Application of quantitative rehabilitation training and the teach-back health education model in fracture patients with anxiety and depression

Abstract

BACKGROUND

Fracture patients often have negative emotions such as anxiety and depression, which not only worsen the pain experience and weaken rehabilitation confidence, but may also lead to a decrease in functional exercise compliance, thereby delaying the overall rehabilitation process. However, traditional rehabilitation nursing models often focus on physiological function recovery and have certain limitations in systematic psychological intervention and health education.

AIM

To investigate quantitative rehabilitation training combined with the teach-back health education model in patients with anxiety and depression.

METHODS

A total of 120 fracture patients were randomly assigned to either a conventional group (n = 60, standard pharmacotherapy and routine care) or a combined group (n = 60, standard pharmacotherapy combined with quantitative rehabilitation training and the teach-back health education model). Postintervention outcomes included Visual Analog Scale (VAS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Barthel Index score, Adult Health Self-Management Skill Rating Scale (AHSMSRS), and the Functional Exercise Compliance Scale.

RESULTS

After the intervention, the combined group showed significantly lower VAS scores (1.83 ± 0.46 vs 2.03 ± 0.55, P < 0.001), HAMA scores (10.53 ± 2.88 vs 14.87 ± 3.27, P < 0.001), and HAMD scores (9.70 ± 2.67 vs 15.77 ± 3.68, P < 0.001) than the conventional group. The Barthel Index score (93.95 ± 3.48 vs 92.53 ± 3.30, P < 0.05), AHSMSRS score (139.87 ± 8.74 vs 135.50 ± 9.72, P < 0.05), and Functional Exercise Compliance Scale score (60.55 ± 3.73 vs 53.97 ± 5.23, P < 0.001) in the combined group were significantly higher than those in the conventional group.

CONCLUSION

Quantitative rehabilitation training combined with the teach-back model alleviates pain, reduces anxiety and depression, and improves exercise compliance and self-management in fracture patients.

Key Words: Quantitative rehabilitation training; Teach-back health education model; Fractures; Anxiety; Depression

Core Tip: For fracture patients with anxiety and depression, the combined application of quantitative rehabilitation training and the teach-back health education model can more effectively alleviate pain and negative emotions, significantly enhance patients' self-management abilities and compliance with functional exercise, and thereby improve their activities of daily living. This integrated intervention demonstrates superior clinical efficacy and application value.

INTRODUCTION

Fractures represent a common clinical traumatic condition, typically characterized by significant swelling, severe pain, and impaired joint mobility at the injury site. These symptoms not only affect the patient’s physiological functions but also exert adverse effects on their psychological state[1]. Anxiety and depression fall within the spectrum of psychological disorders, primarily manifesting as generalized anxiety and episodic panic states, often accompanied by somatic symptoms such as dizziness, chest tightness, palpitations, and dyspnea. With changing lifestyles and increasing life pressures, the global incidence of anxiety and depression has been rising annually[2]. Quantitative rehabilitation training is one of the primary clinical interventions used to promote functional recovery in fracture patients and has been demonstrated to facilitate patient rehabilitation. Based on the specific condition of the patient’s injury, this training systematically guides patients through range-of-motion exercises, muscle strength reinforcement, weight-bearing adaptation drills, balance and coordination training, and functional reconstruction of daily activities. Through this series of targeted exercises, it effectively promotes the recovery and reconstruction of the patient’s impaired physiological functions[3,4]. The teach-back health education model, also referred to as feedback-based education or the “teach-back” method, involves the educator first conveying relevant knowledge to the learner, who is then asked to restate the information in their own words or demonstrate the learned behaviors. If misunderstandings or omissions occur during the retelling, the educator provides additional explanations and corrections, using iterative feedback to ensure the learner accurately and comprehensively masters the knowledge system[5]. Postoperative education has been shown to rapidly enhance treatment compliance and nursing satisfaction among orthopedic trauma patients, which may contribute to accelerating recovery, and alleviating symptoms of anxiety and depression[6].

In recent years, the combination of structured rehabilitation training and enhanced health education has shown positive effects in disease management and postoperative rehabilitation[7,8]. However, in clinical practice of orthopedics, existing joint intervention studies have not differentiated patients’ psychological states and lack specific treatment plans for the population with anxiety and depression after fractures. Compared to individuals with normal psychological states, those with pre-existing anxiety or depression are more susceptible to the negative impacts of trauma, which can exacerbate their symptoms and hinder the recovery process[9]. Therefore, this study aims to explore the integration of quantitative rehabilitation training and teach-back health education models, and apply them to patients with fractures accompanied by anxiety and depression, in order to evaluate their comprehensive impact on functional recovery and psychological status, and provide empirical evidence for the development of more targeted rehabilitation plans in clinical practice.

