延续性功能锻炼指导对类风湿性关节炎患者生活质量的影响

目的探讨延续性功能锻炼指导对类风湿性关节炎患者生活质量的影响。 方法选取中国医科大学附属盛京医院第一风湿免疫内科2018年6月至12月收治的120例类风湿性关节炎患者为研究对象，采用随机抽签法将患者分为观察组和对照组，各60例。对照组患者出院时给予健康指导，嘱患者按时复诊，出院后进行电话随访1次。观察组在对照组的基础上出院后进行延续性功能锻炼指导。采用慢性病自我管理行为量表评价患者出院后自我管理情况，评价患者临床症状的控制情况，采用类风湿性关节炎患者生活质量量表评价患者出院后的生活质量。采用t检验比较组间上述相关评分的差异。 结果观察组出院后3个月，锻炼、认知性症状管理实践、与医师的沟通评分分别为（9.96±1.14）分、（8.97±1.34）分、（6.32±1.28）分，高于对照组的（8.93±1.18）分、（7.96±1.32）分、（5.44±1.51）分，差异均具有统计学意义（t=4.863、4.159、3.442，P<0.001、<0.001、=0.001）。观察组出院后3个月晨僵时间短于对照组［（1.05±0.47）h vs （1.34±0.56）h］，关节疼痛评分低于对照组［（1.34±0.75）分vs（2.48±0.89）分］，关节疼痛个数少于对照组［（3.74±1.31）个vs（5.28±1.61）个］，差异均具有统计学意义（t=3.073、7.587、5.677，P=0.002、<0.001、<0.001）。观察组干预后3个月在心理领域、生理领域、社会领域、健康自我认识及总的健康状况与生存质量方面评分分别为（3.72±1.15）分、（6.20±2.24）分、（5.43±1.37）分、（3.53±1.25）分、（5.72±2.26）分，均高于对照组的（1.59±0.57）分、（3.06±1.32）分、（3.21±1.08）分、（1.35±0.49）分、（2.14±1.15）分，差异均具有统计学意义（t=12.855、9.355、11.559、12.577、10.936，P均<0.001）。 结论延续性功能锻炼指导能够提高类风湿性关节炎患者对疾病的自我管理能力，有利于控制临床症状，改善患者的生活质量。

Effect of continuous functional exercise guidance on quality of life of patients with rheumatoid arthritis

ObjectiveTo explore the effect of continuous functional exercise guidance on the quality of life of patients with rheumatoid arthritis. MethodsOne hundred and twenty patients with rheumatoid arthritis admitted to the first Department of Rheumatology and Immunology of Shengjing Hospital Affiliated to China Medical University from June to December 2018 were divided into either an observation group or a control group, with 60 cases in each group. Both groups were given health guidance at the time of discharge, and the patients were asked to have follow-up visits on time. The observation group additionally received continuous functional exercise guidance after discharge. At 3 months after discharge, the self-management ability of patients was evaluated using the chronic disease self-management behavior scale, and the quality of life was evaluated using the rheumatoid arthritis patient quality of life scale. The control of clinical symptoms was also evaluated. The t-test was used to compare the differences in the above indicators between the two groups. ResultsThe scores of exercise, cognitive symptom management, and communication with doctors in the observation group were 9.96±1.14, 8.97±1.34, and 6.32±1.28, respectively, which were significantly higher than those in the control group (8.93±1.18, 7.96±1.32, and 5.44±1.51; t=4.863, 4.159, and 3.442; P<0.001, <0.001, and =0.001, respectively). Three months after discharge, the time of morning stiffness in the observation group was significantly shorter (1.05±0.47) h vs (1.34±0.56) h, t=3.073, P=0.002], the score of joint pain was significantly lower (1.34±0.75) vs (2.48± 0.89), t=7.587, P<0.001], and the number of joints with pain was significantly fewer than those in the control group (3.74±1.31) vs (5.28±1.61), t=5.677, P<0.001]. After 3 months of intervention, the scores of quality of life improvement in psychological field, physiological field, social field, health self-awareness, general health status, and quality of life in the observation group were 3.72±1.15, 6.20±2.24, 5.43±1.37, 3.53±1.25, and 5.72±2.26, respectively, which were significantly better than those in the control group (1.59±0.57, 3.06±1.32, 3.21±1.08, 1.35±0.49, and 2.14±1.15, respectively; t=12.855, 9.355, 11.559, 12.577, and 10.936, respectively; P<0.001 for all). ConclusionContinuous functional guidance can enhance the self-management ability of patients with rheumatoid arthritis and help to control their clinical symptoms and improve their quality of life.