Faculty of Health Sciences, University of Sydney, NSW, Australia.
Osteoarthritis Cartilage. 2013 Sep;21(9):1257-63. doi: 10.1016/j.joca.2013.06.011.
The increasingly shorter hospitalization following total knee arthroplasty (TKA) requires patients to assume earlier responsibility to self-manage their pain. Poorly managed acute pain increases the risk of persistent pain, reduces quality of life and increases unnecessary healthcare utilization. This study aims to examine post-discharge pain intensity, pain management behaviors and potential barriers to optimal self-management of pain.
We administered a questionnaire at 2 weeks after discharge to 174 patients undergoing TKA in 10 Australian hospitals. Participants rated pain expectation and severity, use of analgesics and non-pharmacological methods, side-effects, walking and exercise times, perceptions of analgesics, adequacy of pain management information provided and satisfaction with pain relief.
Of 171 (98%) participants who completed the questionnaire, 88 (52%) reported that the worst pain period occurred during the first 2 weeks at home. During the first 2 weeks at home, the average pain was 'severe/extreme' for 40 (23%) participants and 92 (54%) experienced severe pain at least some of the time. Many participants sought further medical help for their pain. Adequate information on analgesics and non-pharmacological methods for pain relief were reported by only 73% and 47%, respectively. Approximately 20% had negative perceptions about analgesic use. Higher pain severity was associated with lower satisfaction and less time spent walking daily.
Effective pain relief after hospital discharge following TKA is a challenge. Many participants reported significant pain, sought further medical help for pain relief and had inadequate information at discharge to effectively self-manage their postoperative knee pain.
全膝关节置换术（TKA）后住院时间越来越短，这要求患者更早地承担自我管理疼痛的责任。急性疼痛管理不善会增加持续性疼痛的风险，降低生活质量，并增加不必要的医疗保健利用。本研究旨在调查出院后疼痛强度、疼痛管理行为以及最佳自我管理疼痛的潜在障碍。
我们在 10 家澳大利亚医院接受 TKA 的 174 名患者出院后 2 周时进行了问卷调查。参与者评估了疼痛预期和严重程度、使用镇痛药和非药物治疗方法、副作用、行走和锻炼时间、对镇痛药的看法、提供的疼痛管理信息是否充分以及对疼痛缓解的满意度。
在完成问卷调查的 171 名参与者（98%）中，有 88 名（52%）报告说最严重的疼痛期发生在出院后在家的头 2 周内。在家的头 2 周内，40 名（23%）参与者的平均疼痛为“严重/极度”，92 名（54%）参与者至少有时会感到剧烈疼痛。许多参与者因疼痛寻求进一步的医疗帮助。只有 73%和 47%的参与者分别报告了足够的镇痛药和非药物止痛方法信息。大约 20%的参与者对使用镇痛药有负面看法。较高的疼痛严重程度与较低的满意度和每天行走时间减少相关。
TKA 后出院后的有效疼痛缓解是一个挑战。许多参与者报告有明显的疼痛，为缓解疼痛寻求进一步的医疗帮助，并且出院时获得的信息不足以有效管理他们的术后膝关节疼痛。
