能不同.     

肾气丸联合缩泉丸治疗膀胱频动症的临床观察

<正>膀胱频动症(又称膀胱过度活动症或尿道综合症,OAB)是以临床表现尿急、尿频为主,伴夜尿、尿失禁等膀胱刺激症状的一组症候群。其尿常规、尿培养(细菌加药敏)、尿生化、膀胱镜检查、泌尿系B     

骶神经根磁刺激联合行为治疗对脊髓损伤后 膀胱过度活动症的临床疗效观察

目的：观察骶神经根磁刺激联合行为治疗对脊髓损伤（SCI）后膀胱过度活动症(OAB)的临床疗效。方法：选取我科2017年12月至2018年12月期间收治的SCI后OAB患者33例,均采用行为治疗和骶神经根磁刺激治疗,共治疗4周。比较治疗前后排尿日记记录项目、膀胱过度活动症症状评分（OABSS）问卷评分、尿失禁问卷表简表（ICIQ-SF）评分及尿失禁生活质量量表(I-QOL)评分。结果：治疗后患者24 h平均排尿次数为（7.30±1.01）次、平均排尿量为（204.79±9.19）m L、平均尿急次数为（1.36±0.86）次、平均尿失禁次数为（0.58±0.50）次,OABSS总评分为（3.64±1.06）分,ICIQ-SF评分为（11.61±1.14）分,I-QOL评分为（70.39±2.77）分,与治疗前比较差异均具有统计学意义（均P<0.05）,治疗总有效率为75.76%。结论：骶神经根磁刺激联合行为治疗能够抑制SCI后膀胱过度活动,改善尿频、尿急、尿失禁,改善生活质量。     

膀胱过度活动症的研究进展

膀胱过度活动症是一种新的疾病诊断概念,表现为尿频、尿急,或合并急迫性尿失禁,是相当常见的慢性疾患,可严重困扰患者的生活。现对膀胱过度活动症的病因、诊断和治疗等进展作一综述。     

膀胱过度活动症患者症状发作的环境诱因

目的探讨膀胱过度活动症(overactive bladder,OAB)患者症状发作时的环境诱因。方法便利抽取2013年1月至2014年3月在温州医科大学附属第二医院门诊诊治的76例OAB患者为研究对象,应用自行设计的半结构式问卷调查该组患者发生尿急和尿失禁时的环境诱因,并量化每个患者面对某个诱因时OAB发作的频率(很少=1,有时=2,经常=3,通常=4,总是=5)。结果所有患者(100%)均报告至少1个因素与尿急相关,92.1%的患者(n=70)报告至少1个因素与尿失禁相关;尿急或尿失禁关系最为密切的环境因素有去洗手间的路上、早晨醒来、外出回家开门时、感觉到寒冷时、由卧位站起、看见自来水、想到要去洗手间和因其他原因(除小便)在洗手间时。结论几乎所有的OAB患者均存在某一环境诱因能够诱发尿急或尿失禁发作,条件反射可能与症状发作有关。     

膀胱过度活动症(OAB)治疗近况

膀胱过度活动症(overactive bladder，OAB)是常规的排尿功能障碍的临床症状，也是目前国内外研究的热点之一。OAB的异名很多，但有神经异常原因者，常称逼尿肌反射亢进(detrusor hyperflexia)。根据国际尿控协会将OAB定义为逼尿肌无意识收缩，前提是没有感染或其他明显的病理改变，表现为尿急，伴有／也可不会急迫性尿失禁，并且经常有尿频和夜尿症状。     

