Latent class analysis of symptom cluster characteristics and comparison of quality of life between different categories in patients after total knee arthroplasty_West China Medical Journal

Authors：

ZHANG Mengke ¹ , WEI Minghui ¹ , LI Jiaxue ¹ , ZHANG Yuan ¹ , ZHAO Jiaju ¹ , HOU Guoliang ¹ ,  SHI Lingyun ^1,2,3

1. School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang 830017, P. R. China;
2. Department of Nursing, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P. R. China;
3. Health Care Research Center for Xinjiang Regional Population, Urumqi, Xinjiang 830000, P. R. China;

Corresponding author：

SHI Lingyun, Email: shilingyunguanjie@163.com

Keywords：

Knee; arthroplasty; symptom cluster; latent class analysis; quality of life

DOI：

10.7507/1002-0179.202407182

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Objective To investigate the latent categories of symptom cluster characteristics in patients with knee osteoarthritis (KOA) after total knee arthroplasty (TKA), and compare the quality of life between these categories. Methods Patients undergoing TKA for KOA in the joint surgery departments of four tertiary-level A hospitals in Urumqi, Xinjiang between November 2023 and March 2024 were selected for the study using the convenience sampling method. Symptoms of postoperative pain, swelling, anxiety, depression, and sleep disorders were collected from patients for latent class analysis using Mplus 8.3 software, and their influencing factors and differences in quality of life between categories were analyzed using SPSS 26.0 software. Results A total of 380 copies of questionnaire were distributed and 362 valid ones were returned, with a validity rate of 95.3%. Of the 362 patients, 342 (94.5%) had symptom cluster. The 342 patients aged 47-85 years, with a mean age of (65.25±7.03) years; 83 (24.3%) were male and 259 (75.7%) were female. According to the postoperative symptom cluster, the patients could be categorized into 3 latent categories: high-symptomatic group (16.1%), low-symptomatic group (51.8%), and high swelling group (32.2%). Compared to the low-symptomatic group, the current being the first joint surgery was a risk factor for the high-symptomatic group [odds ratio (OR)=2.732, 95% confidence interval (CI) (1.216, 6.139), P=0.015], whereas body mass index between 24.0 and 27.9 kg/m² was a protective factor for the high-symptomatic group [OR=0.362, 95%CI (0.156, 0.840), P=0.018]; body mass index <24.0 kg/m² was an independent risk factor for the high swelling group [OR=2.769, 95%CI (1.321, 5.803), P=0.007]. Comparison of the quality of life of patients in the 3 latent categories revealed that the high-symptomatic group had the lowest quality of life scores (P<0.05). Conclusion Post-TKA symptom cluster in patients with KOA can be classified into 3 potential categories, and the quality of life performance is different among different categories, so precise symptom management strategies should be provided according to the symptom characteristics of the patients to improve their quality of life.

Citation： ZHANG Mengke, WEI Minghui, LI Jiaxue, ZHANG Yuan, ZHAO Jiaju, HOU Guoliang, SHI Lingyun. Latent class analysis of symptom cluster characteristics and comparison of quality of life between different categories in patients after total knee arthroplasty. West China Medical Journal, 2024, 39(10): 1592-1598. doi: 10.7507/1002-0179.202407182 Copy

