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中国护士群体足部重度疼痛风险预测的列线图模型构建

王立群,  宁宁,  陈佳丽,  李佩芳,  谢静颖,  杨辉亮,  朱红彦,  侯爱琳

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文章导航 > 四川大学学报（医学版）  > 2023 >  54(3): 596-601
王立群, 宁宁, 陈佳丽, 等. 中国护士群体足部重度疼痛风险预测的列线图模型构建[J]. 四川大学学报（医学版）, 2023, 54(3): 596-601. doi: 10.12182/20230560204
引用本文: 王立群, 宁宁, 陈佳丽, 等. 中国护士群体足部重度疼痛风险预测的列线图模型构建[J]. 四川大学学报（医学版）, 2023, 54(3): 596-601. doi: 10.12182/20230560204
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WANG Li-qun, NING Ning, CHEN Jia-li, et al. Nomographic Model for Predicting Severe Foot Pain in Nurses from Tertiary Hospitals in China[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCES), 2023, 54(3): 596-601. doi: 10.12182/20230560204
Citation: WANG Li-qun, NING Ning, CHEN Jia-li, et al. Nomographic Model for Predicting Severe Foot Pain in Nurses from Tertiary Hospitals in China[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCES), 2023, 54(3): 596-601. doi: 10.12182/20230560204
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中国护士群体足部重度疼痛风险预测的列线图模型构建

doi: 10.12182/20230560204

  • 四川大学华西医院 骨科/四川大学华西医院 骨科研究所/四川大学华西护理学院 （成都 610041）

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    E-mail：cjl85614115@163.com

Nomographic Model for Predicting Severe Foot Pain in Nurses from Tertiary Hospitals in China

  • Department of Orthopaedics/Orthopaedic Research Institute, West China Hospital, Sichuan University/West China School of Nursing, Chengdu 610041, China

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    摘要
  • 摘要:   目的  调查护士足部重度疼痛的发生率及常见部位，明确其危险因素，并构建个体足部重度疼痛风险预测列线图。  方法  采用分层整体抽样方法，于2019年8–12月期间选取在我国351家三级医院的10691名护士，调查足部重度疼痛的发生现状。将可能影响其发生的变量进行单因素分析，明确护士足部重度疼痛发生的影响因素，进一步采用logistic逐步回归分析，筛查足部重度疼痛发生的独立危险因素。将多因素回归分析结果中有统计学意义的因素纳入Nomograph预测模型的构建。通过一致性指数（C-index）和1000个bootstrap样本校准来测量Nomograph预测性能。  结果  10691名护士中发生足部疼痛3419名，发生率为31.98%，其中重度疼痛（VAS 7～10分）发生率为2.27%（243名）。重度疼痛部位多见于双侧脚掌与足跟。研究最终纳入年龄、学历、工作鞋材质、工作鞋舒适程度、足部外伤史、是否合并其他并发症这6个因素，构建了Nomograph预测模型。C-index值为0.706，标准曲线与校准预测曲线贴合良好。  结论  该研究构建的模型具有良好的预测效果，指标简单易得，可为护士预防重度足部疼痛提供借鉴。
    Abstract:   Objective  To investigate the prevalence and common sites of severe foot pain among nurses, to define the risk factors of severe foot pain in nurses in tertiary hospital in China, and to construct a nomograph model for predicting individuals' risks for severe foot pain.   Methods  Between August 2019 and December 2019, a stratified global sampling method was used to select 10691 nurses from 351 tertiary hospitals in China to investigate the incidence of severe foot pain among them. The variables that may affect the occurrence of severe foot pain were analyzed by single factor analysis to identify the influencing factors of severe foot pain in nurses. Furthermore, the independent risk factors of severe foot pain were analyzed by stepwise logistic regression analysis. The statistically significant factors identified in the multivariate regression analysis were incorporated into the nomograph prediction model. The predictive performance of the nomograph was measured by the consistency index (C-index) and calibrated with 1000 Bootstrap samples.  Results  A total of 3419 nurses out of the 10691 had foot pain, resulting in an incidence of 31.98%. The incidence of severe pain (VAS score 7-10) was 2.27% (243 of 10691). The locations of severe pain were more commonly found in the soles and heels of both feet. Six factors, including age, education, the material of the work shoes, comfortableness of the work shoes, number of complications, and foot injure history, were incorporated in the nomograph predicting model. The C-index value was 0.706 and the standard curve fitted well with the calibrated prediction curve.  Conclusion  The risk prediction model constructed in this study showed sound performance in predicting the risk of severe foot pain in nurses, and all the indicators involved are simple and the relevant data are easily obtained. The model can provide reference for preventing severe foot pain in nurses.
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  • 图  1  护士足部重度疼痛的Nomograph预测模型列线图