膀胱过度活动症的药物治疗

膀胱过度活动症 (ｏｖｅｒａｃｔｉｖｅｂｌａｄｄｅｒ,ＯＡＢ)是以尿频、尿急和急迫性尿失禁为特征的下尿路功能性疾病。按照国际控尿协会 (ＩＣＳ)的定义 ,ＯＡＢ是指在膀胱充盈期患者主观抑制排尿 ,但逼尿肌自发或被诱发收缩 ,引起膀胱内压升高 (超过 15ｃｍＨ2 Ｏ)。ＯＡＢ可分为两类 ,有明确神经系统疾病者称为逼尿肌反射亢进 (ｄｅｔｒｕｓｏｒｈｙｐｅｒｒｅｆｌｅｘｉａ) ,原因有脊髓损伤、脑血管疾病和Ａｌｚｈｅｉｍｅｒ’ｓ病等 ;无神经系统病变者称为逼尿肌不稳定 (ｄｅｔｒｕｓｏｒｉｎｓｔａｂｉｌｉｔｙ) ,原因多为下尿路梗…     

Predictive Abilities of Balance Confidence and Fear of Falling Measures on Falls in Polio Survivors

Purposes: To determine 1) predictors of falls in adult survivors of polio and 2) if Activities-specific Balance Confidence (ABC) scale or Falls Efficacy Scale-International (FES-I) better predicted falls in this population. Methods: 415 participants completed anonymous on-line surveys, including fall history, walking status, ABC scale, FES-I, and Geriatric Depression Scale-15. Logistic and linear regressions and receiver operating curve analyses performed. Results: 69% and 81% of participants reported falls and fear of falling (FoF) (yes/no), respectively. Walking status significantly predicted falls in overall model. ABC significantly predicted falls in people who walk by separate logistic regressions. FES-I, reported FoF, and in-community walking status predicted fall frequency by linear regression. Conclusions: ABC, FES-I, and reported FoF are related to falling, especially in polio survivors who walk, with the ABC scale better predicting falls. Measures used were unhelpful in fall prediction for people who primarily use wheelchairs for locomotion.     

Do sleep problems or urinary incontinence predict falls in elderly women?

The objectives of this cross-sectional study were: (1) To determine if night-time sleep disturbance, daytime sleepiness, or urinary incontinence were associated with an increased risk of falling in older Australian women and (2) to explore the interrelationships between daytime sleepiness, night-time sleep problems, and urge incontinence. Participants were 782 ambulatory, community-dwelling women aged 75 to 86 recruited from within the existing Calcium Intake Fracture Outcome Study, in which women above 70 years were selected at random from the electoral roll. Daytime sleepiness, night-time sleep problems, urinary incontinence and falls data were collected via self-complete questionnaires. Thirty-five per cent of participants had fallen at least once in the past 12 months and 37.7% reported at least one night-time sleep problem. However, only 8.1% of the study sample experienced abnormal daytime sleepiness (Epworth Sleepiness Scale score > 10). Pure stress, pure urge, and mixed incontinence occurred in 36.8%, 3.7%, and 32.6% of participants respectively. In forward stepwise multiple logistic regression analysis, urge incontinence (OR 1.76; 95% CI 1.29 to 2.41) and abnormal daytime sleepiness (OR 2.05; 95% CI 1.21 to 3.49) were significant independent risk factors for falling after controlling for other falls risk factors (age, central nervous system drugs, cardiovascular drugs). As urge incontinence and abnormal daytime sleepiness were independently associated with an increased falls risk, effective management of these problems may reduce the risk of falling in older women.     

Reliability and validity of the Falls Efficacy Scale-International after hip fracture in patients aged ≥65 years

Abstract

Purpose: To assess the measurement properties of the Falls Efficacy Scale-International (FES-I) in patients after a hip fracture aged ≥ 65 years. Methods: In a sample of 100 patients, we examined the structural validity, internal consistency and construct validity. For the structural validity a confirmatory factor analysis was carried out. For construct validity predetermined hypotheses were tested. In a second sample of 21 older patients the inter-rater reliability was evaluated. Results: The factor analysis yielded strong evidence that the FES-I is uni-dimensional in patients with a hip fracture; the Cronbach’s alpha was 0.94. When testing the reliability, the intra-class correlation coefficient was 0.72, while the Standard Error of Measurement was 6.4 and the Smallest Detectable Change was 17.7 (on a scale from 16 to 64). The Spearman correlation of the FES-I with the one-item fear of falling instrument was high (r?=?0.68). The correlation was moderate with instruments measuring functional performance constructs and low with instruments measuring psychological constructs. Conclusions: Reliability and structural validity of the FES-I in patients after a hip fracture are good. The construct validity appears more closely related to functional performance constructs than to psychological constructs, suggesting that the concept measured by the FES-I may not capture all aspects of fear of falling.