MATERIALS AND METHODS

Research object

A total of 120 fracture patients admitted to the No. 926 Hospital, Joint Logistics Support Force of PLA from January 2023 to June 2025 were selected as the study subjects. They were divided into a conventional group (n = 60) and a combined group (n = 60) using the random number table method. All participants and their family members were informed and provided signed consent. Meanwhile, the study protocol was reviewed and approved by the Ethics Committee of this hospital.

Exclusion and inclusion criteria

Inclusion criteria: (1) Diagnosed with fracture by computer tomography, magnetic resonance imaging, or other examinations; (2) Hamilton Anxiety Scale (HAMA) score > 7 and Hamilton Depression Scale (HAMD) score > 7 upon admission; (3) Clear consciousness, good compliance, and informed consent; and (4) Age ≥ 18 years.

Exclusion criteria: (1) Impairment of heart, lung, liver, or kidney organ function; (2) Combined hematological or immune system diseases; (3) Combined malignant tumor or organ failure; and (4) Combined cognitive dysfunction or unable to communicate.

Withdrawal criteria: (1) Meeting any of the exclusion criteria after enrollment; and (2) Voluntary withdrawal from the study for any reason after enrollment.

Methods

Conventional group: The conventional group received a standardized rehabilitation protocol consisting of routine pharmacological therapy and basic nursing care. Specific interventions included: (1) Conventional anti-infection treatment: Patients were administered cefazolin sodium for injection (Shanghai Xinfeng Pharmaceutical Co., Ltd., national drug approval No. H20184084, 0.5 g) at a dose of 1 g every 12 hours via intravenous drip, twice daily. The entire course comprised two administrations; and (2) Symptomatic treatment: Mannitol injection (Huaren Shuanghe Pharmaceutical Co., Ltd., national drug approval No. H11020861, 250 mL/bottle) was administered at a dose of 125 mL via intravenous drip twice daily to reduce edema. Etoricoxib tablets (Qilu Pharmaceutical Co., Ltd., national drug approval No. H20193272, 60 mg/tablet) were administered orally at a dose of 60 mg once daily for pain relief. Escitalopram oxalate tablets (Zhejiang Jinhua Conba Bio-pharm. Co., Ltd., national drug approval No. H20130105, 5 mg/tablet) were administered orally at a dose of 5 mg twice daily to alleviate severe anxiety and depressive symptoms. Basic nursing care: Basic nursing care is performed by the responsible nurse during the patient's hospitalization. Provide one-time oral education to patients before treatment, explaining treatment plans and precautions, and providing basic psychological comfort. Strictly follow the doctor’s advice to assist in the fixation of the fracture site, and inform the patient that strict braking is necessary to maintain stability before obtaining medical permission. During hospitalization, patients are advised to rest adequately, avoid vigorous exercise and improper weight-bearing, and receive standardized dietary recommendations, such as encouraging the intake of foods rich in calcium, protein, and vitamins, and avoiding spicy and irritating foods. And use general encouragement language for psychological support, communicate with family members to obtain family cooperation. Regularly monitor the patient’s vital signs, pain level, peripheral circulation of the affected limb, and sensory motor function. On the day of discharge, provide verbal guidance to the patient, explain the follow-up time, medication methods, and daily protection principles, and distribute unified health education materials.

