Communication Preferences in Total Joint Arthroplasty: Exploring the Patient Experience Through Generative Research

Experiences and perceptions of adults pre- and/or post-lumbar spine surgery: a meta-ethnography

STUDY DESIGN

Qualitative meta-ethnography. Pre-registered with OSF:10.17605/OSF.IO/UTZE6.

PURPOSE

To understand the patient experience pre- and/or post-lumbar spine surgery.

METHODS

Literature search: A literature search was conducted in MEDLINE, EMBASE, EmCare and CINAHL from inception to October 17, 2022. Study selection criteria: Peer-reviewed qualitative or mixed-method studies of English text investigating the beliefs, perceptions, or experiences of adults (≥18 years old) pre- and/or post-lumbar spine surgery for degenerative, non-traumatic or non-infectious concerns. Data synthesis: The eMERGE meta-ethnography reporting guidelines were followed to create themes and subthemes from the original themes of the included studies. A quality appraisal was performed using the McMaster Quality Appraisal tool.

RESULTS

We included 18 studies and identified five themes that were separated into pre- and post-operative categories. The two pre-operative themes included [1]: the influence of physiotherapy interventions on patients' experiences, and [2] the importance of education/the power of communication, and the three post-operative themes included [1]: psychosocial coping [2], redefining oneself post-operatively, and [3] experience with the healthcare system.

CONCLUSIONS

These findings emphasize the complexity of the peri-operative experience for individuals undergoing lumbar spine surgery. Future research should focus on addressing psychosocial factors that may optimize patient experiences and recovery following LSS.

Mobile and Computer-Based Applications for Rehabilitation Monitoring and Self-Management After Knee Arthroplasty: Scoping Review

BACKGROUND

Successful post-knee replacement rehabilitation requires adequate access to health information, social support, and periodic monitoring by a health professional. Mobile health (mHealth) and computer-based technologies are used for rehabilitation and remote monitoring. The extent of technology use and its function in post-knee replacement rehabilitation care in low and middle-income settings are unknown.

OBJECTIVE

To inform future mHealth intervention development, we conducted a scoping review to map the features and functionality of existing technologies and determine users' perspectives on telerehabilitation and technology for self-management.

METHODS

We followed the Joanna Briggs Institute methodology for scoping reviews. We searched the Embase, Medline, PsycINFO via OVID, and Cochrane Central Register of Controlled Trials databases for manuscripts published from 2001 onward. We included original research articles reporting the use of mobile or computer-based technologies by patients, health care providers, researchers, or family members. Studies were divided into the following 3 categories based on the purpose: validation studies, clinical evaluation, and end user feedback. We extracted general information on study design, technology features, proposed function, and perspectives of health care providers and patients. The protocol for this review is accessible in the Open Science Framework.

RESULTS

Of the 5960 articles, 158 that reported from high-income settings contributed to the qualitative summary (64 studies on mHealth or telerehabilitation programs, 28 validation studies, 38 studies describing users' perceptions). The highest numbers of studies were from Europe or the United Kingdom and North America regarding the use of a mobile app with or without wearables and reported mainly in the last decade. No studies were from low and middle-income settings. The primary functions of technology for remote rehabilitation were education to aid recovery and enable regular, appropriate exercises; monitoring progress of pain (n=19), activity (n=20), and exercise adherence (n=30); 1 or 2-way communication with health care professionals to facilitate the continuum of care (n=51); and goal setting (n=23). Assessment of range of motion (n=16) and gait analysis (n=10) were the commonly validated technologies developed to incorporate into a future rehabilitation program. Few studies (n=14) reported end user involvement during the development stage. We summarized the reasons for satisfaction and dissatisfaction among users across various technologies.

CONCLUSIONS

Several existing mobile and computer-based technologies facilitate post-knee replacement rehabilitation care for patients and health care providers. However, they are limited to high-income settings and may not be extrapolated to low-income settings. A systematic needs assessment of patients undergoing knee replacement and health care providers involved in rehabilitation, involving end users at all stages of development and evaluation, with clear reporting of the development and clinical evaluation can make post-knee replacement rehabilitation care in resource-poor settings accessible and cost-effective.

Discharge Planning and Challenges for Patients With Asian Lifestyles Following Total Hip Arthroplasty: National Survey Design in Japan

This study examined discharge planning and challenges for patients following total hip arthroplasty in Japan. A cross-sectional national survey of 500 hospitals was conducted in May 2019. Discharge planning education tended to include content on dislocation prevention, including prevention while using a squat toilet and crouching down to sit on the floor or sleep on a futon on the floor-activities common in many Asian communities that require a maximum flexion of the hip joint. The challenges of discharge planning included diverse lifestyles, aging issues, lack of assistance at home, lack of consensus on dislocation prevention intervention, limitation of standardized care, interprofessional collaboration, and lack of time to educate family. Tailored discharge planning can be challenging, particularly for aged patients who practice "floor culture", i.e., sleeping, sitting and eating on the floor. Discharge planning needs to be task shifted from the surgeon to the nurse to enhance nurses' empowerment in Japan.

A Model for Delivery of Orthopaedic Perioperative Education via Telehealth

With orthopaedic surgery, there is a risk of poor outcomes such as pain, decreased mobility, and decreased function, particularly if patients do not receive adequate preoperative and postoperative orthopaedic education. Healthcare education delivered via telehealth can be individualized to the patient's specific situation and health literacy level and is accessible, convenient, and timely for patients and providers. The purpose of this article is to combine two models of best practice, the EDUCATE model of patient education and Bashshur's Taxonomy of Telehealth, to describe a framework for improving delivery of preoperative and postoperative orthopaedic education. This innovative model presents a patient-centered approach to orthopaedic education that can increase patient comprehension and retention and address health literacy, through consideration of three dimensions essential for effective telehealth programs: functionality, application, and technology. Applications of the model are presented.

Overcoming fear of movement resulting from knee replacement; strategies used by patients: An interview study

BACKGROUND AND AIMS

Fear of movement is among the main concerns of patients following knee replacement surgery and a determining factor in the success of surgery. The strategies adopted by patients to overcome this fear have not yet been identified, but once pin pointed, these strategies can be strengthened and modified through intervention. The aim of the present study was to explore the personal strategies adopted by patients following knee replacement to overcome fear of movement.

MATERIALS AND METHODS

Interviews were conducted with 15 patients who had undergone knee replacement, selected by purposive sampling. Data were collected through in-depth semi-structured interviews and analyzed using inductive content analysis.

RESULTS

The patients' strategies as depicted in their narratives were classified into three categories: 1) Movement based on awareness; 2) Movement based on support; and 3) Movement based on hope. These three categories are described in eight subcategories and show what strategies the patients used to overcome their fear of movement.

CONCLUSION

These findings can help to increase awareness about strategies to overcome fear of movement in patients following knee replacement and to develop and support tailored treatment strategies with the aim of reducing such fear of movement and increasing physical activity among the patients.