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| 冠心病经皮冠状动脉介入术后体力活动阻碍量表的研发与应用 |
| 王政1,李佳佳1,焦昆立2,严健华2,AliceYmJONES3,韩甲4*,孟舒2* |
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(1. 上海体育学院运动健康学院, 上海 200438;
2. 上海交通大学医学院附属新华医院心血管内科, 上海 200092;
3. 澳大利亚昆士兰大学健康与康复科学学院, 布里斯班 4072;
4. 上海健康医学院康复学院, 上海 201318
*通信作者) |
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| 摘要: |
| 目的 编制国内首个冠心病患者经皮冠状动脉介入术（PCI）后体力活动阻碍量表，对其信、效度进行检验，并使用本量表探究PCI后患者体力活动阻碍的影响因素。方法 基于生物-心理-社会模型，通过国内外多学科专家讨论设计形成量表。经预测调整后，在上海交通大学医学院附属新华医院随机选取45例接受过PCI治疗的冠心病患者，采用Cronbach’s α系数对量表条目进行内部一致性检验，使用组内相关系数（ICC）评估量表重测信度；在此基础上纳入189例接受过PCI治疗的冠心病患者进行量表效度分析，并采用Spearman相关分析和单因素方差分析考察合并症数量是否为影响体力活动参与的因素。结果 本量表共20个条目，从生物、心理、社会3个维度体现患者体力活动阻碍情况。信度研究纳入42例患者，量表总体Cronbach’s α系数为0.915，生物、心理、社会维度Cronbach’s α系数分别为0.825、0.881和0.833；量表总体ICC为0.877（95% CI 0.782～0.932），生物、心理、社会维度ICC分别为0.710（95% CI 0.521～0.833）、0.798（95% CI 0.654～0.886）、0.821（95% CI 0.691～0.900）。效度研究纳入189例患者，探索性因子分析结果显示累积方差贡献率为52%；验证性因子分析结果表明模型拟合效果良好，区分效度理想。189例患者年龄为（66.69±8.70）岁，生物、心理和社会维度得分分别为（18.95±4.34）、（24.63±6.38）和（11.49±3.65）分，总得分为（55.07±11.68）分，Spearman相关分析结果显示PCI后患者的合并症数量与其体力活动阻碍量表得分呈正相关（rs=0.189，P<0.01），单因素方差分析结果显示有3个及以上合并症的PCI后患者体力活动阻碍得分高于无合并症、有1个或2个合并症的患者（P=0.01、0.03、0.05）。结论 冠心病PCI后体力活动阻碍量表具有良好的信度和效度，可作为评价PCI后人群体力活动阻碍的测量工具，为临床开展具有针对性的教育干预提供依据。合并症数量越多的患者体力活动阻碍越大，存在3个及以上合并症的PCI后患者的体力活动阻碍程度最高，是临床宣教的重点干预群体。 |
| 关键词: 冠心病 经皮冠状动脉介入术 体力活动 阻碍 信度 效度 |
| DOI：10.16781/j.CN31-2187/R.20211089 |
| 投稿时间：2021-10-28修订日期：2022-01-06 |
| 基金项目:国家自然科学基金面上项目（31870936），上海交通大学医学院儿科学院2020年儿科学专业“5＋3”教学类科研课题资助项目. |
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| Development and application of barriers to physical activity scale in patients with coronary artery disease post-percutaneous coronary intervention |
| WANG Zheng1,LI Jia-jia1,JIAO Kun-li2,YAN Jian-hua2,Alice Ym JONES3,HAN Jia4*,MENG Shu2* |
(1. School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China;
2. Department of Cardiovasology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;
3. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
4. College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
*Corresponding authors) |
| Abstract: |
| Objective To develop the first barriers to physical activity scale in patients with coronary artery disease (CAD) post-percutaneous coronary intervention (PCI) in China, test its reliability and validity, and use the scale to investigate the influencing factors of physical activity barriers in patients after PCI. Methods Based on the biopsychosocial model, the scale was designed through discussions of multidisciplinary experts at home and abroad. After prediction adjustment, 45 CAD patients after PCI were randomly enrolled from Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The internal consistency of the scale items was evaluated by Cronbach's α coefficient, and the test-retest reliability was evaluated by intraclass correlation coefficient (ICC). On this basis, 189 CAD patients after PCI were included for validity analysis, and Spearman correlation analysis and one-way analysis of variance (one-way ANOVA) were used to examine whether the number of comorbidities was a factor affecting physical activity participation. Results There were 20 items in the scale. They reflected the patients' physical activity barriers from 3 dimensions (biological, psychological, and social dimensions). The reliability study included 42 patients, the overall Cronbach's α coefficient was 0.915, and the Cronbach's α coefficients of biological, psychological and social dimensions were 0.825, 0.881 and 0.833, respectively; the overall ICC was 0.877 (95% confidence interval[CI] 0.782-0.932), and the ICCs of the 3 dimensions were 0.710 (95% CI 0.521-0.833), 0.798 (95% CI 0.654-0.886), and 0.821 (95% CI 0.691-0.900), respectively. The validity study included 189 patients, and exploratory factor analysis showed that the cumulative variance contribution rate was 52%; confirmatory factor analysis showed that the fitting model was good and the discrimination validity was ideal. The age of 189 patients was (66.69±8.70) years old, the scores of the 3 dimensions were 18.95±4.34, 24.63±6.38, and 11.49±3.65, respectively, and the total score was 55.07±11.68. Spearman correlation analysis showed that the number of comorbidities in patients after PCI was positively correlated with their scores of the scale (rs=0.189, P<0.01). One-way ANOVA showed that patients with 3 or more comorbidities had significantly higher scores of the scale than patients with no comorbidity, 1, or 2 comorbidities (P=0.01, 0.03, 0.05). Conclusion The barriers to physical activity scale in patients with CAD post-PCI has good reliability and validity. It can be used as a tool to evaluate the barriers to physical activity in post-PCI patients and provides evidence for specific education in clinical work. The more comorbidities the patients have, the more physical activity barriers they have. Post-PCI patients with 3 or more comorbidities have the highest level of barriers to physical activity, and they are the main intervention group of clinical education. |
| Key words: coronary artery disease percutaneous coronary intervention physical activity barrier reliability validity |
