Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To develop the Exercise Knowledge and Behavior Questionnaire for Osteoporosis Patients suitable for China, and to test its reliability and validity.Methods:Guided by the theory of knowledge, attitude and practice, a questionnaire framework was constructed, and the first draft of the Exercise Knowledge and Behavior Questionnaire for Osteoporosis Patients was formed through literature review, group discussion, semi-structured interview, Delphi expert consultation and pre-investigation. From June to August 2020, convenience sampling was used to select 120 osteoporosis patients admitted to the First Affiliated Hospital of Soochow University as the research object to conduct a questionnaire survey to test the reliability and validity of the questionnaire. A total of 120 questionnaires were distributed, 110 valid questionnaires were recovered, and the valid recovery rate was 91.67% (110/120) .Results:Among 2 rounds of Delphi expert consultation, the expert authority coefficients were 0.880 and 0.900, respectively, and the Kendall harmony coefficients were 0.308 and 0.332, respectively, with statistically significant differences ( P<0.01) . The Exercise Knowledge and Behavior Questionnaire for Osteoporosis Patients included two sub-questionnaire of knowledge and behavior, with a total of 19 items, including 10 items in knowledge and 9 items in behavior. Exploratory factor analysis showed that 2 common factors were extracted from the exercise knowledge sub-questionnaire, and the cumulative variance contribution rate was 60.712%. A total of one common factor was extracted for the exercise behavior sub-questionnaire, and the cumulative variance contribution rate was 72.075%. The content validity index of the total questionnaire and each sub-questionnaire were 0.925, 0.921, and 0.929, respectively, and the item-level content validity index of was 0.857 to 1.000. The Cronbach's α coefficients of the total questionnaire and each sub-questionnaire t were 0.935, 0.830, and 0.953, respectively, and the split-half reliability coefficients of the total questionnaire and each sub-questionnaire were 0.979, 0.898, and 0.974, respectively, and the test-retest reliability coefficients of the total questionnaire and each sub-questionnaire were 0.878, 0.813, 0.860, respectively. Conclusions:The Exercise Knowledge and Behavior Questionnaire for Osteoporosis Patients has good reliability and validity, and can be used to evaluate exercise knowledge and behavior in patients with osteoporosis.

Objective: To explore the risk factors of deep venous thrombosis(DVT) in lower limbs of orthopedic inpatients, and provide reference for clinical nursing and prevention of thrombosis. Methods: A retrospective case-control approach was used in this study. A total of 148 orthopedic inpatients diagnosed with DVT in the First Affiliated Hospital of Soochow University from February 2014 to October 2018 were selected as the case group. At the same time, 148 orthopaedic inpatients with undiagnosed DVT in the same Department were randomly selected as the control group. The electronic medical history data and related laboratory examination indexes of the two groups of patients during hospitalization in Orthopedics Department were analyzed retrospectively. Gender, age, seven indicators of blood coagulation, as well as history of hypertension, diabetes, history of DVT and other common risk factors of DVT in the two groups were statistically analyzed. Results: In the case group, 63 patients (42.5%) DVT developed in the right lower extremity. The differences in the clinical symptoms and characteristics of fever, pulmonary infection, cough, expectoration, chest distress and shortness of breath, pleural effusion and constipation between the two groups were statistically significant (χ² value was 5.688-12.312, P<0.01 or 0.05). Single factor analysis of related risk factors showed the differences of age, type of injury, lower limb joint replacement, a plaster cast, hypertension, history of DVT, central venous catheter, D-dimer and preoperative albumin levels, fibrinogen degradation products, and red blood cell count between the two groups were statistically significant (t value was-7.275-3.998, χ² value was 4.889-13.305, Z value was-3.500--3.454, P < 0.01). Multivariate Logistic regression analysis showed that lower limb joint replacement(OR=0.383, 95%CI0.190-0.773), cough (OR=0.085, 95%CI0.010-0.731), chest distress and shortness of breath (OR=0.240, 95%CI0.077-0.745), constipation (OR=0.312, 95%CI0.135-0.718), red blood cell count (OR=3.314, 95%CI 2.105-5.216), hypertension (OR=0.534, 95%CI0.292-0.976) were independent risk factors for DVT formation in orthopedic inpatients (P<0.01 or 0.05). Conclusions DVT in orthopedic inpatients is a common result of multiple factors, among which, lower limb joint replacement, cough, chest distress and shortness of breath, constipation, red blood cell count and hypertension are independent risk factor, which should be monitored and given preventive care.