1.	Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol, 2020, 72(2): 220-233.
2.	王诗恒, 童元元, 高曼, 等. 中国传统功法治疗膝骨关节炎的网状 Meta 分析. 世界中医药, 2024, 19(10): 1428-1434.
3.	Gress K, Charipova K, An D, et al. Treatment recommendations for chronic knee osteoarthritis. Best Pract Res Clin Anaesthesiol, 2020, 34(3): 369-382.
4.	中华医学会骨科学分会关节外科学组, 中国医师协会骨科医师分会骨关节炎学组, 国家老年疾病临床医学研究中心(湘雅医院), 等. 中国骨关节炎诊疗指南(2021 年版). 中华骨科杂志, 2021, 41(18): 1291-1314.
5.	李思琦, 金梦杰, 骆朝辉, 等. 症状管理策略在全膝关节置换术患者肿痛管理、负性情绪和生命质量中的效果. 中国医药导报, 2024, 21(14): 144-147.
6.	张毓, 王强. 全膝关节置换术后持续被动训练与主动功能锻炼对患者快速康复效果的影响. 中国骨与关节损伤杂志, 2023, 38(12): 1284-1286.
7.	李瑾, 宋佳凝, 郄淑燕. 虚拟情景游戏训练改善膝骨关节炎患者全膝关节置换术后平衡功能及焦虑抑郁的效果. 中国临床医学, 2022, 29(1): 74-78.
8.	Purcell KF, Scarcella N, Chun D, et al. Treating sleep disorders after total hip and total knee arthroplasty. Orthop Clin North Am, 2023, 54(4): 397-405.
9.	Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs, 2005, 28(4): 270-282.
10.	杨红丽, 朱政, 胡雁, 等. HIV 感染者随访期间核心症状及严重程度的调查研究. 中华护理杂志, 2021, 56(5): 727-731.
11.	Hochberg MC, Altman RD, Brandt KD, et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology. Arthritis Rheum, 1995, 38(11): 1541-1546.
12.	中国中西医结合学会骨伤科专业委员会. 膝骨关节炎中西医结合诊疗指南. 中华医学杂志, 2018, 98(45): 3653-3658.
13.	牟红安, 鲍勇. 老年人概念和适老化生活环境需求研究. 智库时代, 2019(22): 1-2.
14.	Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: myths, truths and clinical relevance. Scand J Pain, 2016, 13: 67-75.
15.	Beekman E, Verhagen A. Clinimetrics: Hospital Anxiety and Depression Scale. J Physiother, 2018, 64(3): 198.
16.	Mollayeva T, Thurairajah P, Burton K, et al. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev, 2016, 25: 52-73.
17.	王惠, 姜淑伟. 膝骨性关节炎患者全膝关节置换术后肿胀与疼痛程度的相关性. 国际护理学杂志, 2022, 41(4): 709-712.
18.	Ware J Jr. , Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care, 1996, 34(3): 220-233.
19.	朱云霞, 杨璨, 汪和美, 等. 鼻咽癌调强放疗患者居家康复期症状特征的潜在类别分析. 中华全科医学, 2024, 22(5): 882-886.
20.	何舰, 叶斯哈提·木拉提别克, 贺海艳, 等. 术前单次高剂量静脉滴注甲泼尼龙在全关节置换术后疼痛管理中的有效性和安全性的 meta 分析. 中华骨与关节外科杂志, 2024, 17(6): 533-542.
21.	Turk DC, Fillingim RB, Ohrbach R, et al. Assessment of psychosocial and functional impact of chronic pain. J Pain, 2016, 17(9 Suppl): T21-T49.
22.	林映欣, 庄晨, 黄伟松, 等. 常规康复治疗、淋巴引流联合开玄方对下肢关节置换术后肿胀疗效观察. 中外医学研究, 2022, 20(28): 119-122.
23.	Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad Med, 2019, 131(7): 438-444.
24.	朱勋鹏, 徐辉, 汪林, 等. 膝关节单髁置换前睡眠质量与置换后早期康复的关系. 中国组织工程研究, 2023, 27(36): 5806-5811.
25.	Afolalu EF, Ramlee F, Tang NKY. Effects of sleep changes on pain-related health outcomes in the general population: a systematic review of longitudinal studies with exploratory meta-analysis. Sleep Med Rev, 2018, 39: 82-97.
26.	国家卫生健康委员会公益性行业科研专项《关节置换术安全性与效果评价》项目组, 中国老年保健医学研究会老年骨与关节病分会专家组. 中国人工肩关节置换术加速康复围手术期管理策略专家共识. 中华肩肘外科电子杂志, 2021, 9(2): 97-102.
27.	田彦东, 岳维, 李波, 等. 髋或膝关节置换术后急性疼痛的影响因素和预测模型. 临床麻醉学杂志, 2024, 40(3): 229-236.
28.	吴洪. 体质量指数对肺栓塞患者临床特点与生存质量的影响. 中国预防医学杂志, 2020, 21(5): 580-583.
29.	高福强, 李子剑, 张克, 等. 初次全膝关节置换术后肢体肿胀的影响因素研究. 中国矫形外科杂志, 2011, 19(9): 724-727.
30.	刘红霞, 苏靖雯, 刘伟伟, 等. 围手术期胃癌患者症状群与生活质量的相关性研究. 中国护理管理, 2023, 23(5): 680-685.
31.	周晓娟, 张新宇. 住院老年慢性病患者生活质量影响因素的研究进展. 中华现代护理杂志, 2019, 25(2): 257-260.
32.	吴珩, 李涛, 陈亦笑, 等. 综合医院躯体症状障碍患者的生活质量及其影响因素分析. 中华精神科杂志, 2021, 54(3): 190-196.

1. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol, 2020, 72(2): 220-233.
2. 王诗恒, 童元元, 高曼, 等. 中国传统功法治疗膝骨关节炎的网状 Meta 分析. 世界中医药, 2024, 19(10): 1428-1434.
3. Gress K, Charipova K, An D, et al. Treatment recommendations for chronic knee osteoarthritis. Best Pract Res Clin Anaesthesiol, 2020, 34(3): 369-382.
4. 中华医学会骨科学分会关节外科学组, 中国医师协会骨科医师分会骨关节炎学组, 国家老年疾病临床医学研究中心(湘雅医院), 等. 中国骨关节炎诊疗指南(2021 年版). 中华骨科杂志, 2021, 41(18): 1291-1314.
5. 李思琦, 金梦杰, 骆朝辉, 等. 症状管理策略在全膝关节置换术患者肿痛管理、负性情绪和生命质量中的效果. 中国医药导报, 2024, 21(14): 144-147.
6. 张毓, 王强. 全膝关节置换术后持续被动训练与主动功能锻炼对患者快速康复效果的影响. 中国骨与关节损伤杂志, 2023, 38(12): 1284-1286.
7. 李瑾, 宋佳凝, 郄淑燕. 虚拟情景游戏训练改善膝骨关节炎患者全膝关节置换术后平衡功能及焦虑抑郁的效果. 中国临床医学, 2022, 29(1): 74-78.
8. Purcell KF, Scarcella N, Chun D, et al. Treating sleep disorders after total hip and total knee arthroplasty. Orthop Clin North Am, 2023, 54(4): 397-405.
9. Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs, 2005, 28(4): 270-282.
10. 杨红丽, 朱政, 胡雁, 等. HIV 感染者随访期间核心症状及严重程度的调查研究. 中华护理杂志, 2021, 56(5): 727-731.
11. Hochberg MC, Altman RD, Brandt KD, et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology. Arthritis Rheum, 1995, 38(11): 1541-1546.
12. 中国中西医结合学会骨伤科专业委员会. 膝骨关节炎中西医结合诊疗指南. 中华医学杂志, 2018, 98(45): 3653-3658.
13. 牟红安, 鲍勇. 老年人概念和适老化生活环境需求研究. 智库时代, 2019(22): 1-2.
14. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: myths, truths and clinical relevance. Scand J Pain, 2016, 13: 67-75.
15. Beekman E, Verhagen A. Clinimetrics: Hospital Anxiety and Depression Scale. J Physiother, 2018, 64(3): 198.
16. Mollayeva T, Thurairajah P, Burton K, et al. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev, 2016, 25: 52-73.
17. 王惠, 姜淑伟. 膝骨性关节炎患者全膝关节置换术后肿胀与疼痛程度的相关性. 国际护理学杂志, 2022, 41(4): 709-712.
18. Ware J Jr. , Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care, 1996, 34(3): 220-233.
19. 朱云霞, 杨璨, 汪和美, 等. 鼻咽癌调强放疗患者居家康复期症状特征的潜在类别分析. 中华全科医学, 2024, 22(5): 882-886.
20. 何舰, 叶斯哈提·木拉提别克, 贺海艳, 等. 术前单次高剂量静脉滴注甲泼尼龙在全关节置换术后疼痛管理中的有效性和安全性的 meta 分析. 中华骨与关节外科杂志, 2024, 17(6): 533-542.
21. Turk DC, Fillingim RB, Ohrbach R, et al. Assessment of psychosocial and functional impact of chronic pain. J Pain, 2016, 17(9 Suppl): T21-T49.
22. 林映欣, 庄晨, 黄伟松, 等. 常规康复治疗、淋巴引流联合开玄方对下肢关节置换术后肿胀疗效观察. 中外医学研究, 2022, 20(28): 119-122.
23. Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad Med, 2019, 131(7): 438-444.
24. 朱勋鹏, 徐辉, 汪林, 等. 膝关节单髁置换前睡眠质量与置换后早期康复的关系. 中国组织工程研究, 2023, 27(36): 5806-5811.
25. Afolalu EF, Ramlee F, Tang NKY. Effects of sleep changes on pain-related health outcomes in the general population: a systematic review of longitudinal studies with exploratory meta-analysis. Sleep Med Rev, 2018, 39: 82-97.
26. 国家卫生健康委员会公益性行业科研专项《关节置换术安全性与效果评价》项目组, 中国老年保健医学研究会老年骨与关节病分会专家组. 中国人工肩关节置换术加速康复围手术期管理策略专家共识. 中华肩肘外科电子杂志, 2021, 9(2): 97-102.
27. 田彦东, 岳维, 李波, 等. 髋或膝关节置换术后急性疼痛的影响因素和预测模型. 临床麻醉学杂志, 2024, 40(3): 229-236.
28. 吴洪. 体质量指数对肺栓塞患者临床特点与生存质量的影响. 中国预防医学杂志, 2020, 21(5): 580-583.
29. 高福强, 李子剑, 张克, 等. 初次全膝关节置换术后肢体肿胀的影响因素研究. 中国矫形外科杂志, 2011, 19(9): 724-727.
30. 刘红霞, 苏靖雯, 刘伟伟, 等. 围手术期胃癌患者症状群与生活质量的相关性研究. 中国护理管理, 2023, 23(5): 680-685.
31. 周晓娟, 张新宇. 住院老年慢性病患者生活质量影响因素的研究进展. 中华现代护理杂志, 2019, 25(2): 257-260.
32. 吴珩, 李涛, 陈亦笑, 等. 综合医院躯体症状障碍患者的生活质量及其影响因素分析. 中华精神科杂志, 2021, 54(3): 190-196.

West China Medical Journal

Latent class analysis of symptom cluster characteristics and comparison of quality of life between different categories in patients after total knee arthroplasty

Abstract Full text Figures/Tables Video References Cited by

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