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

Video：

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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.	王詩恒, 童元元, 高曼, 等. 中國傳統功法治療膝骨關節炎的網狀 Meta 分析. 世界中醫藥, 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.	中華醫學會骨科學分會關節外科學組, 中國醫師協會骨科醫師分會骨關節炎學組, 國家老年疾病臨床醫學研究中心(湘雅醫院), 等. 中國骨關節炎診療指南(2021 年版). 中華骨科雜志, 2021, 41(18): 1291-1314.
5.	李思琦, 金夢杰, 駱朝輝, 等. 癥狀管理策略在全膝關節置換術患者腫痛管理、負性情緒和生命質量中的效果. 中國醫藥導報, 2024, 21(14): 144-147.
6.	張毓, 王強. 全膝關節置換術后持續被動訓練與主動功能鍛煉對患者快速康復效果的影響. 中國骨與關節損傷雜志, 2023, 38(12): 1284-1286.
7.	李瑾, 宋佳凝, 郄淑燕. 虛擬情景游戲訓練改善膝骨關節炎患者全膝關節置換術后平衡功能及焦慮抑郁的效果. 中國臨床醫學, 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.	楊紅麗, 朱政, 胡雁, 等. HIV 感染者隨訪期間核心癥狀及嚴重程度的調查研究. 中華護理雜志, 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.	中國中西醫結合學會骨傷科專業委員會. 膝骨關節炎中西醫結合診療指南. 中華醫學雜志, 2018, 98(45): 3653-3658.
13.	牟紅安, 鮑勇. 老年人概念和適老化生活環境需求研究. 智庫時代, 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, 姜淑偉. 膝骨性關節炎患者全膝關節置換術后腫脹與疼痛程度的相關性. 國際護理學雜志, 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, 楊璨, 汪和美, 等. 鼻咽癌調強放療患者居家康復期癥狀特征的潛在類別分析. 中華全科醫學, 2024, 22(5): 882-886.
20.	何艦, 葉斯哈提·木拉提別克, 賀海艷, 等. 術前單次高劑量靜脈滴注甲潑尼龍在全關節置換術后疼痛管理中的有效性和安全性的 meta 分析. 中華骨與關節外科雜志, 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, 莊晨, 黃偉松, 等. 常規康復治療、淋巴引流聯合開玄方對下肢關節置換術后腫脹療效觀察. 中外醫學研究, 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.	朱勛鵬, 徐輝, 汪林, 等. 膝關節單髁置換前睡眠質量與置換后早期康復的關系. 中國組織工程研究, 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.	國家衛生健康委員會公益性行業科研專項《關節置換術安全性與效果評價》項目組, 中國老年保健醫學研究會老年骨與關節病分會專家組. 中國人工肩關節置換術加速康復圍手術期管理策略專家共識. 中華肩肘外科電子雜志, 2021, 9(2): 97-102.
27.	田彥東, 岳維, 李波, 等. 髖或膝關節置換術后急性疼痛的影響因素和預測模型. 臨床麻醉學雜志, 2024, 40(3): 229-236.
28.	吳洪. 體質量指數對肺栓塞患者臨床特點與生存質量的影響. 中國預防醫學雜志, 2020, 21(5): 580-583.
29.	高福強, 李子劍, 張克, 等. 初次全膝關節置換術后肢體腫脹的影響因素研究. 中國矯形外科雜志, 2011, 19(9): 724-727.
30.	劉紅霞, 蘇靖雯, 劉偉偉, 等. 圍手術期胃癌患者癥狀群與生活質量的相關性研究. 中國護理管理, 2023, 23(5): 680-685.
31.	周曉娟, 張新宇. 住院老年慢性病患者生活質量影響因素的研究進展. 中華現代護理雜志, 2019, 25(2): 257-260.
