Abstract:

Objective　To analyze the mesomeric effect of resilience between self-management ability and quality of life in patients with cervical spondylosis. Methods　A prospective controll and cohort study was conducted. A total of 202 patients with cervical spondylosis (observation group) and 202 healthy individuals (control group) were selected from the First Affiliated Hospital of Henan University of Chinese Medicine from January 2022 to July 2023. There were 105 males and 97 females in the observation group, aged 22-78 (40.50±8.52) years. There were 103 males and 99 females in the control group, aged 27-79 (40.24±5.88) years. The self-management abilities, psychological resilience, and qualities of life of the two groups were evaluated and compared by the Adult Health Self-Management Skill Rating Scale III (AHSMSRS III), Connor-Davidson Resilience Scale (CD-RISC), and 36-item Short-Form (SF-36). The correlations between psychological resilience and self-management ability and quality of life, and the correlation between self-management ability and quality of life in the observation group were analyzed. Mplus 8.3 software was used to analyze the mesomeric effect of resilience between self-management ability and quality of life in the observation group, which was verified by Bootstrap method. Independent sample t test, χ² test, and Pearson correlation analysis were used. Results　In the observation group, there were 7 cases of invalid questionnaires and 3 cases of poor compliance, and there were 9 cases of invalid questionnaires and 2 cases of poor compliance in the control group, all of whom fell off. The scores of self-management behaviors, self-management cognition, self-management environment, self-management ability, strength, resilience, optimism, psychological resilience, physical health, mental health, and quality of life in the observation were (33.48±5.12) points, (30.52±4.89) points, (20.76±3.73) points, (84.76±7.36) points, (11.07±2.05) points, (32.25±4.88) points, (22.18±3.75) points, (65.50±6.59) points, (54.36±6.48) points, (43.74±5.75) points, and (98.10±8.57) points, respectively, which were lower than those in the control group [(50.25±6.27) points, (51.09±6.73) points, (38.27±5.18) points, (139.61±10.35) points, (15.48±4.10) points, (48.09±5.92) points, (33.12±4.38) points, (96.69±8.75) points, (71.69±8.69) points, (58.40±7.24) points, and (130.09±11.89) points], with statistically significant differences (t=22.532, 24.867, 28.259, 43.406, 9.478, 21.675, 18.192, 28.357, 15.626, 16.024, and 22.148, all P<0.001). There were positive correlations between each two scores mentioned above in the observation group (all P<0.05). According to the linear regression analysis, the self-management ability in the observation group could affect psychological resilience and quality of life (P<0.05), and psychological resilience had a partial mesomeric effect between self-management ability and quality of life in the observation group (P<0.05). The mesomeric effect structural equation model constructed and Bootstrap method both confirmed that resilience played a mesomeric effect between self-management ability and quality of life in the observation group (P<0.05), the direct effect of self-management ability on quality of life was 0.66, and the indirect effect of psychological resilience on quality of life was 0.24, with a total effect of 0.90. The indirect effect accounted for 26.67% of the total effect. Conclusions　Patients with cervical spondylosis have low self-management ability, resilience, and quality of life. Self-management ability is directly related to quality of life, and resilience plays a mesomeric effect between the two.

Key words:

Cervical spondylosis, Psychological resilience, Self-management ability, Quality of life, Mesomeric effect

摘要：

目的　分析心理弹性在颈型颈椎病患者自我管理能力与生活质量间的中介效应。方法　采用前瞻性对照与队列研究。选取河南中医药大学第一附属医院2022年1月至2023年7月收治的202例颈型颈椎病患者（观察组）和202例健康体检者（对照组）。观察组男105例、女97例；年龄22～78（40.50±8.52）岁。对照组男103例、女99例；年龄27～79（40.24±5.88）岁。采用成年人健康自我管理能力测评量表Ⅲ（AHSMSRSⅢ）、心理弹性量表（CD-RISC）、简明生活质量量表-36（SF-36）分别对两组自我管理能力、心理弹性、生活质量进行评价并比较。分析观察组患者心理弹性与自我管理能力、生活质量，自我管理能力与生活质量的相关性；Mplus 8.3软件分析心理弹性在观察组自我管理能力与生活质量间的中介效应，Bootstrap法验证。采用独立样本t检验、χ²检验、Pearson相关性分析。结果　观察组有7例调查问卷无效、3例依从性差，对照组有9例调查问卷无效、2例依从性差，均脱落。观察组健康自我管理行为、健康自我管理认知、健康自我管理环境评分及自我管理能力总分，力量、坚韧、乐观评分及心理弹性总分，躯体健康、心理健康评分及生活质量总分分别为（33.48±5.12）分、（30.52±4.89）分、（20.76±3.73）分、（84.76±7.36）分、（11.07±2.05）分、（32.25±4.88）分、（22.18±3.75）分、（65.50±6.59）分、（54.36±6.48）分、（43.74±5.75）分、（98.10±8.57）分，均低于对照组［（50.25±6.27）分、（51.09±6.73）分、（38.27±5.18）分、（139.61±10.35）分、（15.48±4.10）分、（48.09±5.92）分、（33.12±4.38）分、（96.69±8.75）分、（71.69±8.69）分、（58.40±7.24）分、（130.09±11.89）分］，差异均有统计学意义（t=22.532、24.867、28.259、43.406、9.478、21.675、18.192、28.357、15.626、16.024、22.148，均P<0.001），且观察组上述每两项评分间均呈正相关性（均P<0.05）。经线性回归分析，观察组自我管理能力可影响心理弹性、生活质量（P<0.05），且心理弹性在观察组自我管理能力与生活质量间呈部分中介效应（P<0.05）。构建的中介效应结构方程模型和Bootstrap法均证实心理弹性在观察组自我管理能力与生活质量间起中介效应（P<0.05），且自我管理能力对生活质量的直接效应为0.66，心理弹性对生活质量的间接效应为0.24，总效应为0.90，间接效应占总效应的26.67%。结论　颈型颈椎病患者自我管理能力、心理弹性和生活质量低，自我管理能力与生活质量直接相关，且心理弹性在二者间起中介效应。

关键词:

颈型颈椎病, 心理弹性, 自我管理能力, 生活质量, 中介效应