摘要
目的探讨基于虚拟现实技术(virtual reality,VR)的体感游戏融入居家透析运动管理对透析患者跌倒风险及生活质量的影响。方法纳入陆军特色医学中心血液净化中心42名血液透析患者,随机分成研究组和对照组。2组均予常规血液透析治疗及护理,包括饮食营养指导、各种并发症的处理等。对照组采用常规治疗,日常活动照常,患者根据日常习惯进行常规运动活动。研究组在对照组的基础上采用基于VR的体感游戏融入居家透析运动管理。持续观察6个月,并比较干预前和干预后患者自我规律运动的信心程度,评估跌倒风险及生存质量。结果入组前2组患者运动自我效能评分无差异,入组后6个月研究组的运动自我效能量表(self-efficacy for exercise,SEE)各项目评分及总体高于对照组(天气影响运动实施:32.42±12.05/50.61±14.38,t=-4.442,P<0.001;认为运动项目枯燥:34.71±14.72/50.9±19.67,t=-3.019,P=0.004;运动时感到不适:34.28±14.07/54.52±20.44,t=-3.737,P=0.001;运动时感到很孤单:28.85±11.59/60.90±22.27,t=-5.850,P<0.001;不喜欢运动:29.52±12.58/53.19±18.13,t=-4.912,P<0.001;运动太频繁:32.76±15.72/63.28±17.91,t=-5.867,P<0.001;运动太累:35.71±15.40/58.90±17.09,t=-4.619,P<0.001;运动压力太大:27.19±9.58/58.33±21.82,t=-5.986,P<0.001;运动感到沮丧:28.80±15.43/60.85±20.35,t=-5.748,P<0.001;合计:30.82±3.79/56.83±3.35,t=-23.542,P<0.001)。入组前2组患者跌倒风险评分无差异,入组后3个月研究组的Morse跌倒评分低于对照组(40.38±10.73/29.23±7.46,t=3.068,P<0.001),6个月研究组低于对照组(37.09±9.40/18.42±6.88,t=4.063,P<0.001),差异有统计学意义;入组时2组患者的生存质量量表(the MOS item short from health survey,SF-36)的8个维度评分均较低,入组6个月后研究组的躯体功能(42.00±12.85/55.71±12.34,t=-3.525,P=0.001)、由躯体问题所造成的角色限制(42.23±12.87/59.90±17.34,t=-3.748,P<0.001)、躯体不适(42.76±11.76/51.38±11.91,t=-2.358,P=0.023)、健康总体自评(41.28±10.82/50.47±8.20,t=3.101,P=0.003)、活力(38.85±13.52/55.00±11.99,t=-4.091,P<0.001)和心理健康(34.23±14.24/51.80±22.45,t=-3.028,P=0.004)分值均高于对照组。结论将VR融入透析患者居家运动,有利于改善透析患者居家自我规律运动的信心,提高规律运动的积极性,降低患者跌倒风险,从而提高患者生活质量,具有一定的临床和现实意义。
Objective To explore the impact of virtual reality(VR)-based somatosensory games integrated into the home exercise management on fall risk and quality of life in dialysis patients.Methods A total of42 hemodialysis patients from the Blood Purification Center of the Army Special Medical Center were randomly designated into the study group or the control group.Patients in both groups were treated with conventional hemodialysis and nursing management including diet and nutrition guidance and treatment of complications.VR-based somatosensory games were integrated into the home exercise management in the study group,while exercise and daily activities were allowed ad libitum in the control group.They were followed up for 6 months.The confidence of self and regular exercise,the fall risk,and the quality of life were evaluated before and after the intervention between the two groups.Result Six months after the enrollment,the self-efficacy for exercise(SEE)scores and overall scores were significantly higher in the study group than in the control group.The Morse fall score decreased significantly in the study group than in the control group[(40.38±10.73)vs.(29.23±7.46),t=3.068,P<0.001]after 3 months of intervention,and so did[(37.09±9.40)vs.(18.42±6.88),t=4.063,P<0.001]after 6 months of intervention.The scores of the eight dimensions in the SF-36 quality of life scale were lower in both groups at the beginning of the enrollment.After 6 months of intervention,physical function(PF)[(42.00±12.85)vs.(55.71±12.34),t=-3.525,P=0.001],restriction problem due to physical function(RP)[(42.23±12.87)vs.(59.90±17.34),t=-3.748,P<0.001],body perturbation(BP)[(42.76±11.76)vs.(51.38±11.91),t=-2.358,P=0.023],general health prediction(GHP)[(41.28±10.82)vs.(50.47±8.20),t=3.101,P=0.003],vital test(VT)[(38.85±13.52)vs.(55.00±11.99),t=-4.091,P<0.001],and mental health(MH)[(34.23±14.24)vs.(51.80±22.45),t=-3.028,P=0.004]scores were higher in the study group than in the control group.Conclusion The integration of VR-based somatosensory games into the home exercise management is beneficial to improve the confidence and initiative of self-and regular-exercise,to reduce fall risks,and to increase the quality of life.Therefore,this method is worthwhile to be used clinically.
作者
封蕾
李云姝
杨杰
陈客宏
向杨
李萍
FENG Lei;LI Yun-shu;YANG Jie;CHEN Ke-hong;XIANG Yang;LI-Ping(Blood Purification Center,Department of Nephrology,Daping Hospital,Army Military Medical University,Chongqing 400042,China)
出处
《中国血液净化》
CSCD
2021年第5期302-305,332,共5页
Chinese Journal of Blood Purification
基金
重庆市技术创新与应用发展专项面上项目(cstc2019jscx-msxmX0258)
国家自然科学基金项目(81770731)。
关键词
透析患者
虚拟现实
体感游戏
跌倒
生活质量
Dialysis
Virtual reality
Somatosensory game
Fall
Quality of life
