Background: Total hip replacement (THR) is among the most frequent surgical interventions in older adults. Although THR can ultimately relieve pain, restore function and improve quality of life, many patients have early hospital discharge after THR. Such patients may benefit from interventions to speed their recovery. Self-management (SM) is an effective approach for those with chronic disease, but no studies have yet addressed the incorporation of SM in a mobile application (app) for patients with THR. Therefore, it seemed appropriate to develop an eHealth SM (eH-SM) app to manage day-to-day health behaviors, using program management, real-time monitoring and support, and disease health knowledge. Therefore, we hypothesized that an intense eH-SM program will have clinical benefits for patients with THR.
Methods: This quantitative research will be divided into two phases (6 steps) in three years. In Phase I, we will develop an eH-SM intervention, conduct a pilot study, and do psychometric testing of the instruments. In Phase II, an experimental design will be used to examine the effectiveness of the eH-SM intervention. In this 12-month randomized controlled trial, 220 hospitalized patients with THR will be recruited from a hospital. The control group (N=110) will receive usual care only; the experimental group will receive usual care and the new eH-SM intervention (N=110). The eH-SM intervention will be developed based on Bundura’s self-efficacy theory, which provides four sources of information for SM: peer support, appraisal, goal setting and self-monitoring of exercise, and symptom management. The “symptom management” strategy will focus on pain and early signs of complications from THR. To examine the effects of the eH-SM intervention, data will be collected at baseline (pre-discharge hospital) and at 1, 3, 6 and 12 months after discharge. We will record seven health-related outcomes: hip function, self-efficacy, depressive symptom, quality of life, SM behaviors, hip performance and health services use. Outcome measures of this study will be analyzed using descriptive and inferential statistics and generalized estimating equations.
Results:
Based on the preceding literature review, the following hypotheses will be tested:
- Patients after THR in the experimental group who receive an eH-SM intervention will have significantly higher scores of hip function compared to those in the control group.
- Patients after THR in the experimental group who receive an eH-SM intervention will have significantly higher scores in self-efficacy for arthritis compared to those in the control group.
- Patients after THR in the experimental group who receive a self-management intervention will have significantly higher levels of THR SM behavior compared to those in the control group.
- Patients after THR in the experimental group who receive an eH-SM intervention will have significantly lower scores in depressive symptoms compared to those in the control group.
- Patients after THR in the experimental group who receive an eH-SM intervention will have significantly higher levels of quality of life compared to those in the control group.
- Patients after THR in the experimental group who receive an eH-SM intervention will have significantly higher levels of hip performance compared to those in the control group.
- Patients after THR in the experimental group who receive an eH-SM intervention will have significantly lower rates of health services use for THR compared to those in the control group.
Conclusion: The development of an effective eH-SM intervention should help THR patients improve their SM ability and quality of life by removing the gap between patients and healthcare providers. Thus, we expect the eH-SM program will help patients improve their health status through the different strategies used. This approach could motivate governments and policymakers to speed implementation of such apps that can lower costs and improve health outcomes.