Pre- and Post-Operative Education and Health-Related Quality of Life for Patients with Hip/Knee Replacement and Hip Fracture.

Arthroplasty for the hip/knee and surgeries for hip fractures are increasing worldwide. The aims of this study were to investigate changes in health-related quality of life (HRQOL) after surgery with an early mobility education program, and to explore their associations with pain and anxiety. Pain intensity and anxiety were assessed with the visual analogue scale (VAS) and Beck Anxiety Inventory (BAI), and HRQOL was assessed with the Short Form-36 (SF-36). The physical component summary (PCS) and mental component summary (MCS) and eight subscales of the SF-36 were calculated. At pre-operation, the patients suffered from moderate pain and mild anxiety, and their HRQOL scores were low (4.9, 7.8, 35.4, and 48.2 for the VAS, BAI, PCS, and MCS, respectively). The pain, anxiety, and HRQOL improved after surgery and had moderate to large effect sizes at 6-month follow-up (Glass's delta = 1.23, 0.88, 0.81, and 0.67 for VAS, BAI, PCS, and MCS, respectively). Pain and anxiety were strongly correlated to HRQOL at each stage, with the maximum correlation (r = -0.34 to -0.93) reached at 6-month follow-up. The surgery effectively improves HRQOL, as the reduced pain and anxiety lead to better physical and mental HRQOL.