Objective? To understand patient motivation and its influencing factors prior to posterior lumber interbody fusion surgery. Methods? Using convenient sampling method, a total of 200 patients who will undergo posterior lumber interbody fusion surgery due to degenerative disc disease were selected from 3 ClassⅢ Grade A hospitals in Suzhou. General Condition Questionnaire, the Chinese version of Patient Activation Measure (PAM), Hospital Anxiety and Depression Scale were used in the survey. Univariate analysis and multiple linear regression analysis were used to explore the influencing factors of patient motivation. The correlation between patient activation and anxiety and depression were analyzed by Spearman rank correlation. Results? The median and interquartile range of PAM is 48.90 and 10.30. The univariate analysis showed that patient motivation was significantly influenced by patient gender, age, education, marital status, employment status, per-capita income, chronical disease, anxiety and depression (χ2/Z=-3.433, 29.882, 56.322, 8.852, -2.785, 54.092, -3.714, 13.031, 16.712; P＜0.05). Multiple linear regression analysis showed that marital status, education, depression, income, age were the main influencing factors (R2=0.396, P＜ 0.05). Conclusions? Patient motivation needs to be further improved. Intervention strategies can be designed to motivate patients and improve post-operative outcomes.

Objective To evaluate the effective e measures of the prevention and treatment of venous thrombosis in hospital and evaluate the effect of"antibolt work"in patients with multidisciplinary cooperation. Methods Compare the level of venous thromboembolism (VTE) incidence, average hospital day, patient satisfaction and the level of knowledge of medical staff in the high risk department of VTE. Results After intervention in high-risk departments staff VTE related knowledge level improved, 2013 high- risk departments medical staff about the basic knowledge, risk assessment, VTE prevention knowledge of three dimensional awareness were 34.7％ (26/75), 49.3％ (37/75), 32.0％ (24/75), respectively, 2016 were 56.0％(42/75), 69.3％(52/75), 90.7％(68/75), respectively, two groups compare the difference was statistically significant (χ2=6.887, 6.217, 54.423, P<0.01 or 0.05). Reduced incidence of VTE 2 groups, 2013 annual incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) were 31.7％ (38/120), 11.7％ (14/120), respectively, in 2016 the annual incidence of DVT and PE were 14.2％(17/120), 4.2％(5/120), respectively, two groups compare the difference was statistically significant (χ2 =10.402, 4.630, P<0.01 or 0.05). VTE in 2016 patients with high-risk departments the average hospitalization time significantly below 2013, 2013 was (18.3 ± 3.5) days while 2016 was (12.7 ± 2.9 )days, two groups compare the difference was statistically significant (t = 13.496, P < 0.01). In 2016, the satisfaction rate of patients with VTE was higher than that in 2013, 77.5％(93/120) in 2013, 90.8％(109/120) in 2016, and the difference between the two groups was statistically significant (χ2=8.004, P=0.005). Conclusion The prevention and control of venous thrombosis based on multi-disciplinary integration is effective in preventing the occurrence of thrombosis in hospitalized patients and is worthy of clinical promotion.

Objective To evaluate the effect of of home-care orthopedic nursing platform in rehabilitation exercise of patients after knee replacement.Methods A total of 60 patients with knee joint replacement were randomly divided into experimental group (n =30) and control group (n =30).The control group adopted conventional nursing,while the experimental group was added home care platform for orthopedics.Joint function recovery (HSS score),quality of life score (SF-36) and daily living ability (Barthel index) between the two groups were compared on admission,and at 6 months after discharge.Results No statistical differences in culture and knowledge absorption and understanding ability were found between the two groups before intervention (P ＞ 0.05).After intervention,the score of knee function,quality of life and ability of daily living of the patients in the experimental group were significantly higher than that in the control group (P ＜ 0.01).Conclusion Home care platform of orthopedics provides a new extension nursing mode for patients after total knee arthroplasty.It is a scientific and reliable rehabilitation consultation platform,which significantly improves postoperative rehabilitation and quality of life.

