For patients who have to wait for total knee arthroplasty (TKA), they suffer from the progression of knee osteoarthritis (OA) due to pain and disability. These symptoms lead to limitations in performing daily activities and engaging in social activities resulting in decreased quality of life (Ackerman, Ademi, Osborne, & Liew, 2013). To alleviate these symptoms is essential for patients with OA who are waiting for TKA. Therefore, designed preoperative care interventions could be beneficial to decrease progression of the disease while waiting for surgery (Calatayud et al., 2017; Desmevles, Hall, & Woodhouse, 2013; Mat Eil, Sharifudin, Shokri, & Rahman, 2016; van Leeuwen, de Ruiter, Nolte, & de Haan, 2014). The purpose of this study was to determine the effectiveness of the Preoperative Care Bundle Program (PCBP) on the self-efficacy in health behavior, health outcomes (pain, quadriceps muscle strength, range of motion, movement ability and health-related quality of life), and patients’ satisfaction with nursing care in patients on a wait list for TKA.
Methods:
Design
This study was quasi-experimental and used a repeated measures design. The participants were assessed four times during the study: at baseline, 2nd week, 8th week, and 12th week after participation in the program.
Sample
The sample consisted of 96 Thai older adults who were on a wait list for receiving a primary TKA procedure at the Orthopaedics Outpatient Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University. The sample who met the inclusion criteria was matched by gender and age, and randomly assigned either into an experimental (n = 48) or control group (n = 48).
Intervention
The PCBP was developed by researcher. Based on self-efficacy theory (Bandura, 1997), the program consists of 1) a health educational session in a small group (5 – 12 persons) for 30 minutes, 2) quadriceps training exercises for 45 minutes following home-based exercise at least three times a week for 12-weeks, and 3) monitoring health behavior by a researcher with telephone weekly. The control group received standard care.
Measurements
Data on demographics and health information, self-efficacy in health behavior, pain, Health-Related Quality of Life, and patients’ satisfaction with nursing care were assessed by using standardized measures. Quadriceps muscle strength, range of motion, and movement ability were investigated by using Hand-Held Dynamometry (HHD), goniometer, and Time-Up-and-Go Test (TUGT), respectively. A pilot test was conducted in 10 patients who met the inclusion criteria so to test inter-rater reliability of using the HHD and goniometer. The inter-rater reliability results were .91 and .95, respectively. The pilot sample was not included in the larger study sample.
Data collection
After institutional review board approval was granted by the Faculty of Medicine Ramathibodi Hospital, Mahidol University, written consent form was completed by the participants before participating in the study. Data collection was collected by research assistants who were trained to collect the data.
Data analysis
The Predictive Analytics SoftWare (PASW) Statistics version 18 downloaded @ Mahidol University License, was used to determine the effects of PCBP on self-efficacy in health behavior, health outcomes, and patients’ satisfaction with nursing care. Multivariate analysis of variance with repeated measures (MANOVA-RM) was used to analyze the change of all health outcomes over time between groups. Analysis of variance with repeated measures (ANOVA-RM) was used to analyze the change of each variable over time. T-tests were used to analyze patients’ satisfaction with nursing care. A statistically significant level was set at p<.01.
Results:
Of the 96 participants enrolled in the study; four participants in the control group dropped out due to receiving a TKA earlier than anticipated. The remaining 92 participants were evaluated. Most of them were female (89.1%), and young-old (53.3%). More than half of participants (55.4%) were married. About one third of them had graduated (36.9%) from primary school. More than half of them (54.3%) were pre-obese. At baseline, there were no significant differences in all the study variables between the experimental and control groups. There was a significant main effect on self-efficacy in health behavior between groups, F(1, 90) = 30.738, p < .001, partial η2 = .255, and there was a significant interaction between groups and time, Greenhouse-Geisser Adjusted F(2.152, 193.683) = 22.632, p < .001, partial η2 = .201. For MANOVA-RM, there was a significant interaction between groups and time on health outcomes, Greenhouse-Geisser Adjusted F(14, 77) = 10.365, p < .001, partial η2 = .653. Regarding the effects of PCBP on patients’ satisfaction with nursing care, the experimental group (M = 72.35, SD = 3.36) was significantly more satisfied than the control group (M = 53.73, SD = 9.79) after completing the study, [t(90) = 12.414, p < .001].
Conclusion:
The present study suggested that the PCBP which consists of health education, quadriceps training exercise and monitoring components is beneficial for older adults waiting for TKA. Self-efficacy in health behavior, health outcomes, and patients’ satisfaction were improved using this program during waiting time for TKA.