    Figure  1.  Nomograph predicting severe foot pain in nurses

    下载: 全尺寸图片 幻灯片

    图  2  Nomograph预测模型的特征曲线图

    Figure  2.  Feature curves of nomograph predicting severe foot pain in nurses

    下载: 全尺寸图片 幻灯片

    图  3  Nomograph预测模型的校准曲线图

    Figure  3.  Calibration curve of nomograph predicting severe foot pain in nurses

    下载: 全尺寸图片 幻灯片

    表  1  护士的临床特征及足部重度疼痛调查结果

    Table  1.   Clinical features of the nurses covered in the study and the results of the severe foot pain survey

    Clinical featureVariableCase%
    Sex Male 275 2.57
    Female 10416 97.42
    Age/yr. 18-25 1953 18.26
    26-30 3464 32.40
    31-40 3958 37.02
    41-60 1316 12.30
    Body mass index/(kg/m2) <18.5 1345 12.58
    18.5-23.99 7429 69.48
    24-27.99 1566 14.64
    ≥28 351 3.32
    Education Secondary 122 1.14
    Junior college 2492 23.33
    Bachelor 7896 73.85
    Postgraduate 181 1.69
    Marital status Never married 3247 30.37
    Married 7220 67.53
    Widowed or divorced 224 2.10
    Childbirth 0 4020 37.60
    Pregnancy 301 2.82
    1 4610 43.12
    2 1572 14.70
    ≥3 188 1.76
    Department Medical department 3244 30.34
    Surgery department 4543 42.49
    Others 2904 27.16
    Professional title Nurse 2597 24.29
    Senior nurse 4891 45.74
    Supervisor nurse 2718 25.42
    (Associate) professor of nursing 485 4.53
    Years of nursing experience/year ≤5 3402 31.82
    6-10 3465 32.41
    11-20 2575 24.09
    ≥21 1249 11.68
    VAS 1-3 1929 56.42
    4-6 1247 36.47
    7-10 243 7.10
    Pain location Left sole 133 54.73
    Right sole 118 48.56
    Left heel 102 41.98
    Right heel 98 40.33
    Quality of pain Swelling pain 142 58.44
    Sourness and pain 160 65.84
    Stabbing pain 67 27.57
    下载: 导出CSV

