Expectations and experiences of patients with osteoarthritis undergoing total joint arthroplasty: An integrative review

BACKGROUND

The effectiveness of educational interventions for osteoarthritic patients undergoing total joint arthroplasty remains inconclusive. It is essential to understand the educational needs of these patients from their perspectives.

AIM

The aim of this study was to systematically summarize and synthesize osteoarthritic patients' expectations and experiences in undergoing total joint arthroplasty to identify their educational needs.

DESIGN

An integrative review was conducted.

METHODS

Twenty studies (13 qualitative and 7 quantitative), published between 2006 and 2016, were independently appraised by 2 reviewers using the Critical Appraisal Skills Programme checklist for qualitative studies and the Joanna Briggs Institute Critical Appraisal Tools for quantitative studies. Data were analysed using thematic analysis, and the findings were synthesized in a narrative summary.

RESULTS

Six themes describing patients' preoperative and post-operative educational needs were identified: (1) preoperative anxiety, (2) unrealistic expectations of recovery, (3) post-operative pain, (4) regaining functional abilities, (5) physical and psychological sense of loss, and (6) lack of continuity of care.

CONCLUSION

This review is the first to capture the osteoarthritic patients' educational needs from their perspectives. The biopsychosocial model can address the multidimensionality (biological, psychological, and social) of patients' educational needs. A robust infrastructure supporting interprofessional collaborative practice and continuity of care should be adopted to enhance current educational efforts.

Understanding factors influencing the choice of discharge destination by older patients post total lower limb replacement: A qualitative study

Background:

In Singapore, the clinical pathway for total knee replacement was introduced in 1997 to streamline multidisciplinary care and reduce length of stay for patients in acute hospitals. However, patients who chose to be discharged to a community hospital for rehabilitation currently have a longer length of stay due to the higher demand and longer waiting time for beds in these step-down care facilities. To our knowledge, no qualitative studies have been done in Singapore to investigate the post-discharge issues faced by these patients. This study aims to understand how decisions about discharge were being made among elderly patients post-discharge.

Design:

Grounded theory qualitative methodology was applied.

Method:

Data was collected from nine inpatients who recently underwent total knee replacement or total hip replacement surgery in a tertiary hospital in Singapore by in-depth interviews conducted between October 2012 and July 2013. Data was analyzed using thematic analysis.

Findings:

Three major themes emerged from the interviews when participants were asked about the reasons for choosing a community hospital instead of going home after discharge. The themes were: perceived lack of caregiver; lack of confidence; and services provided in the community hospitals.

Conclusion:

This study showed that factors related to perceived unavailability of caregivers, low level of confidence and accessibility of comprehensive community rehabilitation services were important considerations among elderly patients when choosing their discharge destinations and care. Relevant stakeholders can then explore solutions to these problems so as to correctly site patients.

Development and Psychometric Testing of a Scale for Evaluating Self-Management Needs of Knee Osteoarthritis (SMNKOA) in Taiwan

Self-management of osteoarthritis (OA) of the knee is important for treating this chronic disease. This study developed and psychometrically tested a new instrument for measuring adult patients' self-management needs of knee osteoarthritis (SMNKOA). The theoretical framework of self-care guided the development of the 35-item SMNKOA scale. Participants ( N = 372) were purposively sampled from orthopedic clinics at medical centers in Taiwan. The content validity index was 0.83. Principal components analysis identified a three-factor solution, accounting for 53.19% of the variance. The divergent validity was -0.67; convergent validity was -0.51. Cronbach's alpha was .95, Pearson's correlation coefficient was .88, and the intraclass correlation coefficient was .95. The scale's reliability and validity supports the SMNKOA, as a tool to measure self-management needs of adults with knee OA. Nurses and other health care providers can use this instrument to evaluate knee OA patients and identify strategies for improving health-related outcomes and patient education.