• Implications for Rehabilitation

• The Falls Efficacy Scale-International (FES-I), which is commonly used to measure fear of falling in community-dwelling older persons, can also be used to assess fear of falling in patients after a hip fracture.

• The reliability and the structural validity of the FES-I for these hip patients are good, whereas the construct validity of the FES-I is not optimal.

• The FES-I may not capture all aspects of fear of falling and may be more closely related to functional performance than to psychological concepts such as anxiety.

     

Psychometric properties of the Swedish version of the Falls Efficacy Scale-International for older adults with osteoporosis,self-reported balance deficits and fear of falling

Abstract

Purpose: Investigate the psychometric properties of the Swedish version of the Falls Efficacy Scale-International (FES-I).

Method: Cross-sectional study. Community-dwelling older adults with self-reported balance deficits and fear of falling were recruited from an ongoing randomised controlled study to evaluate the psychometric properties of the FES-I using Rasch model analysis.

Results: The Rasch model analysis revealed good category function, the questionnaire measured one dimension with an explained variance of 68.6% and item goodness-of-fit with mean square values (MnSq) 0.7–1.44. The item map showed that all items are spread over the scale, which indicates different difficulties in the items. Non-satisfactory person goodness-of-fit was shown with seven persons and showed person misfit according to both the MnSq-value and the z-value, 38 persons (40%) showed a person misfit when only following the threshold for MnSq.

Conclusions: The Swedish version of FES-I shows good psychometric properties with unidimensionality and item goodness-of-fit. Lower person goodness-of-fit was shown probably because of confounding factors that may influence the answers. The transformed values of the FES-I make it possible to use parametric statistics preferable for this population in future research.

• Implications for rehabilitation

• The Falls Efficacy Scale-International (FES-I) shows good psychometric properties with unidimensionality, item goodness-of-fit and good item reliability, which means that FES-I is a valuable tool when measuring concerns about falling in an older population with osteoporosis and could be useful in clinical settings.

• Confounding factors such as pain, high number of falls, low fall self-efficacy, experience of previous falls, and vertigo may influence the answers and result in low person goodness-of-fit.

     

Analysis of measurement tools of fear of falling for high-risk, community-dwelling older adults

Fear of falling has many health consequences among older adults and may lead to curtailment of activities, immobility, functional dependence, falls, and serious injury. The lack of clarity as to how to best measure fear of falling among high-risk, community-dwelling older adults defined as those who are nursing home eligible, functionally dependent, and vulnerable is further complicated by the multiple definitions used throughout the science. Fear of falling is important to measure effectively if we are to develop and test interventions to promote safe aging in place and prevent injury and institutionalization. This integrative review, 1982 to the present, leads to the conclusion that the Falls Efficacy Scale-International (FES-I) long form stands out as the most appropriate measurement tool to best assess fear of falling in this unique, understudied, and underserved population.     

Disparity between perceived and physiological risks of falling among older patients in an acute care hospital