32.	吳珩, 李濤, 陳亦笑, 等. 綜合醫院軀體癥狀障礙患者的生活質量及其影響因素分析. 中華精神科雜志, 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. 王詩恒, 童元元, 高曼, 等. 中國傳統功法治療膝骨關節炎的網狀 Meta 分析. 世界中醫藥, 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. 中華醫學會骨科學分會關節外科學組, 中國醫師協會骨科醫師分會骨關節炎學組, 國家老年疾病臨床醫學研究中心(湘雅醫院), 等. 中國骨關節炎診療指南(2021 年版). 中華骨科雜志, 2021, 41(18): 1291-1314.
5. 李思琦, 金夢杰, 駱朝輝, 等. 癥狀管理策略在全膝關節置換術患者腫痛管理、負性情緒和生命質量中的效果. 中國醫藥導報, 2024, 21(14): 144-147.
6. 張毓, 王強. 全膝關節置換術后持續被動訓練與主動功能鍛煉對患者快速康復效果的影響. 中國骨與關節損傷雜志, 2023, 38(12): 1284-1286.
7. 李瑾, 宋佳凝, 郄淑燕. 虛擬情景游戲訓練改善膝骨關節炎患者全膝關節置換術后平衡功能及焦慮抑郁的效果. 中國臨床醫學, 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. 楊紅麗, 朱政, 胡雁, 等. HIV 感染者隨訪期間核心癥狀及嚴重程度的調查研究. 中華護理雜志, 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. 中國中西醫結合學會骨傷科專業委員會. 膝骨關節炎中西醫結合診療指南. 中華醫學雜志, 2018, 98(45): 3653-3658.
13. 牟紅安, 鮑勇. 老年人概念和適老化生活環境需求研究. 智庫時代, 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, 姜淑偉. 膝骨性關節炎患者全膝關節置換術后腫脹與疼痛程度的相關性. 國際護理學雜志, 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, 楊璨, 汪和美, 等. 鼻咽癌調強放療患者居家康復期癥狀特征的潛在類別分析. 中華全科醫學, 2024, 22(5): 882-886.
20. 何艦, 葉斯哈提·木拉提別克, 賀海艷, 等. 術前單次高劑量靜脈滴注甲潑尼龍在全關節置換術后疼痛管理中的有效性和安全性的 meta 分析. 中華骨與關節外科雜志, 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, 莊晨, 黃偉松, 等. 常規康復治療、淋巴引流聯合開玄方對下肢關節置換術后腫脹療效觀察. 中外醫學研究, 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. 朱勛鵬, 徐輝, 汪林, 等. 膝關節單髁置換前睡眠質量與置換后早期康復的關系. 中國組織工程研究, 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. 國家衛生健康委員會公益性行業科研專項《關節置換術安全性與效果評價》項目組, 中國老年保健醫學研究會老年骨與關節病分會專家組. 中國人工肩關節置換術加速康復圍手術期管理策略專家共識. 中華肩肘外科電子雜志, 2021, 9(2): 97-102.
27. 田彥東, 岳維, 李波, 等. 髖或膝關節置換術后急性疼痛的影響因素和預測模型. 臨床麻醉學雜志, 2024, 40(3): 229-236.
28. 吳洪. 體質量指數對肺栓塞患者臨床特點與生存質量的影響. 中國預防醫學雜志, 2020, 21(5): 580-583.
29. 高福強, 李子劍, 張克, 等. 初次全膝關節置換術后肢體腫脹的影響因素研究. 中國矯形外科雜志, 2011, 19(9): 724-727.
30. 劉紅霞, 蘇靖雯, 劉偉偉, 等. 圍手術期胃癌患者癥狀群與生活質量的相關性研究. 中國護理管理, 2023, 23(5): 680-685.
31. 周曉娟, 張新宇. 住院老年慢性病患者生活質量影響因素的研究進展. 中華現代護理雜志, 2019, 25(2): 257-260.
32. 吳珩, 李濤, 陳亦笑, 等. 綜合醫院軀體癥狀障礙患者的生活質量及其影響因素分析. 中華精神科雜志, 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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