    表  2  护士足部重度疼痛的单因素分析

    Table  2.   Univariate analysis of severe foot pain in nurses

    VariableVAS 0-6 (n=10448)/case (%) or $ \bar x \pm s $VAS 7-10 (n=243)/case (%) or $ \bar x \pm s $t/χ2P
    Age/yr. 31.89±7.278 34.84±8.151 − <0.001
    Body mass index/(kg/m2) 23.39±4.560 22.61±4.461 − 0.011
    Sex 0.51 0.473
    　Male 267 (2.6) 8 (3.3)
    　Female 10181 (97.4) 235 (96.7)
    Highest education achieved 11.18 0.011
    　Secondary 115 (1.1) 7 (2.9)
    　Junior college 2450 (23.4) 42 (17.3)
    　Bachelor 7707 (73.8) 189 (77.8)
    　Postgraduate 176 (1.7) 5 (2.1)
    Marital status 14.56 <0.001
    　Never married 3200 (30.6) 47 (19.3)
    　Married 7031 (67.3) 189 (77.8)
    　Widowed or divorced 217 (2.1) 7 (2.9)
    Childbirth 16.38 0.003
    　0 3958 (37.9) 62 (25.5)
    Pregnancy 291 (2.8) 10 (4.1)
    　1 4485 (42.9) 125 (51.4)
    　2 1532 (14.7) 40 (16.5)
    　≥3 182 (1.7) 6 (2.5)
    Professional title 5.04 0.169
    　Nurse 2545 (24.4) 52 (21.4)
    　Senior nurse 4787 (45.8) 104 (42.8)
    　Supervisor nurse 2647 (25.3) 71 (29.2)
    　(Associate) professor of nursing 469 (4.5) 16 (6.6)
    Department 4.24 0.120
    　Medical department 3165 (30.3) 79 (32.5)
    　Surgery department 4455 (42.6) 88 (36.2)
    　Others 2828 (27.1) 76 (31.3)
    Years of nursing experience/year 35.19 <0.001
    　≤5 3346 (32.0) 56 (23.0)
    　6-10 3402 (32.6) 63 (25.9)
    　11-20 2505 (24.0) 70 (28.8)
    　≥21 1195 (11.4) 54 (22.2)
    Nightshift/(times/month) 2.39 0.665
    　0 2551 (24.4) 66 (27.2)
    　1 424 (4.1) 13 (5.3)
    　2-3 1022 (9.8) 23 (9.5)
    　4-5 3030 (29.0) 64 (26.3)
    　≥6 3421 (32.7) 77 (31.7)
    Sleep/(h/d) 15.46 <0.001
    　<6 h 388 (3.7) 20 (8.2)
    　6-8 h 9506 (91) 216 (88.9)
    　≥8 h 554 (5.3) 7 (2.9)
    Complication 75.21 <0.001
    　0 7726 (73.9) 123 (50.6)
    　1 1828 (17.5) 70 (28.8)
    　2 537 (5.1) 27 (11.1)
    　3 357 (3.4) 23 (9.5)
    Foot injury history 50.52 <0.001
    　No 5587 (53.5) 74 (30.5)
    　Yes 4861 (46.5) 169 (69.5)
    Footwear type 10.01 0.007
    　Nursing shoes 8785 (84.1) 186 (76.5)
    　Crocs 1057 (10.1) 36 (14.8)
    　Others 606 (5.8) 21 (8.6)
    Footwear material 7.87 0.049
    　Real leather 1618 (15.5) 44 (18.1)
    　Artificial leather 6774 (64.8) 140 (57.6)
    　Cotton 173 (1.7) 8 (3.3)
    　Plastics 1883 (18.0) 51 (21.0)
    Shape of the toebox 22.89 <0.001
    　Pointed shoes 130 (1.2) 4 (1.6)
    　Rounded toes 9018 (86.3) 194 (79.8)
    　Square head shoes 1096 (10.5) 30 (12.3)
    　Open toe shoes 204 (2.0) 15 (6.2)
    Footwear comfort 31.65 <0.001
    　Very uncomfortable 131 (1.3) 13 (5.3)
    　Uncomfortable 844 (8.1) 22 (9.1)
    　General 3496 (33.5) 84 (34.6)
    　Comfortable 4423 (42.3) 90 (37.0)
    　Very comfortable 1554 (14.9) 34 (14.0)
    Frequency of changing into clean socks /(times/d) 13.14 0.041
    　0 820 (7.8) 24 (9.9)
    　1-2 8296 (79.4) 194 (80.2)
    　3-5 1099 (10.5) 16 (6.6)
    　≥6 233 (2.2) 8 (3.3)
    下载: 导出CSV

    表  3  护士足部重度疼痛的多因素logistic回归分析

    Table  3.   Multivariate logistic regression analysis of severe foot pain in nurses

    VariableβOR (95% CI)P
    Age 0.034 1.03 (1.02-1.05) 0.000
    Highest education achieved (secondary)
    　Junior college −0.998 0.37 (0.16-0.87) 0.022
    　Bachelor −0.710 0.49 (0.22-1.10) 0.085
    　Postgraduate −0.408 0.67 (0.20-2.21) 0.506
    Footwear material (real leather)
    　Artificial leather −0.170 0.84 (0.59-1.21) 0.355
    　Cotton 0.938 2.56 (1.11-5.86) 0.027
    　Plastics −0.135 0.87 (0.51-1.49) 0.621
    Footwear comfort (very uncomfortable)
    　Uncomfortable −1.238 0.29 (0.14-0.60) 0.001
    　General −1.121 0.33 (0.17-0.62) 0.001
    　Comfortable −1.319 0.27 (0.14-0.51) 0.000
    　Very comfortable −1.263 0.28 (0.14-0.57) 0.000
    Complication (0)
    　1 0.635 1.89 (1.39-2.57) 0.000
    　2 0.816 2.26 (1.45-3.52) 0.000
    　3 0.906 2.47 (1.53-4.01) 0.000
    Foot injury history (no)
    　Yes 0.731 2.08 (1.56-2.76) 0.000
    　β: patial regression coefficient; OR: odds ratio; CI: confidence interval.
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-09-19
  • 修回日期:  2023-04-14
  • 网络出版日期:  2023-05-20
  • 刊出日期:  2023-05-20

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