结构化期望校准式沟通干预对腰椎滑脱融合术后功能恢复的影响

Effects of a Structured Expectation-Calibration Communication Intervention on Functional Recovery after Lumbar Fusion for Degenerative Lumbar Spondylolisthesis

摘要: 目的：探讨结构化期望校准式沟通干预对退变性腰椎滑脱融合术后患者预期落差、功能锻炼依从性及腰椎功能恢复的影响。方法：采用前瞻性随机对照试验设计，选取2024年1月至2025年1月在潍坊市人民医院接受单侧双通道内镜下单节段腰椎滑脱复位融合内固定术治疗的72例患者为研究对象，按照随机分配原则分为对照组和干预组，各36例。对照组实施常规围手术期护理及健康教育，干预组在此基础上实施结构化期望校准式沟通干预，包括术前期望识别、手术目标澄清、恢复轨迹校准、个体差异解释、分阶段目标设定、Teach-back复述确认及术后早期再校准。比较两组患者术后1个月实际达到得分和预期落差，并比较两组术前至术后3个月Oswestry功能障碍指数(ODI)及功能锻炼依从性评分的变化。结果：两组患者一般资料及术前基线指标比较，差异均无统计学意义(P > 0.05)。术后1个月，干预组实际达到得分为(62.78 ± 4.32)分，高于对照组的(57.25 ± 4.16)分，差异有统计学意义(t = −5.530, P < 0.001)；干预组预期落差得分为(9.50 ± 5.92)分，低于对照组的(13.39 ± 5.87)分，差异有统计学意义(t = 2.799, P= 0.007)。重复测量方差分析显示，两组ODI评分的组间效应、时间效应及组别 × 时间交互效应均有统计学意义(F = 99.406、1970.846、11.037，均P < 0.001)；两组功能锻炼依从性评分的组间效应、时间效应及组别 × 时间交互效应亦均有统计学意义(F = 53.391、205.938、13.399，均P < 0.001)。干预组术后ODI评分下降幅度及功能锻炼依从性评分升高幅度均大于对照组。结论：结构化期望校准式沟通干预能够降低退变性腰椎滑脱融合术后患者的预期落差，提高功能锻炼依从性，并有助于促进术后早期腰椎功能恢复。

Abstract: Objective: To investigate the effects of a structured expectation-calibration communication intervention on expectation discrepancy, adherence to functional exercise, and lumbar functional recovery in patients undergoing lumbar fusion for degenerative lumbar spondylolisthesis. Methods: In this prospective randomized controlled trial, 72 patients who underwent unilateral biportal endoscopic single-level reduction, fusion, and internal fixation for degenerative lumbar spondylolisthesis at Weifang People’s Hospital between January 2024 and January 2025 were randomly assigned in a 1:1 ratio to an intervention group or a control group, with 36 patients in each group. The control group received routine perioperative care and health education. In addition to routine care, the intervention group received a structured expectation-calibration communication intervention, which included preoperative expectation identification, clarification of surgical goals, calibration of the anticipated recovery trajectory, explanation of individual differences, establishment of stage-specific goals, teach-back confirmation, and early postoperative recalibration. Scores for perceived achievement and expectation discrepancy at 1 month after surgery were compared between the two groups. Changes in the Oswestry Disability Index (ODI) and functional exercise adherence scores from baseline to 3 months after surgery were also compared. Results: No statistically significant differences were observed between the two groups in demographic characteristics or preoperative baseline indicators (all P > 0.05). At 1 month after surgery, the perceived achievement score was higher in the intervention group than in the control group (62.78 ± 4.32 vs. 57.25 ± 4.16; t = −5.530, P < 0.001), whereas the expectation discrepancy score was lower in the intervention group than in the control group (9.50 ± 5.92 vs. 13.39 ± 5.87; t = 2.799, P = 0.007). Repeated-measures analysis of variance demonstrated significant group, time, and group-by-time interaction effects for ODI scores (F = 99.406, 1970.846, and 11.037, respectively; all P < 0.001). Significant group, time, and group-by-time interaction effects were also observed for functional exercise adherence scores (F = 53.391, 205.938, and 13.399, respectively; all P < 0.001). The intervention group showed a greater reduction in ODI scores and a greater increase in functional exercise adherence scores than the control group. Conclusion: The structured expectation-calibration communication intervention can reduce expectation discrepancy, improve adherence to functional exercise, and facilitate early functional recovery after lumbar fusion in patients with degenerative lumbar spondylolisthesis.