IMB 모델 기반 요추 척추관 협착증 수술 환자 자가관리 프로그램의 개발 및 효과

Abstract

As the number of patients with lumbar spinal stenosis increases, various intervention programs are implemented to prevent complications. However, there are few intervention programs for prevention of spine health status for lumbar spinal stenosis patients. This study developed a self-management program for patients with lumbar spinal stenosis surgery based on IMB model(Information-Motivation-Behavioral skills model). This intervention programs which attempted to verify the effects of self-management program for patients with lumbar spinal stenosis surgery on self-management information, motivations, behavioral skills, behaviors, health related quality of life, lower extremity muscular strength, pain and health outcome. This study was conducted for lumbar spinal stenosis patients who had surgery in a General hospital in Busan city. A nonequivalent control group pretest-posttest non-synchronized design was used in this study. Data were collected from August 11, 2022 to March 31, 2023, with a control group of 28 patients and an experimental group of 30 patients from General hospital A. The data analysis was performed using an SPSS/WIN 23.0 program, and either and independent t-test, χ2-test, or Fisher’s exact test was used for preliminary testing regarding homogenity. To test the hypotheses, the normality of the differences between the pretest and posttest data of the experimental and control group was assessed using the Shapiro-Wilks test and, subsequently, the Mann-Whitney U test, because the data were not normally distributed. Experimental group was provided with a total of 6 times of education individually, counseling and practices, whereas control group was given one-time general health counseling. In order to assess the effects of self-management program for patients with lumbar spinal stenosis surgery based on IMB model, questionnaire surveys were used to measure self-management information, personal and social motivations, behavior skills, behavior and health related quality of life. Among the disease-related characteristics, lower extremity muscle strength directly measured the time taken for STS5 test, and EMR were used to measure pain using VAS score, disc height, lumbar lordotic angle. Results of the study showed that there were significant differences in self-management information(p<.001), personal motivation(p=.002), social motivation(p=.002), behavior skills(p=.002), behaviors(p=.003), health related quality of life(p<.001) and disc height (p=.006) of experimental group after intervention program were implemented, as compared to control group. However, no significant differences were identified in lower extremity muscular strength, lumbar lordotic angle, VAS score of LBP and leg pain between the two groups. Therefore, self-management program for patients with lumbar spinal stenosis surgery based on IMB model, which was developed in this study, was found to be effective in improving lumbar spinal stenosis patients’ self-management information, motivation, behavior skills, behaviors, health related quality of life and self-management health outcomes. However, future research directions are recommended to be toward studies to verify the effects of self-management program for patients with lumbar spinal stenosis surgery by extending the period of intervention programs.