BackgroundFalls are the most frequent adverse events among hospitalised older adults. Previous studies highlighted that older adults might not understand the risk factors associated with falls and may have an altered perception of their actual risk.AimTo describe differences between perceived and actual physiological risk of falling among older adults and to explore factors associated with the differences.Methods: A prospective cohort study was done. Older adults (age 65 years and above) were interviewed one-to-one at bedside. Morse Fall Scale (MFS) and other risk factors for falls were used to identify the patients’ physiological fall risks. Patients’ perceived risk of falls were assessed using the Falls Efficacy Scale-International (FES-I).ResultsThree hundred patients were recruited. Patients’ mean age was 75.3 (SD = ± 6.2). Majority were males (51.7%), lived with others (91.7%), and had received primary school education (35.3%). Based on the MFS, most patients had moderate fall risk (59.7%). Using the FES-I, more than half the patients (59%) interviewed had high concerns about falling. About one-third of the patients’ (31.3%) perceived risk matched with their physiological fall risk (Risk-Aware). Half of the patients’ perceived risks was higher than their physiological fall risk (50.7%) (Risk-Anxious), while the remaining patients’ perceived risks was reported to be lower than their physiological fall risk (18%) (Risk-Taker).ConclusionOlder patients are poor at recognizing their fall risks. Both patients’ perceived and actual fall risks should be evaluated in the inpatient setting in order to inform individualized fall prevention education and strategies.     

The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke

OBJECTIVES: To describe the frequency of falls; to relate capacity-based and self-efficacy measures to fall history; and to determine to what extent capacity-based and self-efficacy measures are explained by subject characteristics and stroke impairments. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: Convenience sample of 50 people with chronic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fall history, Falls Efficacy Scale-Swedish Version, fear of falling, and the mood subscore of the Stroke Impact Scale. Balance, strength, and functional mobility were measured using the Berg Balance Scale, timed sit to stand, and Timed Up & Go, respectively. RESULTS: Falls were reported by 40% (n=20) of subjects; 22% (n=11) reported multiple falls. Subjects with fall history had more fear of falling (relative risk [RR], 2.4; 95% confidence interval [CI], 1.1-4.9), had less falls-related self-efficacy (P=.04), and more depressive symptoms (P=.02) than nonfallers. Subjects with multiple fall history had poorer balance (P=.02), more fear of falling (RR=5.6; 95% CI, 1.3-23), and used a greater number of medications (P=.04) than non- and 1-time fallers. Strength partially explained balance, mobility, and falls-related self-efficacy. CONCLUSIONS: Balance and falls-related self-efficacy are associated with fall history and should be addressed in people with chronic stroke.     

Cross-cultural validation of the Falls Efficacy Scale-International to assess concerns about falls among Hungarian community-living older people

Abstract

Purpose: The Falls Efficacy Scale-International (FES-I) is a reliable and valid tool for assessing concerns about falling. Our aims were to translate, culturally adapt, and evaluate the main psychometric characteristics (internal consistency, reproducibility, and convergent construct validity) of the Hungarian version of the FES-I on a sample of community-living older adults.

Methods: After translating and culturally adapting the original scale, 165 community-living older adults (aged 60?years or over) participated in the measurements and filled in the questionnaire. After two weeks, a subsample of 64 persons filled in the FES-I again to determine the test–retest reliability.

Results: The test–retest analysis showed excellent reliability: Intraclass Correlation Coefficient was 0.831. The FES-I Hungarian consisted of two factors that showed good internal consistency: Cronbach’s alpha 0.95 (Factor 1), 0.89 (Factor 2), and 0.93 (whole scale). The FES-I was able to discriminate the participants based on gender and fall history. It showed a significant correlation with the Timed Up and Go test (r?=?0.740) and the general health perception (r?=??0.713).

Conclusions: Translation and cultural adaptation of the original scale were successful. The Hungarian version proved to be a reliable, valid tool confirming that it can be used in future clinical and scientific work with Hungarian older people.

• Implications for rehabilitation

• Excessive concerns about falls may lead to avoidance of activities, decreasing functional abilities, increasing of risk of a future fall, ultimately premature nursing home admission.

• The Falls Efficacy Scale-International is a widespread tool for assessing concerns about falls.

• The Hungarian version of Falls Efficacy Scale-International has an excellent test–retest reliability, good internal consistency, and acceptable construct validity.

• The Hungarian version of Falls Efficacy Scale-International is a valid and reliable tool for measuring the concerns about falls among Hungarian-speaking community-living older people in everyday clinical practice and scientific studies.