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결론
본 연구는 신장운동을 포함한 자조관리프로그램이 섬유조직염환자의 증상완화에 미치는
효과를 확인하기 위한 유사실험연구로 1997년 2월 24일부터 7월 8일까지 제3차 진료기관인
H대학교 부속 류마티스병원에서 American College of Rheumatology(1990)기준에 의해 진
단 받은 섬유조직염 외래환자를 임의 선정하였다. 이중 서울과 경기도 거주환자 38명은 실
험군으로, 지방 거주환자는 대조군으로 배정하되 압통점의 수, 섬유조직염영향척도, 자기효
능점수를 고려한 짝짓기로 38명을 선정하였으며, 수집된 자료를 SPSS windows를 이용하여
분석한 결과는 다음과 같다.
1. 우울과 압통점의 수를 공변수로 하여 분석한 결과 자조관리프로그램에 참여한 실험군
대조군보다 자기효능 점수가 높았다.
2. 자조관리프로그램에 참여한 실험군이 대조군보다 통증, 압통점 수, 우울, 신체활동장애,
피로, 수면장애, 불안점수가 더 낮아져 섬유조직염의 모든 증상이 완화되었다.
3. 실험군에서 3주후의 자기효능점수와 4∼6주간의 운동수행점수와 순 상관성이 있었다.
4. 실험군에서 운동수행정도에 따른 증상완화와의 관계에서는 운동수행점수와 신체활동장
애 점수에서만 유의한 역 상관성이 있었다.
5. 실험군에서 자기효능점수와 통증, 압통점의 수, 우울, 신체활동, 피로, 수면장애, 불안수
간에 역 상관성이 나타나 자기효능증진점수가 높을수록 증상이 완화된 것으로 나타났다.
본 연구결과를 통하여 신장운동을 포함한 자조관리프로그램에 의해 자기효능이 증진되었
고, 신체적 증상(통증, 압통점의 수, 신체활동장애)과 정신적 증상(우울, 피로, 수면장애, 불
안)이 완화되었음이 확인되었다. 뿐만 아니라 자기효능이 높을수록 자신이 목표로 한 신장
운동량 달성정도가 높았다. 또한 운동수행정도는 섬유조직염의 증상 중 신체활동장애 정도
에 영향을 미쳤다. 그러므로 자기효능증진에 의해 운동수행과 증상완화가 이루어졌다고 결
론지을 수 있다. 따라서 신장운동을 포함한 자조관리프로램이 섬유조직염환자의 증상완화를
위한 적절한 간호중 재전략으로 적용될 수 있을 것이다.
This study was an quasi-experimental study, done to identify factors influencing the
reduction of symptoms in patients with fibromyalgia.
The primary purpose of the study was to develop a Self-Help Program suitable for
patients with fibromyalgia in Korea. The secondary purpose was to identify the effects
of a Self-Help Program which included stretching exercise. This study was carried out
between Feb. 24 and July 8, 1997 and patients in the study included out patient
diagnosed with fibromyalgia based on the criteria developed by the American College of
Rheumatology(1990) and H. University which is a tertiary patient care clinic for
Rheumatism.
The experimental group included 38 patients who were residents of Seoul or Kyungi
province, and a control group of 38 patients who were residents of other areas. The
control patients were matched to the experimental group patients and they were selected
considering the number of tender points on the Fibromyalgia Impact Questionnaire score
and a score of self-efficacy.
The experimental group participated in a Self-Help Program based on the American
Arthritis foundation(1995) guidelines. The program participants participated in a small
group which consisted of 12-15 members attending the program once a week, for 6
weeks with each program lasted two to two and a half hours. The stretching exercise
was carried out in each patient's home every day following the video tape exercise
provided by the researcher, and the researcher provided encouragement and concern to
the patients by calling them once a week. The number times the exercise was
performed was divided by the number of participants to calculate the percentage of
performance and determine the amount of exercise.
Self-efficacy was measured by the Self-Efficacy Scale developed by Lorig et al.
(1989) for arthritis patients. The degree of pain was converted to scores based on the
Visual Analog Scale, the number of tender points was converted to scores based on the
criteria of the ACR(1990) and of Yunus. Depression was measured by CES-D and
physical disability, sleep disturbance, fatigue, and anxiety of patients with fibromyalgia
were measured by the Fibromyalgia Impact Questionnaire. The level of the exercise
performance was converted to scores using the number of times the exercise was
performed following the video tape prepared by Association of Rheumatology Health
Professionals.
Data were analyzed by SPSS windows and the results are described below.
1. The experimental group which participated in the Self-Help Program showed higher
efficacy scores than the control group when both groups were analyzed for depression
and the number of tender points as common variables(F=9.146, p=.003).
2. The experimental group which participated in the Self-Help Program showed lower
scores than the control group, for pain, the number of tender points, depression, physical
disability, fatigue, sleep disturbance and anxiety. These symptoms of fibromyalgia can
all be seen to hale subsided(F=9.483, p=.003, F=32.680, p=.001 ; F=11.104, p=.001, F=5.344
; p=.024, F=7.630 ; p=.007, F=15.6512, p=.003 ; F=7.5412, p=.008).
3. In the experimental group, the self-efficacy score for the first three weeks showed
a positive correlation with the exercise-performance score for four to six weeks(r=.387,
p=.043).
4. In the experimental group, the relationship between the level of
exercise-performance and the reduction of symptoms showed a significant correlation
only to physical disability(r=-.500, p=.001).
5. In the exeprimental group, the relationship between the self-efficacy score and pain,
the number of tender points, depression, physical disability, fatigue, sleep disturbance
and anxiety score showed inverse correlations and thus, a reduction of symptoms
occurred when the self-efficacy score increased(r=-.325, p=.004, r=-.253, p=.027 ; r=-.452,
p=.001, r=-.434, p=.001, r=-.316, p=.005, r=-.460, p=.001, r=-.397, p=.014).
Therefore, self-efficacy improved following the Self-Help Program including the
stretching exercise. It was also found that physical symptoms (pain, number of tender
points, level physical disability) and psychological symptoms (depressopn, fatigue, sleep
disturbance, anxiety) were reduced. Moreover, it was found that the higher the
self-efficacy, the the higher the degree of achievement of goals set for the stretching
exercises. In addition, the level of exrcise-performance influenced the level of physical
disability, one of the symptoms of fibromyalgia.
Accordingly, the conslusions from this study are that exercise-performance and the
reduction of symptoms is achieved through promotion of self-efficacy. Therefore, it is
proposed that are the Self-Help Program including stretching exercises is an appropriate
nursing intervention for the reduction of symptoms of fibromyalgia.
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