Combined group: The combined group adopted a care plan integrating quantitative rehabilitation training with the teach-back health education model. The specific interventions were as follows: (1) Establishment of a rehabilitation training and health education guidance team: The team consisted of a rehabilitation physician (responsible for guiding and periodically evaluating the patient’s intervention progress), a head nurse (responsible for literature review, developing survey questionnaires, and providing standardized operational training to nurses), and rehabilitation nurses (responsible for supervising the implementation of quantitative rehabilitation training and conducting teach-back health education). The rehabilitation physician served as the team leader. All team members were required to be proficient in conventional pharmacological treatment, routine nursing care, and the combined quantitative rehabilitation training and teach-back health education model for patients with fractures accompanied by anxiety and depression (specific operational details are provided below); (2) Quantitative rehabilitation training: Postoperative days 1-7: Respiratory training-the rehabilitation physician instructed patients in effective coughing and deep breathing techniques. The regimen consisted of two sessions per day, each lasting five minutes. Postoperative weeks 1-4: Early edema reduction and joint mobilization-patients were positioned supine with lower limbs extended and ankles relaxed. They slowly and forcefully pointed their toes, holding for 5-10 seconds, then pulled their toes back toward themselves, holding for 5-10 seconds. Each session lasted 5 minutes, performed 2-3 times per day. Ankle rotations (clockwise and counterclockwise) were incorporated, along with limb elevation to promote edema reduction. Postoperative weeks 4-8: Muscle strength and core stability training: (a) Straight leg raises: With the lower limb extended, the leg was slowly raised 30°-45° above the bed, held at the highest point for 5 seconds, then slowly lowered. After a 5-second rest, the exercise was repeated on the opposite leg. Five sets per session, 2-3 sessions per day; (b) Simulated cycling: In the supine position with lower limbs extended, patients mimicked a cycling motion at a slow and steady pace. Three sessions per day, each lasting 5 minutes; (c) Bridge exercise: Lying supine with knees bent, patients lifted their hips and lower back off the bed, supported by the head, elbows, and feet, until the torso and thighs formed a straight line. The position was held for 5-10 seconds before slowly lowering (three sets per day, with five repetitions per set); and (d) Swallow exercise: In the prone position, patients performed stepwise movements-first lifting only the upper body to the maximum height and holding for 5 seconds; hen lifting only the lower body and holding for 5 seconds; finally, after proficiency was achieved, simultaneously lifting both the upper and lower body and holding for 5 seconds. Each movement was performed in three sets daily, with five repetitions per set. After the patient adapted to the aforementioned training intensity and was assessed by the rehabilitation physician as having met the expected standards in both physiological response and functional performance, the training intensity, frequency, and duration could be gradually increased under medical guidance, based on the individual patient's condition. After 8 weeks post operation: Functional recovery training-single-leg standing balance training was introduced, gradually increasing from 10-30 seconds per repetition; grip strength and lifting exercises using a 500 mL water bottle; and supervised simulation of stair climbing, with gradual increases in training duration. Before the commencement and upon the completion of each phase of rehabilitation therapy, the rehabilitation physician conducted a systematic assessment of the patient's functional status. Based on the evaluation results, the subsequent phase’s rehabilitation training plan was dynamically adjusted to ensure optimal recovery outcomes for the patient; and (3) Teach-back health education model: (a) Information delivery: On the first day of admission, the responsible nurse assessed the patient’s educational background and used easily understandable language combined with live demonstrations to instruct the patient in various rehabilitation exercises, such as respiratory training, ankle rotation and flexion-extension, straight leg raises, and simulated cycling. The positive effects of these exercises on alleviating anxiety and improving mood were clearly explained; (b) Response elicitation: When the patient’s condition permitted after the initial education, the responsible nurse used encouraging, low-pressure language and open-ended questions to assess the patient’s understanding of the previous day’s health education content. Examples included: “Shall we go through the ankle rotation and flexion-extension exercises together again?” and “Shall we discuss how these exercises contribute to your recovery?”; (c) Commentary and clarification: Based on the patient’s verbal expression of knowledge and performance of functional exercises, the nurse evaluated their grasp of key health guidance points. If misunderstandings or incorrect execution were identified, the responsible nurse reinitiated the teach-back process to repeat the health education steps; and (d) Confirmation of understanding: Open-ended questioning was used to identify any remaining areas of uncertainty. Before discharge, the nurse provided repeated explanations and guidance on any content not yet fully mastered until comprehensive understanding was achieved. Both groups of participants underwent a continuous intervention period of three months.

Observation indicators

Pain degree: The Visual Analog Scale (VAS)[10] was used to assess the patients’ pain level before and after the intervention. The total score of the scale is 10 points. It typically consists of a 10-cm line, placed either horizontally or vertically, with one end labeled “0” representing “no pain” and the opposite end labeled “10” representing “the most severe pain”, patients mark a point on the line according to their subjective feeling, and the distance from the start of the line to the marked point is measured. The score is positively correlated with pain intensity, and a higher score indicates more severe pain in the patient.

Anxiety and depression: The HAMA[11] and HAMD[12] were used for evaluation. The HAMA scale consists of 14 items covering both psychological and somatic aspects of anxiety, with a total score of 56 points. A score > 8 suggests possible anxiety, and higher scores reflect more severe anxiety symptoms. The HAMD scale includes 17 items that comprehensively assess various symptoms of depression, with a total score of 68 points. A score > 7 indicates the presence of depressive symptoms, and higher scores correspond to more severe depressive symptoms.

