만성요통환자의 요통관리지식과운동자기효능감이 요통관리행위에 미치는영향

Abstract

This study examines the general characteristics of chronic back pain patients, back pain-related characteristics, back pain management knowledge, and exercise self-efficacy that affect back pain management behavior. It is also a correlation study of behavior to improve back pain management. The data collection period for this study is from April 8, 2021, to April 23, 2021. The subjects were patients who visited neurosurgery and orthopedics due to chronic back pain at H General Hospital in Seoul. These are all adults aged 18 and older, with no other muscle or skeletal disorders other than the lumbar spine, non-surgical treatment, and medication, or patients who have experienced spinal surgery. All subjects have had back pain for more than three months. A total of 111 people surveyed, but a total of 110 people, excluding one who unfaithfully wrote down the questionnaire, were subject to the study. The questionnaire in this study consisted of 17 general characteristics and back pain management characteristics, 15 back pain management knowledge questions, 9 exercise self-efficacy questions, and 16 back pain management questions. All data were statistically analyzed using the SPSS WIN 22.0 program. The results of this study are as follows. 1. General characteristics and back pain-related characteristics The total number of peoples in this study is 110. The average age was 56.2±15.17. Among the subjects, 68 women (61.8%), 54 people (49.1%) had a bachelor's degree or higher, 75 people (68.2%) had no religion, and 44 people (40.0%) had an average monthly income of 3 million won or more accounted for a large portion. Characteristics related to back pain are as follows. The average duration of low back pain was 8.3±9.47 years, and the frequency of low back pain was 40 patients (36.4%) every day. The symptoms related to back pain were herniated disc in 32 patients (29.1%), spinal stenosis in 33 patients (30.0%), spondylolisthesis in 10 patients (9.1%), and non-specific low back pain in 35 patients (31.8%). There were 72 patients (65.5%) who had never had back pain surgery and 92 patients (83.6%) who had not had surgery. Methods for managing low back pain (multiple responses) 72 patients (37.7%) were treated with drugs, and 65 patients (59.1%) did not take analgesic or anti-inflammatory drugs. The path of acquiring knowledge related to low back pain was 47 medical personnel (42.7%) and 47 by media (42.7%), and 85% (77.3%) of those who had no experience in back pain-related education. As for the content (multiple responses) related to back pain, exercise method was the most common among 22 people (33.8%), and among 59 people (53.6%) who exercised regularly, walking was the most with 39 people (35.3%). The average perceived pain level was 5.7±1.85. 2. The overall average of the subjects' low back pain management knowledge was 11.4±2.17, the overall mean of exercise self-efficacy was 33.8±20.52, and the overall average of the low back pain management behavior was 37.7±8.83. 3. According to the general characteristics, it is as follows. Low back pain management knowledge was age (F=11.01, P<.001), education (F=10.48, P<.001), marriage (t=4.49, P<.001), occupation (F=4.09, P<.01), and economic status (F=3.24, P<.05) showed a significant difference. As a result of the posttest on age, it was found that "over 65 to 85" had lower back pain management knowledge than "under 21 to 45" and "over 45 to under 65", respectively. showed that the group with a bachelor's degree or higher had higher back pain management knowledge than the group with a high school diploma or lower. In the post-test results of occupation, professional occupations showed higher back pain management knowledge than full-time housewives, and there was a significant difference in each characteristic in economic status, but it was not significant in the post-test. and the back pain management behavior showed a significant difference in age (F=3.21, P<.05). 4. Results according to the subject's low back pain-related characteristics are as follows. Low back pain management knowledge was significant according to medical diagnosis (t=7.00, P<.001), low back pain frequency (F=3.08, P<.05), and low back pain education experience (t=4.92, P<.001). As a result of post-mortem examination of the medical diagnosis, it was found that the knowledge of low back pain management was significantly higher in disc herniation and non-specific low back pain than in spinal stenosis. The self-efficacy of exercise was different according to whether or not exercise was normally performed (t=4.86, P<.001). The low back pain management behavior was significant by the duration of low back pain (F=2.92, P<.05), whether surgery (t=2.30, P<.05), experience in back pain education (t=3.21, P<.01), and regular exercise (t = 5.11, P < .001). 5. Low back pain management behavior showed a positive correlation between knowledge (r=.302, p<.05) and exercise self-efficacy (r=.512, p<.001). 6. Low back pain management knowledge and exercise self-efficacy affect low back pain management behavior according to back pain education experience (β=.193, p<.05) and exercise self-efficacy (β =513, p<.001). In this study, it can be seen that education related to low back pain is necessary to promote low back pain management behavior. In particular, it is important to provide personalized education according to patient characteristics in the nursing field. Such education enables patients to gain knowledge of low back pain management and to feel a great sense of efficacy of exercise self-efficacy. As a result, it is thought that it will have a good effect on the promotion and prevention of low back pain management behavior of chronic low back pain patients.|본 연구는 만성 요통 환자들의 요통관리지식과 운동자기효능감이 요통관리행위에 미치는 영향을 파악하여, 요통관리행위 증진방안을 마련하기 위한 서술적 상관관계조사 연구이다. 서울시 소재 H상급종합병원에서 만성요통으로 신경외과 및 정형외과 외래를 방문하는 환자를 대상으로 하였다. 요통이 지속된 지 3개월이상된 만 18세 이상의 성인 환자, 요추부 이외의 관절염, 외상, 기형 등 다른 근, 골격계 질환이 없으며, 척추 수술환자의 경우 1회이상의 척추수술 이후에도 요통 지속이 3개월이상 지속되며, 비 수술요법 및 약물치료중인 환자로 하였다. 본 연구의 자료수집은 2021년 4월8일부터 2021년 4월 23일까지였으며, 대상자 설문지는 111부를 수집하였고, 이 중 불성실하게 응답한 대상자 1명을 제외한 110명을 대상으로 진행하였다. 측정도구는 요통관리지식은 박춘자(1995)가 요통을 일으킬 수 있는 자세나 행동, 요통을 예방할 수 있는 자세, 운동에 대한 지식을 측정위해 개발한 도구를 김성경과 정순녀가 수정한도구, 자기효능감은 Bandura(1986)의 이론적 정의를 근거로 운동자기효능감은 Resnick과 Jenkins(2000)의 Self-Efficacy for Exercise Scale(SEE)를 최모나와 정덕유(2012)가 번안한 한국판 운동자기효능감 측정도구(SEE-K)를 사용하였으며, 요통관리행위는 정정숙(2006) 이 요통경감 및 요통 재발 방지를 위해 수행정도를 의미하는것으로 신인호(2011)가 수정보안한 도구를 이용하여 측정하였다. 수집한 자료는 SPSS WIN 22.0 프로그램을 이용하였고, 빈도,백분율, 평균, 표준편차, t-test, one-way ANOVA, Pearson’s Correlation Coefficient, Multiple Stepwise Regression를 이용하여 분석하였으며, 사후검정은 Scheffe′ test로 분석하였다.

