Ho Cheng-Jung, Chen Yen-Ti, Wu Hung-Lan, Huang Hsuan-Ti, Lin Sung-Yen
Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan.
Departments of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan.
J Pers Med. 2022 Apr 29;12(5):719. doi: 10.3390/jpm12050719.
The perioperative care of patients undergoing total knee arthroplasty (TKA) affects functional recovery and clinical outcomes. This study aims to introduce a patient-specific integrated education program (IEP) into the TKA clinical pathway and to evaluate patient outcomes between the intervention and control groups. We performed a two-site, two-arm, parallel-prospective controlled trial. The experiment group received an IEP incorporating verbal preoperative education, prehabilitation, multidisciplinary personalized rehabilitation during hospitalization, and supervised self-executed home-based exercise after discharge. The control group received regular TKA clinical care. We monitored the pain intensity, anxiety scores, and functional scores at six time points from the pre-operation interview to 3 months post-operation. The pain score was significantly decreased in the IEP group during hospitalization (p < 0.01) and before discharge (p < 0.05). The anxiety status was also improved after intervention in terms of state and trait anxiety inventory scores (p < 0.001) during hospitalization. The patient-reported (WOMAC) or physician-reported (American Knee Society Score) functional scores (p < 0.01 at most of the time points) all improved significantly under hospitalization. We found that the patient-specific IEP combining preoperative education, prehabilitation, the in-hospital group education class, and postoperative care navigation is effective in reducing postoperative pain, decreasing perioperative anxiety, and facilitating functional recovery following TKA.
全膝关节置换术（TKA）患者的围手术期护理会影响功能恢复和临床结局。本研究旨在将针对患者的综合教育计划（IEP）引入TKA临床路径，并评估干预组和对照组的患者结局。我们进行了一项双中心、双臂、平行前瞻性对照试验。试验组接受了一项IEP，包括术前口头教育、术前康复、住院期间的多学科个性化康复以及出院后监督下的家庭自主锻炼。对照组接受常规的TKA临床护理。我们在从术前访谈至术后3个月的六个时间点监测疼痛强度、焦虑评分和功能评分。IEP组在住院期间（p < 0.01）和出院前（p < 0.05）疼痛评分显著降低。在住院期间，就状态和特质焦虑量表评分而言，干预后焦虑状态也得到改善（p < 0.001）。患者报告的（WOMAC）或医生报告的（美国膝关节协会评分）功能评分在住院期间大多时间点均显著改善（p < 0.01）。我们发现，结合术前教育、术前康复、住院期间小组教育课程和术后护理指导的针对患者的IEP在减轻TKA术后疼痛、降低围手术期焦虑以及促进功能恢复方面是有效的。
