만성요통 노인의 건강관련 삶의 질 구조모형 상세보기

Abstract

The purpose of this study was to achieve substantial knowledge on the structural equation modeling of health-related quality of life in elderly patients with chronic low back pain. To achieve this, a structural equation modeling of health-related quality of life of older patients with chronic low back pain was developed and validated.

The hypothetical model used in this study was based on Wilson and Cleary's model of health-related quality of life. Furthermore, social support, symptoms, fear-avoidance beliefs, functional disability, health perception, and health-related quality of life were selected as main variables after considering the literature review on these topics.

A total of 211 participants aged 65 years or older, who had been diagnosed with low back pain for more than three months, were included in this study. The data were collected from two hospitals in D Metropolitan City and A City, one public health center, and two senior citizen centers.

Descriptive statistics, t-test, and ANOVA correlation using SPSS/WIN 24.0 were analyzed, and the significance of the measurement model analysis, structural model analysis, and path using the R package 'plpm' (R Version 3.1.3) were verified.

As a result of the verification of the PLS structural model, internal consistency, convergent validity, and discriminant validity were verified in the measurement model analysis. Moreover, the suitability of the structural model was confirmed in the structural model analysis.

The path analysis results of the main variables showed that social support had a significant direct effect on symptoms (β=-.49, p<.001), disability (β=-.28, p<.001), and health perception (β=.22, p<.001). In addition, the path of the symptom to fear-avoidance beliefs (β=.51, p<.001), functional disability (β=.36, p<.001), health perception (β=-.38, p<.001), and health-related quality of life (β=.18, p<.001) were statistically significant.

Fear-avoidance beliefs had a significant direct effect on functional disability (β=.45, p<.001), health perception (β=-.21, p<.001), and health-related quality of life (β=.18, p<.001).

Functional disability had a significant direct effect on health-related quality of life (β=.18, p<.001), and the path of health perception to health-related quality of life (β=.18, p<.001) was statistically significant.

Additionally, social support had an indirect effect on functional disability (β=-.19, p<.001), health perception (β=.22, p<.001), and health-related quality of life (β=.37, p<.001). Social support, symptoms, fear-avoidance beliefs, functional disability, and health perception were factors that had direct and indirect effects on health-related quality of life, explaining 75.1 % of the variance. The study found that the higher the social support, the lower the negative physical and mental experiences such as symptoms, fear-avoidance beliefs, and functional disability. Additionally, the higher the social support, the higher the health perception, which may lead to an improved health-related quality of life for older patients with chronic low back pain.

Therefore, to improve the health-related quality of life of older patients with chronic low back pain, personalized nursing intervention programs are needed to enhance social support and health perception to alleviate fear-avoidance beliefs and functional disability by considering physical and psychological symptoms.

본 연구의 목적은 만성요통 노인의 건강관련 삶의 질 구조모형을 구축하고 검증하는 것이다. 본 연구의 가설적 모형은 Wilson과 Cleary (1995)의 건강관련 삶의 질 모형과 선행연구 결과들을 통해 사회적 지지, 증상, 두려움-회피신념, 기능장애, 건강지각과 건강관련 삶의 질을 주요변수로 선정하였다.

본 연구의 대상자는 총 211명이며, D광역시와 A시의 병원 2곳, 보건소 1곳, 지역사회 경로당 2곳에 방문한 65세 이상 만성요통 노인을 대상으로 자료를 수집하였다.

자료분석은 SPSS/WIN 24.0을 이용하여, 서술적 통계, t-test, ANOVA 상관관계를 분석하였고, R패키지 'plspm'(R Version 3.1.3)을 이용하여 측정모형 분석과 구조모형 분석 및 경로에 대한 유의성을 검증하였다.

PLS 구조모형의 검증 결과, 측정모형 분석에서 내적일관성, 집중타당도 및 판별타당도가 검증되었으며, 구조모형 분석에서 구조모형의 적합도가 확인되었다. 주요변수들의 경로분석 결과는 사회적 지지가 증상(β=-.49, p<.001), 기능장애(β=-.28, p<.001), 건강지각(β=.22, p<.001)으로 가는 경로가 통계적으로 유의하였다. 또한, 증상이 두려움-회피신념(β=.51, p<.001), 기능장애(β=.36, p<.001), 건강지각(β=-.38, p<.001), 건강관련 삶의 질(β=.18, p<.001)로 가는 경로가 통계적으로 유의하였다. 두려움-회피신념은 기능장애(β=.45, p<.001), 건강지각(β=-.21, p<.001), 건강관련 삶의 질(β=-.23, p<.001)로 가는 경로가 통계적으로 유의하였으며, 기능장애가 건강관련 삶의 질로 가는 경로(β=-.28, p<.001), 건강지각이 건강관련 삶의 질로 가는 경로가(β=.18, p<.001) 통계적으로 유의하였다. 마지막으로 사회적 지지는 기능장애(β=-.19, p<.001), 건강지각(β=.22, p<.001)을 통해 건강관련 삶의 질(β=.37, p<.001)에 간접효과가 나타났다. 사회적 지지, 증상, 두려움-회피신념, 기능장애, 건강지각은 건강관련 삶의 질에 직·간접영향을 미치는 요인으로 그 설명력은 75.1%이었다. 사회적 지지가 높을수록 증상과 두려움-회피신념, 기능장애와 같은 부정적인 경험은 낮고 건강지각은 높게 나타나 만성요통 노인의 건강관련 삶의 질은 향상된다.

따라서 만성요통 노인의 건강관련 삶의 질 향상을 위해서는 신체적·심리적 증상을 반영하고 만성요통 환자의 질병 특성인 두려움-회피신념과 기능 장애 완화와 사회적 지지와 같은 긍정적인 사회적 자원과 건강지각을 향상 시키기 위한 질환 맞춤형 간호중재 방안 및 다양한 프로그램을 개발과 실제 간호 현장에서의 적용이 필요하다.