Szöts Kirsten, Konradsen Hanne, Solgaard Søren, Østergaard Birte
Kirsten Szöts, MScN, PhD Student, Department of Orthopedic Surgery, Gentofte University Hospital, Hellerup, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. Hanne Konradsen, PhD, Research Manager, Research Unit, Gentofte University Hospital, Hellerup, Denmark. Søren Solgaard, MD, DMSc, Surgeon, Department of Orthopedic Surgery, Gentofte University Hospital, Hellerup, Denmark. Birte Østergaard, PhD, Associate Professor, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; and OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
Orthop Nurs. 2016 Nov/Dec;35(6):411-420. doi: 10.1097/NOR.0000000000000298.
BACKGROUND/PURPOSE: Because of shorter hospitalizations, patients now have to take responsibility for their recovery period at a very early stage. We evaluated the effects of structured, nurse-managed telephone follow-up (TFU) after discharge from the hospital following total knee arthroplasty (TKA).
METHOD/DESIGN: The design was a single-center, unblinded, parallel-group randomized clinical trial. The primary outcome was self-reported physical function according to the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Secondary outcomes were stiffness and pain according to the WOMAC Index; health-related quality of life, measured with the Medical Outcomes Study Short Form (SF-36); general self-efficacy, measured with the General Self-Efficacy Scale; and number of acute visits to the orthopaedic outpatient clinic. In total, 117 patients were randomized to 2 groups: an intervention group receiving TFU 4 and 14 days after discharge in addition to conventional treatment, and a control group receiving conventional treatment. The TFUs were structured by key subjects for health status, as defined by the VIPS model (the Swedish acronym for the concepts of Well-being, Integrity, Prevention, and Safety). The effect was measured 1 and 3 months postsurgery.
No significant effects on physical function in the disease-specific WOMAC Index were identified. However, significant differences in scores were identified in favor of the intervention group on general self-efficacy (p = .014) and physical function (p = .031), measured with the Medical Outcomes Study Short Form 1 month after TKA, but this effect was not seen at 3 months. A positive improvement in several dimensions of health status and health-related quality of life was identified in favor of the intervention group, but patients who had TFU had more unscheduled visits to the outpatient clinic.
Telephone follow-up did not improve physical function compared with conventional treatment, as measured with the WOMAC Index. A short-term effect was identified, improving general self-efficacy and physical function as dimensions of health-related quality of life.
背景/目的：由于住院时间缩短，患者现在必须在很早的阶段就对自己的康复期负责。我们评估了全膝关节置换术（TKA）出院后由护士管理的结构化电话随访（TFU）的效果。
方法/设计：该设计为单中心、非盲、平行组随机临床试验。主要结局是根据西安大略和麦克马斯特大学骨关节炎指数（WOMAC）自我报告的身体功能。次要结局是根据WOMAC指数评估的僵硬和疼痛；使用医学结局研究简表（SF - 36）测量的健康相关生活质量；使用一般自我效能量表测量的一般自我效能；以及骨科门诊急性就诊次数。总共117名患者被随机分为两组：干预组在出院后4天和14天接受TFU，外加常规治疗；对照组接受常规治疗。TFU由VIPS模型（瑞典语中表示幸福、完整、预防和安全概念的首字母缩写）定义的健康状况关键主题构建。在术后1个月和3个月测量效果。
在疾病特异性WOMAC指数中未发现对身体功能有显著影响。然而，在TKA术后1个月使用医学结局研究简表测量时，发现干预组在一般自我效能（p = 0.014）和身体功能（p = 0.031）方面的得分有显著差异，但在3个月时未观察到这种效果。发现干预组在健康状况和健康相关生活质量的几个维度上有积极改善，但接受TFU的患者门诊非预约就诊次数更多。
与常规治疗相比，用WOMAC指数测量，电话随访并未改善身体功能。确定了短期效果，改善了作为健康相关生活质量维度的一般自我效能和身体功能。
