基于行为改变轮理论的全膝关节置换术患者康复管理数字化干预方案与实施路径的构建 [中文引用][英文引用]

目的  构建基于行为改变轮（behavior change wheel，BCW）理论的全膝关节置换术（total knee arthroplasty，TKA）患者康复管理数字化干预方案与实施路径。方法  2024 年 4 月至 6 月，采用目的抽样法，选择上海某三级甲等综合医院 28 例TKA 患者进行半结构化访谈。基于 BCW 理论中的能力、机会与动机（capability，opportunity，motivation-behaviour，COM-B）模型识别患者术后 12w 内康复旅程（急性反应期、功能重塑期、功能增强期）的康复管理障碍因素，明确干预靶点；随后，通过文献法整合患者康复管理证据，为构建患者康复管理数字化干预方案中康复视频、科普手册等数字化资料提供知识库；最后，采用多学科专家论证，对干预方案及实施路径框架进行科学性与可行性的论证。结果  通过质性访谈，获得患者从能力、机会与动机 3 方面影响康复管理的关键问题；形成了 TKA 康复管理知识库，开发了 21 项康复训练视频、1 份图文并茂的康复科普手册、3项适老化特色视频；构建了康复管理数字化干预方案与实施路径框架。结论  本研究将 BCW 理论与循证实践相结合，构建了TKA 术后患者康复管理数字化干预方案与实施路径，为临床应用奠定了基础。

Objective To develop a digital intervention plan and implementation path for rehabilitation management of the patients with total knee arthroplasty（TKA）based on the behaviour change wheel（BCW）. Methods Between April and June 2024， 28 TKA patients were purposively sampled from a tertiary general hospital in Shanghai for semi-structured interviews. Guided by the COM-B（Capability，Opportunity，Motivation-Behaviour）model of the BCW，factors that hindered rehabilitation behaviour management within 12 weeks after surgery were identified and categorised according to three phases（acute reaction，functional remodelling，functional enhancement），and subsequently clarified the intention targets. A systematic literature synthesis was then conducted to integrate existing evidence on rehabilitation management，which served as the knowledge base for developing a digital resource library encompassing rehabilitation training videos，illustrated booklets and other educational resources. Finally，multidisciplinary expert consultation involved to evaluate the scientific validity and feasibility of the intervention plan and framework for implementation pathway. Results Qualitative interviews revealed key issues affecting rehabilitation management across the aspects of capability，opportunity，and motivation. A comprehensive knowledge base for TKA rehabilitation management was established，along with the development of 22 rehabilitation training videos and an illustrated and accessible rehabilitation education booklet，and three age-friendly videos. A digital intervention plan for rehabilitation management and the corresponding implementation pathway framework were successfully developed. Conclusion This study combines the BCW with evidence-based practice to develop a digital rehabilitation management plan and implementation pathway for TKA patients，laying a foundation for clinical application.