اثربخشي درمان مبتني بر پذيرش و تعهد بر رفتارهاي خودمراقبتي و پيروي از درمان در بيماران دياليزي

Effectiveness of treatment based on commitment and acceptance on self-care behaviors and follow-up of treatment in hemodialysis patients

ﺧﻼﺻﻪ ﻣﻘﺪﻣﻪ: ﺗﺤﻘﯿﻘﺎت ﻧﺸﺎن داده اﺳﺖ ﮐﻪ اﺑﻌﺎد روان ﺷﻨﺎﺧﺘﯽ ﺳﻬﻢ ﻋﻤﺪهاي در درﻣﺎن ﻣﺸﮑﻼت ﺟﺴﻤﺎﻧﯽ دارد. ﺑﻨﺎﺑﺮاﯾﻦ؛ ﻫﺪف از اﻧﺠﺎم ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺮرﺳﯽ اﺛﺮﺑﺨﺸﯽ درﻣﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ ﺑﺮ رﻓﺘﺎرﻫﺎي ﺧﻮدﻣﺮاﻗﺒﺘﯽ و ﭘﯿﺮوي از درﻣﺎن در ﺑﯿﻤﺎران دﯾﺎﻟﯿﺰي ﺑﻮد. روش ﮐﺎر: روش ﺗﺤﻘﯿﻖ ﻧﯿﻤﻪ ﺗﺠﺮﺑﯽ و ﻃﺮح ﺗﺤﻘﯿﻖ ﺑﻪﺻﻮرت ﭘﯿﺶآزﻣﻮن- ﭘﺲآزﻣﻮن ﺑﺎ ﮔﺮوهﻫﺎي ﺗﺠﺮﺑﯽ و ﮐﻨﺘﺮل ﻣﯽﺑﺎﺷﺪ. ﺟﺎﻣﻌﻪ آﻣﺎري ﭘﮋوﻫﺶ را ﮐﻠﯿﻪ ﺑﯿﻤﺎران دﯾﺎﻟﯿﺰي ﺑﺨﺶ دﯾﺎﻟﯿﺰ ﺑﯿﻤﺎرﺳﺘﺎن ﺑﻮﻋﻠﯽ ﺷﻬﺮ ﻣﺮﯾﻮان ﺗﺸﮑﯿﻞ دادﻧﺪ. ﺗﻌﺪاد آزﻣﻮدﻧﯽﻫﺎي ﮔﺮوه آزﻣﺎﯾﺸﯽ 15 ﻧﻔﺮ و ﮔﺮوه ﮔﻮاه ﻧﯿﺰ 15 ﻧﻔﺮ ﺑﻮد. ﮔﺮوه آزﻣﺎﯾﺸﯽ ﺗﺤﺖ 8 ﺟﻠﺴﻪ درﻣﺎن ﭘﺬﯾﺮش و ﺗﻌﻬﺪ ﻗﺮار ﮔﺮﻓﺖ و ﮔﺮوه ﮔﻮاه ﻫﯿﭻ درﻣﺎﻧﯽ درﯾﺎﻓﺖ ﻧﮑﺮد. اﺑﺰار ﮔﺮدآوري دادهﻫﺎ، ﭘﺮﺳﺸﻨﺎﻣﻪ ﭘﯿﺮوي از درﻣﺎن ﻣﺪاﻧﻠﻮ و ﭘﺮﺳﺸﻨﺎﻣﻪ ﺗﻮان ﺧﻮدﻣﺮاﻗﺒﺘﯽ )SCAS( ﺑﻮد. دادهﻫﺎي ﺣﺎﺻﻞ از ﻃﺮﯾﻖ ﻧﺮم اﻓﺰار SPSS ﻧﺴﺨﻪ 24 و ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮن ﺗﺤﻠﯿﻞ ﮐﻮوارﯾﺎﻧﺲ، ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﺷﺪ. ﻧﺘﺎﯾﺞ: ﻧﺘﺎﯾﺞ ﺣﺎﮐﯽ از آن ﺑﻮد ﮐﻪ ﺗﻔﺎوت ﺑﯿﻦ ﻣﯿﺎﻧﮕﯿﻦ ﻧﻤﺮات ﺑﯿﻤﺎران ﮔﺮوه آزﻣﺎﯾﺶ و ﮔﺮوه ﮐﻨﺘﺮل در ﻧﺘﯿﺠﻪ اﺛﺮ ﻣﺘﻐﯿﺮ ﻣﺴﺘﻘﻞ درﻣﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ )ACT( ﺑﺮ ﻣﺘﻐﯿﺮﻫﺎي ﺧﻮدﻣﺮاﻗﺒﺘﯽ، اﻫﺘﻤﺎم در درﻣﺎن، ﺗﻤﺎﯾﻞ ﺑﻪ ﻣﺸﺎرﮐﺖ در درﻣﺎن، ﭼﺴﺒﯿﺪن ﺑﻪ درﻣﺎن، ﺗﻌﻬﺪ ﺑﻪ درﻣﺎن و ﺗﺪﺑﯿﺮ در اﺟﺮاي در ﺑﯿﻤﺎران دﯾﺎﻟﯿﺰي ﻣﺆﺛﺮ اﺳﺖ )0/001≤p(. اﻣﺎ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻌﻨﯽ دار ﻧﺸﺪن ﺗﻔﺎوت ﺑﯿﻦ ﻣﯿﺎﻧﮕﯿﻦ ﻧﻤﺮات ﺑﯿﻤﺎران ﮔﺮوه ﮐﻨﺘﺮل ﺑﺎ ﮔﺮوه آزﻣﺎﯾﺸﯽ در زﻣﯿﻨﻪ ﺗﺄﺛﯿﺮ ﻣﺘﻐﯿﺮ ﻣﺴﺘﻘﻞ، درﻣﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ )ACT( ﺑﺮ ﺗﻮاﻧﺎﯾﯽ ﺗﻄﺎﺑﻖ ﺑﺎ ﺑﯿﻤﺎري و ﺗﻠﻔﯿﻖ درﻣﺎن ﺑﺎ زﻧﺪﮔﯽ در ﺑﯿﻤﺎران دﯾﺎﻟﯿﺰي، ﻣﺆﺛﺮ ﻧﻤﯽﺑﺎﺷﺪ )0/001≥p(. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﺑﻪ ﻧﻈﺮ ﻣﯽرﺳﺪ روﯾﮑﺮد درﻣﺎن ﻣﺒﺘﻨﯽ ﺑﺮ ﭘﺬﯾﺮش و ﺗﻌﻬﺪ ﺑﺮ ﻣﺘﻐﯿﺮﻫﺎي ﻣﺒﻨﯽ ﺑﺮ ﺧﻮدﻣﺮاﻗﺒﺘﯽ ﻣﻮﺛﺮ اﺳﺖ. ﺑﺎ اﯾﻦ ﺣﺎل در ﺟﻬﺖ ﺑﺎﻻ ﺑﺮدن اﻋﺘﺒﺎر ﺑﯿﺮوﻧﯽ ﺗﺤﻘﯿﻖ ﭘﯿﺸﻨﻬﺎد ﻣﯽﮔﺮدد ﮐﻪ ﺗﺤﻘﯿﻘﺎت ﺑﯿﺸﺘﺮي در اﯾﻦ راﺳﺘﺎ ﺻﻮرت ﺑﮕﯿﺮد.