Activities of daily living: The Barthel Index[13] was used to evaluate the patients’ functional status in daily living activities. The total score of the scale ranges from 0 to 100, and a higher score indicates better self-care ability of the individual.

Behavior and cognition: The Adult Health Self-Management Skill Rating Scale (AHSMSRS)[14] and the Functional Exercise Compliance Scale for Orthopedic Patients[15] were used to assess the patients’ behavioral and cognitive levels. The AHSMSRS includes three core dimensions: Self-management behavior, self-management cognition, and self-management environment, providing a comprehensive reflection of an individual’s health management potential. The total score is 190 points, and a higher score suggests better self-management ability of the patient. In orthopedic studies, patients with higher self-management ability may engage more proactively in functional exercise, manage pain and emotions more effectively, and thus achieve better rehabilitation outcomes. The Functional Exercise Compliance Scale for Orthopedic Patients is used to measure the extent to which patients adhere to the functional exercise regimen prescribed by healthcare professionals. The total score is 75 points, and the score is positively correlated with the patient’s compliance with functional exercise.

Statistical analysis

Statistical analysis was performed using SPSS 21.0. The measurement data conforming to normal distribution were expressed as mean ± SD, with independent samples t test adopted for between-group comparisons and paired samples t-test used for within-group comparisons. The counting data were presented as n (%), and χ² test or Fisher's exact test was employed for between-group comparisons. A significance level of α = 0.05 was used for all tests.

RESULTS

General characteristics

The results are presented in Table 1. No significant differences were observed in general characteristics such as age, body mass index (BMI), gender, education level, etiology, fracture classification, surgical approach, and occurrence of complications between the two groups of patients (P > 0.05). The average age of the patients was approximately 47 years, with an average BMI of about 21.9 kg/m². The proportion of males was slightly higher than that of females, and most patients had an education level of high school/technical secondary school or below. The main cause of injury was external force trauma, and the majority of fractures were type A. Most patients underwent non-surgical treatment, and the majority reported no complications. The baseline characteristics were evenly distributed between the two groups.

Table 1 Comparison of general data between the 2 groups.

Class	Conventional group (n = 60)	Combined group (n = 60)	Test statistics	P value
Age (year)	47.15 ± 7.37	46.80 ± 8.38	0.243	0.808
BMI (kg/m2)	21.84 ± 2.47	21.88 ± 2.47	-0.104	0.918
Gender			0.304	0.581
Male	32 (53.3)	35 (58.3)
Female	28 (46.7)	25 (41.7)
Education level			0.496	0.780
Lower secondary and below	21 (35.0)	18 (30.0)
Upper secondary	32 (53.3)	33 (55.0)
Tertiary education	7 (11.7)	9 (15.0)
Etiology			1.516	0.469
Traumatic injury	44 (73.3)	38 (63.3)
Osteoporosis	10 (16.7)	15 (25.0)
Other causes	6 (10.0)	7 (11.7)
Fracture classification			3.556	0.169
Type A	39 (65.0)	37 (61.7)
Type B	12 (20.0)	19 (31.7)
Type C	9 (15.0)	4 (6.6)
Surgical modality			2.466	0.291
Open reduction and internal fixation	13 (21.7)	11 (18.3)
Minimally invasive approach	16 (26.7)	10 (16.7)
Non-operative modality	31 (51.7)	39 (65.0)
Complications			-	1.000
No	56 (93.3)	57 (95.0)
Yes	4 (6.7)	3 (5.0)

Data were presented as n (%) or mean ± SD.

Pain intensity

The results are shown in Table 2. After the intervention, the combined group showed significantly lower scores in VAS (1.83 ± 0.46) compared with the conventional group (2.03 ± 0.55), and the differences were statistically significant (P < 0.05).

Table 2 Comparison of pain levels between the 2 groups, mean ± SD.

Items	Before intervention	After intervention	t value	P value
Conventional group	5.77 ± 1.53	2.03 ± 0.55	17.254	< 0.001
Combined group	6.00 ± 1.80	1.83 ± 0.46	17.693	< 0.001
t value	-0.766	2.163	-	-
P value	0.445	0.033	-	-

Anxiety and depression

The results are shown in Table 3. Post-intervention, the combined group demonstrated significantly lower HAMA scores (10.53 ± 2.88) and HAMD scores (9.70 ± 2.67) compared with the conventional group (14.87 ± 3.27 and 15.77 ± 3.68), and the differences were statistically significant (P < 0.05).

