Technol Health Care. 2024;32(6):4593-4601. doi: 10.3233/THC-240780.
The Stepped Care Model (SCM) is an evidence-based treatment approach that tailors treatment intensity based on patients' health status, aiming to achieve the most positive treatment outcomes with the least intensive and cost-effective interventions. Currently, the effectiveness of the Stepped Care Model in postoperative rehabilitation for TKA (Total Knee Arthroplasty) patients has not been reported.
The present study aimed to investigate whether the stepped care model could improve early-stage self-report quality of life and knee function after total knee arthroplasty via a prospective randomized controlled design.
It was a mono-center, parallel-group, open-label, prospective randomized controlled study. Patients who aging from 60-75 years old as well as underwent unilateral primary total knee arthroplasty due to end-stage knee osteoarthritis between 2020.06 to 2022.02 were enrolled. Participants were randomized and arranged into two groups in a 1:1 allocation. The control group was given traditional rehabilitation guidance, while the stepped care model group was given continued stepped care. Hospital for special surgery knee score, daily living ability (ADL), knee flexion range, and adverse events at 1, 3, and 6 months after total knee arthroplasty were recorded.
88 patients proceeded to the final analysis. There was no significant difference of age, gender, length of stay, BMI, and educational level between the two groups at the baseline. After specific stepped care model interventions, patients showed significant improvements in HHS in 1 month (85.00 (82.25, 86.00) vs. 80.00 (75.00, 83.00), p< 0.001), 3 months (88.00 (86.00, 92.00) vs. 83.00 (76.75, 85.00), p< 0.001), and 6 months (93.00 (90.25, 98.00) vs. 88.00 (84.25, 91.75), p< 0.001) when compared with the control group. Similar results were also found in both daily living ability and knee flexion angle measurements. No adverse event was observed during the follow-up.
The present study found that the stepped care model intervention significantly improved early-stage knee function and self-reported life quality after total knee arthroplasty due to knee osteoarthritis. Female patients and those less than 70 years old benefit more from the stepped care model intervention after total knee arthroplasty.
阶梯式护理模式（SCM）是一种基于证据的治疗方法，根据患者的健康状况调整治疗强度，旨在以最积极的治疗效果和最少的强化及具有成本效益的干预措施。目前，阶梯式护理模式在 TKA（全膝关节置换术）患者术后康复中的有效性尚未报道。
本研究旨在通过前瞻性随机对照设计，探讨阶梯式护理模式是否能改善全膝关节置换术后早期的自我报告生活质量和膝关节功能。
这是一项单中心、平行组、开放标签、前瞻性随机对照研究。纳入了 2020.06 年至 2022.02 年间年龄在 60-75 岁之间且因终末期膝骨关节炎行单侧初次全膝关节置换术的患者。参与者按照 1:1 分配随机分组。对照组给予传统康复指导，而阶梯式护理模式组则给予持续的阶梯式护理。记录全膝关节置换术后 1、3 和 6 个月的美国特种外科医院膝关节评分、日常生活能力（ADL）、膝关节屈曲范围和不良事件。
88 例患者进入最终分析。两组在基线时的年龄、性别、住院时间、BMI 和教育水平方面无显著差异。经过特定的阶梯式护理模式干预后，患者在 1 个月时 HHS 显著改善（85.00（82.25，86.00）与 80.00（75.00，83.00），p<0.001）、3 个月时（88.00（86.00，92.00）与 83.00（76.75，85.00），p<0.001）和 6 个月时（93.00（90.25，98.00）与 88.00（84.25，91.75），p<0.001），与对照组相比。在日常生活能力和膝关节屈曲角度测量方面也得到了相似的结果。在随访期间未观察到不良事件。
本研究发现，阶梯式护理模式干预可显著改善膝骨关节炎全膝关节置换术后早期膝关节功能和自我报告生活质量。女性患者和 70 岁以下患者从全膝关节置换术后的阶梯式护理模式干预中获益更多。