Introduction: Researches have shown that psychological dimensions play major role in the treatment of physical problems. Therefore, the aim of this study was to evaluate the effectiveness of treatment based on acceptance and commitment on self-care behaviors and follow-up of treatment in dialysis patients. Methods: The research method is quasi-experimental and the research design is pre-test post-test with experimental and control groups. The statistical population of the study consisted of all dialysis patients in the dialysis ward of Bu Ali Hospital in Marivan. The number of subjects in the experimental group was 15 and the control group was 15. The experimental group underwent 8 sessions of acceptance and commitment treatment and the control group did not receive any treatment. Data collection tools were Madanloo treatment adherence questionnaire and self-care ability questionnaire (SCAS). Data were analyzed by SPSS software version 24 using analysis of covariance. Results: The results showed that the difference between the mean scores of patients in the experimental group and the control group was due to the effect of the independent variable of acceptance and commitment therapy (ACT) on the variables of self-care, treatment diligence, willingness to participate in treatment, adherence to treatment, commitment to treatment and management in dialysis patients (P≤0.001). However, due to the lack of significant differences between the mean scores of patients in the control and the experimental groups in the effect of independent variable, acceptance and commitment therapy (ACT) is not effective on the ability to adapt to the disease and integrate therapy to life in dialysis patients (P≥0.001). Conclusion: It seems that acceptance and commitment-based treatment approach is effective on self-care variables. However, it is suggested that more research be done in this field to increase the external credibility of the research.