Table 3 Comparison of anxiety and depression mood between the 2 groups, mean ± SD.

Items	HAMA		HAMD
	Before intervention	After intervention	Before intervention	After intervention
Conventional group	22.35 ± 6.32	14.87 ± 3.27	20.30 ± 5.54	15.77 ± 3.68
Combined group	22.52 ± 5.95	10.53 ± 2.88	20.57 ± 5.95	9.70 ± 2.67
t value	-0.149	7.700	-0.254	10.337
P value	0.882	< 0.001	0.800	< 0.001

HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale.

Barthel index

The results are shown in Table 4. Following the intervention, the combined group achieved significantly higher Barthel Index scores (93.95 ± 3.48) than the conventional group (92.53 ± 3.30), and the difference was statistically significant (P < 0.05).

Table 4 Comparison of Barthel index score between the 2 groups, mean ± SD.

Items	Before intervention	After intervention	t value	P value
Conventional group	48.55 ± 4.26	92.53 ± 3.30	-77.884	< 0.001
Combined group	48.07 ± 5.18	93.95 ± 3.48	-54.059	< 0.001
t value	0.558	-2.287	-	-
P value	0.578	0.024	-	-

AHSMSRS score and functional exercise compliance

The results are shown in Table 5. After the intervention, the combined group registered significantly higher AHSMSRS scores (139.87 ± 8.74) and Functional Exercise Compliance Scale scores (60.55 ± 3.73) than the conventional group (135.50 ± 9.72 and 53.97 ± 5.23), and the differences were statistically significant (P < 0.05).

Table 5 Comparison of Adult Health Self-Management Skill Rating Scale score and Functional Exercise Compliance Scale between the 2 groups, mean ± SD.

Items	AHSMSRS		Functional Exercise Compliance Scale
	Before intervention	After intervention	Before intervention	After intervention
Conventional group	92.72 ± 10.35	135.50 ± 9.72	48.25 ± 4.31	53.97 ± 5.23
Combined group	92.00 ± 11.72	139.87 ± 8.74	47.87 ± 4.94	60.55 ± 3.73
t value	0.355	-2.588	0.453	-7.938
P value	0.723	0.011	0.651	< 0.001

AHSMSRS: Adult Health Self-Management Skill Rating Scale.

DISCUSSION

Functional limitation, together with symptoms of anxiety and depression, jointly constitute risk factors that impede the rehabilitation of fracture patients; the two interact and create a vicious cycle. On one hand, pain and limited mobility directly restrict patients’ participation in daily activities and social interactions, predisposing them to negative emotions such as helplessness and frustration. These factors may further exacerbate neuroendocrine dysregulation through persistent activation of the stress response system, thereby inducing or aggravating symptoms of anxiety and depression. On the other hand, negative psychological states can, by impairing treatment adherence, altering pain perception thresholds, and diminishing self-efficacy, hinder patients’ initiative in performing functional exercises. This may lead to secondary dysfunctions such as muscle atrophy and joint stiffness, ultimately delaying bone healing and functional recovery[16,17]. We therefore sought an intervention model that could simultaneously address both physiological function and psychological state. This study aimed to evaluate the comprehensive effect of integrating quantitative rehabilitation training with the teach-back health-education model in fracture patients with comorbid anxiety and depression.

