护士主导支持对患有肠易激综合征的年轻人的疼痛和生活质量的影响

  67171652007703433

  Abstract

  Background

  Irritable bowel syndrome is a chronic pain condition that needs life-long self-management. However, the effect of self-management among young adults with irritable bowel syndrome is limited.

  Objectives

  This study aimed to examine the effect of a nurse-led self-management program on pain, symptoms, and quality of life among young adults with irritable bowel syndrome.

  Design

  A randomized controlled trial.

  Settings and participants

  Eighty young adults with irritable bowel syndrome recruited from two campuses of a public university and two gastrointestinal clinics were randomly assigned into a self-management online education and learning modules alone group (Online Modules, n?=?41) or a nurse-led one-to-one consultation plus self-management online education and learning modules group (Nurse-Led Online Modules, n?=?39). Twenty-one healthy controls were also recruited from these two campuses.

  Methods

  Both the intervention groups received ten online modules after baseline data collection. Participants in the Nurse-Led Online Modules group received additional three nurse-led one-to-one consultations at baseline, 6- and 12-week follow up. Self-reported pain, symptoms, quality of life, self-efficacy for managing chronic disease, and coping were measured at baseline, and 6- and 12-week follow up among the participants with irritable bowel syndrome. The healthy controls completed data collection of pain and symptoms at baseline and 12-week follow up. The intervention effects across study time points and the comparisons between the two interventional groups were analyzed using linear mixed models. A longitudinal mediation analysis was also conducted to explore the mediation effects of self-management mechanisms of the interventions.

  Results

  Both the intervention groups showed significant interventional effects on decreasing pain intensity and pain interference and increasing quality of life at the 12-week follow up (all p?<?0.05). At the 12-week follow up, the Nurse-Led Online Modules significantly reduced anxiety (p?=?0.016) and had a significant greater improvement in quality of life than the Online Modules (p?=?0.040). Increased self-efficacy mediated the intervention effect of the Nurse-Led Online Modules group on reducing pain interference and improving quality of life, while the effect of the Online Modules was mediated through decreased an inefficient coping strategy-catastrophizing.

  Conclusions

  This study showed that both the pain self-management online education and nurse-led intervention were effective for alleviating pain and improving quality of life among young adults with irritable bowel syndrome by targeting the self-management process. The nurse-led intervention had a better outcome than the online education alone in improving quality of life.

  摘要翻译(仅供参考)

  背景介绍

  肠易激综合征是一种慢性疼痛疾病,需要终身自我管理。然而,在患有肠易激综合征的年轻成年人中,自我管理的效果是有限的。

  研究目的

  本研究旨在研究由护士领导的自我管理计划对患有肠易激综合征的年轻人的疼痛、症状和生活质量的影响。

  设计

  一项随机对照试验。

  场所和参与者

  从一所公立大学的两个校区和两个胃肠道诊所招募的80名患有肠易激综合征的年轻人被随机分配到自我管理在线教育和学习模块组(在线模块,n = 41)或护士领导的一对一咨询加自我管理在线教育和学习模块组(护士领导的在线模块,n = 39)。在这两个校区还招募了21名健康对照组的成员。

  方法

  在基线数据收集后,两个干预组都接受了十个在线模块。在基线、6周和12周的随访中,护士指导的在线模块组的参与者还接受了三次护士指导的一对一咨询。患有肠易激综合征的参与者在基线、6周和12周的随访中对自我报告的疼痛、症状、生活质量、管理慢性疾病的自我效能和应对能力进行了测量。健康对照组在基线和12周随访时完成了疼痛和症状的数据收集。使用线性混合模型分析了各研究时间点的干预效果和两个干预组之间的比较。还进行了纵向调解分析,以探索干预措施的自我管理机制的调解效果。

  结果

  在12周的随访中,两组干预组在降低疼痛强度和疼痛干扰以及提高生活质量方面都显示出显著的干预效果(所有P<0.05)。在12周的随访中,护士指导的在线模块明显减少了焦虑(p = 0.016),生活质量的改善也明显大于在线模块(p = 0.040)。自我效能的提高是护士指导下的在线模块组在减少疼痛干扰和改善生活质量方面的干预效果的中介,而在线模块的效果是通过减少低效的应对策略--灾难化来中介的。

  结论

  本研究表明,疼痛自我管理在线教育和护士指导的干预都能有效地缓解疼痛,并通过针对自我管理过程来改善患有肠易激综合征的年轻成年人的生活质量。在改善生活质量方面,护士引导的干预措施比单纯的在线教育有更好的效果。