Nurse-led telephone follow-up after total knee arthroplasty--content and the patients' views

AIM AND OBJECTIVES

To generate information on how telephone follow-up consultations, structured by nursing status according to the VIPS-model, functioned after total knee arthroplasty. The objectives were to unfold the content of the telephone follow-ups according to the structure for nursing status and to explore the patients' views of the telephone follow-ups.

BACKGROUND

The length of stay in hospital following total knee arthroplasty has fallen markedly, and patients now have to be responsible for their recovery from a very early stage. After discharge, patients may experience a variety of health problems. A clinical trial was conducted to evaluate the effect of telephone follow-up, and information on how the telephone follow-ups functioned is relevant for implementation into clinical practice.

DESIGN

A qualitative design was used.

METHOD

One hundred and four case reports from telephone follow-up consultations and individual interviews with 10 patients formed the data material. Content analysis was used for the analysis.

RESULTS

The content of the telephone follow-ups included dialogues relating to all key subjects for nursing status except 'culture/spirituality'. The structured Telephone follow-up was valued by total knee arthroplasties patients as representing a holistic approach and providing adequate information, counselling and support after discharge to home. Three categories were identified with regard to the patients' views: 'A means for reflection and provision of adequate information and counselling', 'Supportive' and 'Not the only resource for support and counselling'.

CONCLUSION

Nursing status according to the VIPS model is a comprehensive structure to identify the need for counselling, information and support after total knee arthroplasty. The structured telephone follow-ups were valued for representing a holistic approach and providing adequate information, counselling and support after discharge to home. Conducting telephone follow-up with a holistic approach demands specialised and broad nursing experience.

RELEVANCE TO CLINICAL PRACTICE

Postdischarge follow-up is important.

Telephone follow-up by nurse following total knee arthroplasty - protocol for a randomized clinical trial (NCT 01771315)

BACKGROUND

Due to shorter hospitalization, patients have to take responsibility for their rehabilitation period at a very early stage. The objective of this trial is to study the effects of two treatment schemes following total knee arthroplasty: conventional treatment following discharge from hospital and early follow-up by telephone consultations in addition to conventional treatment following discharge from hospital. The ultimate aim is to increase the effectiveness of the treatment by improving patients' health status, promote self-efficacy, and reduce the number of acute visits to the orthopaedic outpatient clinic during the rehabilitation period.

METHOD/DESIGN

The design is a randomized un-blinded parallel group clinical trial conducted at the Department of Orthopaedic Surgery, Gentofte Hospital, the Capital Region of Denmark. In total, 116 patients will be allocated by an external randomization program to 2 groups: an intervention group following usual treatment after discharge supplemented by a nurse managed structured follow-up consultation conducted by telephone 4 and 14 days after discharge from hospital and a control group following treatment as usual. The consultations are structured by key subjects relevant to assess the health status according to the VIPS-model (the Swedish acronym for the concepts Well-being, Integrity, Prevention and Safety). The content of the consultations can vary according to the patients´ individual situations and needs. All consultations are conducted by the researcher responsible for the trial. The effect is measured 1, 3, 6 and 12 months post-surgery. The primary outcome is self-reported physical function measured by The Western Ontario and McMaster Universities Arthritis Index. Secondary outcomes are self-reported health-related quality of life, general self-efficacy and the number of acute visits to the orthopaedic outpatient clinic.

DISCUSSION

The result of this trial is expected to provide new knowledge to support the development of targeted and effective follow-up after total knee arthroplasty in order to improve the patients´ health-related knowledge and skills of being able to take actively part in their illness and improve their health status.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01771315.

Effective management strategies for osteoarthritis

Osteoarthritis (OA) is a chronic disease which affects a significant number of people during working life and retirement. The principle symptoms of OA are pain, stiffness, and potentially reduced movement and function of the affected joint. In severe OA the ability to engage in work or social activity may be restricted and as a result, the health-related quality of life of the patient may be affected. There are a variety of approaches which can be implemented to manage symptoms, including the use of orthoses, exercise programmes or in severe cases, arthroplasty. It is important that emphasis is placed on patient empowerment and shared decision-making with regard to managing symptoms and preserving or improving function or the affected joint(s).