본 연구의 결과는 다음과 같다

1. 요통 관련 특성으로는 평균 요통지속기간은 8.3±9.47년으로 나타났으며, 지각한 요통 빈도는 매일이 40명(36.4%)으로 가장 많았고, 대상자중 72명(65.5%)이 시술을 받은 경험이 없으며, 92명(83.6%)가 수술을 받은 경험이 없었다, VAS(Visual Analogue Scale)척도를 이용한 지각된 통증 정도는 10점 만점 중 평균 5.7±1.85였다

2. 대상자의 요통관리지식, 운동자기효능감 및 요통관리행위의 정도는 요통관리지식은 15점 만점 중 평균11.4±2.17점, 운동자기효능감은 90점 만점 중 평균 33.8±20.52점, 요통관리행위는 64점 만점 중 평균 37.7± 8.83점이었다.

3. 요통관리지식은 연령(F=11.01, p <.001), 학력(F=10.48, p <.001), 결혼유무(t=4.49, p <. 001), 직업(F=4.09, p <.01), 경제상태(F=3.24, p <.05)에 따라 유의하게 나타났다. 운동자기효능감은 종교 (t=-2.31, p < .05)에서 유의한 차이가 있었고, 요통관리행위는 연령(F=3.21, p < .05)에서 유의한 차이를 보였다.

4. 대상자의 요통관련특성에 따른 요통관리지식, 운동자기효능감, 요통관리행위의 차이는 요통관리지식은 의학적 진단명에 따라(t=7.00, p < .001), 요통 빈도(F=3.08, P < .05), 요통교육경험 (t=4.92, p < .001)에 따라 유의한 차이가 있었고, 운동자기효능감은 평상시 운동 여부 (t=4.86, p < .001), 요통관리행위는 요통 기간(F=2.92, p <. 05), 수술 여부(t=2.30, p <. 05), 요통교육경험(t=3.21, p <. 01), 평상시 운동 여부(t=5.11, p <. 001)에 따라 유의한 차이가 있었다.

5. 변수간의 상관관계 결과, 요통관리행위는 요통관리지식(r=.302, p<.01), 운동자기효능감(r=. 512, p <. 001)의 유의한 양의 상관관계를 나타냈다.

6. 요통관리행위에 미치는 영향요인으로는 요통교육경험 (β=.193,p < .05) 나타났으며, 운동자기효능감이 (β=.513, p <.001)영향을 미치는 요인으로 나타났다.

만성요통환자의 요통관리행위를 증가시키기 위해서는 요통관리교육을 제공하여 올바른 관리 지식을 높여주고, 지속적인 교육프로그램을 통하여 운동자기효능감을 증가시켜야 한다. 만성요통은 장기적인 자기관리가 필요함으로 만성요통환자의 운동자기효능감을 높여 지속적인 요통관리행위가 이어질 수 있도록 간호중재 방안을 개발하기 위한 기초 자료로 활용되기를 기대한다.