When this combined approach was applied, post-intervention VAS, HAMA and HAMD scores in the intervention group were lower than those in the usual-care group, whereas AHSMSRS, Barthel Index and functional-exercise-compliance scores were higher. These findings indicate that the prompted combined intervention regimen demonstrated positive effects in the rehabilitation of orthopedic patients. This approach contributed to significant pain relief and effective amelioration of negative emotional states such as anxiety and depression. Concurrently, it enhanced patients’ adherence to functional exercises and strengthened their self-management capacity as well as performance in activities of daily living. Ultimately, these effects aim to systematically promote the recovery of motor function, serving as a core strategy for achieving rehabilitation goals. We hypothesize that enhanced self-efficacy is the pivotal mediator[18]; ample empirical evidence regards self-efficacy as a key determinant of disease prognosis, arguing that higher self-efficacy fosters adherence and self-management and thereby improves recovery outcomes[19,20]. The likely mechanism is as follows. Quantitative rehabilitation training matches exercise dosage to the patient’s stage of recovery, optimises the physiological trajectory of joint restoration, and systematically consolidates exercise behaviour; the resultant functional gains provide powerful positive feedback that boosts self-efficacy[21]. The teach-back model is not passive knowledge delivery but an active, closed-loop cognitive-restructuring process: By ensuring accurate comprehension and mastery of rehabilitation knowledge it strengthens the patient’s belief that he or she can control the recovery process, further elevating self-efficacy. In addition, the educator’s continuous positive reinforcement and interaction constitute effective psychosocial support, creating a virtuous cycle of physical and psychological improvement[22]. Our results are consistent with those of Ni et al[23] and Yuan et al[24], who respectively reported beneficial effects of quantitative rehabilitation training and feedback-based health education on negative affect. The present study extends these findings by showing that systematic integration of the two interventions produces synergistic effects: Quantitative training provides objective evidence that confirms the correctness of the knowledge conveyed by teach-back, while teach-back-reinforced cognition increases the patient’s persistence in quantitative training. Physiological feedback and cognitive reinforcement thus form a positive loop that markedly elevates self-efficacy.

According to Bandura’s cognition theory, individuals with high self-efficacy are more likely to set challenging goals and persevere[25]. In this study, enhanced self-efficacy enabled patients to overcome avoidance behaviors caused by pain and negative emotions, leading to more proactive and regular participation in functional exercise. Meanwhile, increased confidence in health management motivated them to more actively apply acquired knowledge-such as self-monitoring of pain, nutritional support, and complication prevention-in their daily lives. These behaviors translated directly into greater exercise adherence and more effective self-management, which accounts for the improved scores on the AHSMSRS and the Functional Exercise Adherence Scale. With the increase in exercise adherence and self-management capacity, patients demonstrated systematic improvements in muscle strength, joint stability, and physical coordination, thereby facilitating their ability to perform daily activities-such as dressing and eating-independently and safely. This explains the observed increase in Barthel Index scores, a finding consistent with that reported by Yu et al[26]. Moreover, progressive functional recovery, diminishing pain[27], exercise-induced release of endorphins and dopamine[28], and the positive psychological feedback generated by teach-back method[29] jointly contributed to the alleviation of anxiety and depression. Endorphins, as endogenous analgesic substances, effectively modulate pain conduction pathways and induce pleasurable sensations; whereas dopamine, a key neurotransmitter in the reward system, enhances positive emotional experiences. Together, these mechanisms form an essential neurochemical foundation for alleviating anxiety and depression symptoms. At the psychosocial level, the systematic implementation of the teach-back health education model deepened and streamlined patient-provider communication. Through iterative confirmation and feedback loops, it strengthened patients’ understanding of disease management and sense of control, thereby establishing a positive psychological feedback mechanism. The combined intervention not only improved treatment adherence but also, by fostering patient engagement and self-efficacy, significantly reduced uncertainty and helplessness during rehabilitation, leading to marked alleviation of anxiety and depression. However, this study has its limitations. Firstly, this study is a single-center randomized controlled trial with a relatively limited sample size. Additionally, the subjects of the study are sourced from medical institutions in the same region, sharing certain homogeneity in demographic and sociological characteristics, medical environment, and nursing resource allocation. This may limit the generalizability of the research conclusions across different regions, hospitals of different levels, and broader populations. Secondly, this study primarily relies on patient self-assessment scales and observational scales as the basis for efficacy determination, which may be influenced by social expectations, recall bias, and the subjective judgments of evaluators. Lastly, the combined intervention strategy adopted in this study has achieved positive results, but the current design makes it difficult to determine the proportion of the effects and interaction effects of quantitative rehabilitation training and teach-back health education, respectively. Furthermore, although self-efficacy is theoretically speculated to be a potential mediating mechanism, there is a lack of empirical evidence. In the future, it is necessary to conduct multi-center large-sample studies, introduce objective physiological indicators and biomarkers, and explore the specific mechanisms and pathways of the combined intervention to further validate and optimize this intervention program.

CONCLUSION

In summary, for fracture patients with symptoms of anxiety and depression, the integrated intervention combining quantitative rehabilitation training and the teach-back health education model can effectively alleviate negative emotions, promote functional recovery of the affected limb, and significantly improve overall rehabilitation quality and prognosis. This model demonstrates clear clinical efficacy and practical feasibility, indicating substantial potential for broader application.