Objective To evaluate the effect of of home-care orthopedic nursing platform in rehabilitation exercise of patients after knee replacement.Methods A total of 60 patients with knee joint replacement were randomly divided into experimental group (n =30) and control group (n =30).The control group adopted conventional nursing,while the experimental group was added home care platform for orthopedics.Joint function recovery (HSS score),quality of life score (SF-36) and daily living ability (Barthel index) between the two groups were compared on admission,and at 6 months after discharge.Results No statistical differences in culture and knowledge absorption and understanding ability were found between the two groups before intervention (P ＞ 0.05).After intervention,the score of knee function,quality of life and ability of daily living of the patients in the experimental group were significantly higher than that in the control group (P ＜ 0.01).Conclusion Home care platform of orthopedics provides a new extension nursing mode for patients after total knee arthroplasty.It is a scientific and reliable rehabilitation consultation platform,which significantly improves postoperative rehabilitation and quality of life.

Objective To measure the reliability and validity of the Chinese version of Patient Activation Measure(PAM)and to explore its applicability in assessment of self-health management among lumbar degenerative disease patients scheduled for lumbar spinal fusion.Methods From January to June 2017,we selected 120 lumbar degenerative disease patients who had a right mind,none communication disorders and were treated at a Class Ⅲ Grade A hospital in Suzhou as well as scheduled for lumbar spinal fusion as subjects by convenience sampling.All of the patients were investigated with the questionnaire involving the general information questionnaire,the Chinese version of PAM and Self-Efficacy for Managing Chronic Disease Scale(SEMCDS).Psychometric characteristics of the Chinese version of PAM were assessed by indexes,such as item analysis,internal consistency reliability,retest reliability,content validity,construct validity and criterion-related validity.Results A total of 120 questionnaires were sent out and all of them were collected with 100.0％for the effective recovery rate.The Chinese version of PAM included 13 items and 4 levels.Its standardized total score ranged from 33 to 100 and the average score was(50.25±11.33).There were 59 patients(49.2％)withthe score less than or equal to 47.0 belong to the first level of activation which indicated they were not aware the importance of self-health management;22 patients(18.3％)the score between 47.1 and 55.1 belong to the second level of activation which indicated they lacked knowledge and confidence of self-health management;31 patients(25.8％)with the score from 55.2 to 67.0 belong to the third level of activation which indicated they began to take action of self-health management;8 patients(6.7％)with the score greater than or equal to 67.1 belong to the fourth level of activation which showed they insisted on life style of self-health management even facing pressure.The Cronbach's α of the whole scale was 0.835.Guttman split-half reliability and retest reliability was 0.736 and 0.878 respectively.The content validity was 0.923 with it of each item ranging from 0.833 to 1.Exploratory factor analysis extracted four common factors which were renamed as the awareness of self-health management for disease,preoperative disease-related knowledge,postoperative prevention ability and the belief to insist on healthy life style transformation according to the rehabilitative characteristics of lumbar spinal fusion with 63.75％for the cumulative variance contribution rate.Spearman rank correlation coefficient in criterion-related validity was 0.689 between the Chinese version of PAM and the SEMCDS.Conclusions The Chinese version of PAM has good reliability and validity.It could be an assessment instrument of self-disease and health management activation for lumbar degenerative disease inpatients scheduled for lumbar spinal fusion in China.Clinic workers could preliminarily screen potential high-risk patients who may undergo unsatisfactory postoperative rehabilitation based on the level of activation and formulate individualized nursing intervention,reasonably distribute medical resources and improve patients satisfaction.

Objective To measure osteoporosis knowledge,belief and self-efficacy of elderly patients with vertebral fracture,and to provide the basis for reducing the incidence of refracture.Methods Totally 72 patients were recruited from an upper first-class hospital in suzhou by using the convenience sampling method.They were measured with the self-designed general information questionnaire,Osteoporosis Knowledge Tests (OKT),Osteopomsis Health Belief scale (OHBS) and Osteoporosis Self-Efficacy Scale (OSES).Results The total score of knowledge was (1 1.06±6.71),the factor scores of risk factors,exercise and calcium intake were(4.13±2.82),(2.90±2.54),(4.04±2.54).The average score of OHBS was (141.82± 13.00).The total score of self-efficacy was (79.49±35.15).Conclusions Health education for elderly patients with vertebral fractures needs to be improved,and to reduce the occurrence of refracture according to different groups of targeted education.