| Objective1. To work out the feasibility and practical home-based care programme for total hip replacement(THR) patients, including " home-based care services content index system framework for THR patients" and " home-based care rehabilitation training paths and evaluation basic contents for THR patients ", on the basis of the present state of home-based care and relevant documents and THR patients'demand.2. To evaluate the effects of home-based care programme applied to the home-based care for THR patientsMethods1. Designing home-based care programme for THR patients:Combining the demand investigation of the home-based care among THR patients and their main care-takers, considering the practical situation in our country, the primary home-based care programme for THR patient, including " home-based care services content index system framework for THR patients " and " home-based care rehabilitation training paths and evaluation scale for THR patients ", has been worked out on the basis of relevant documents, consulting experts and our initial research. With Delphi technique,24specialists have taken part in questionnaire investigations for twice to explore the logicality, necessity,feasibility and risk of home-based care services content index system framework. Opening questions were designed in questionnaire to help collect some advice from specialists.Home-based care rehabilitation training paths and evaluation scale for THR patients were further discussed and improved by experts group so as to be more perfect.2. Applying and evaluating the effects of home-based care programme for THR patients:By establishing inclusion and exclusion standard,100patients with inicial unilateral total hip replacement were selected as research subjects, then randomized controlled trial was carried out with50cases as an intervention group and a control group respectively. Home-based care programme in this study was conducted in the intervention group, and usual care in the control group. The intervention measures include4categories:body care, psychological and spiritual support, rehabilitation guidance and social support. The intervention time lasts for6months. The effects were evaluated at the3th and6th months. The evaluation indexes consist of Harris score system, quality of life scale(SF-36) and complication occurrences. Results1. The answering rates of the experts in the two questionnaires are96%and100%respectively, which reflect the concern and support of the specialists for the study. The experts authority coefficient mean value is0.8and each index authority coefficients is over0.7. After two investigations, only one index's variation coefficient is more than25%, accounting for1.9%, the others less than25%; Kendal harmonious coefficients play a statistically significant part in five aspects of logicality, necessity, technical feasibility, human feasibility and risk (P<0.005); Finally, the index system of home-based care services composed of4primary indexes,12second-level indexes,383-level indexes and the home-based care rehabilitation training paths and evaluation scale for THR patients are established, which compose home-based care programme for THR patients.2. Application and effect evaluation of home-based care programme for THR patients(1) Harris scores system:3months and6months after intervention, the differences of Harris scores between the two groups are statistically significant (P<0.05), the scores of intervention group are more than those of control group, moreover, the longer intervention time is, the higher Harris scores are; The excellent rate of functions between two groups is different(P<0.05).6months after intervention, the excellent rate of intervention group was100%, while that of control group 82%.(2) Quality of life scores:3months or6months after intervention, quality of life scores of eight dimensions from SF-36scale exists significance between two groups(P<0.05), the scores from intervention group are higher than those of control group, moreover, the longer intervention time is, the higher scores are.(3) Complications:3months or6months after intervention, the occurrence rate of complications between two groups is different(P<0.05), and the rate of intervention group is lower than that of control group;3months after intervention, the rates of complications of intervention group and control group are respectively16%,52%;6months after intervention, the rates are respectively4%,28%.Conclusions1. The home-based care programme for THR patients is characterized by operability and practicality. On the one hand, it includes concrete, feasible and clear home-based care services index system framework, rehabilitation training paths and evaluation scale for THR patients, and related video atlas and manual, which all make it conducted simply and easily. On the other hand, it is guided by the demand of the THA patients and the care-takers, and the service items selected are suitable to be conducted in home, which make the service comprehensive, systematic, humane and standardized. 2. Application of home-based care programme on THR patients is beneficial to promote hip function recovery and psychological health, as well as improve the quality of life. Meanwhile the intervention time is longer, the effect trends better. Therefore, the application of home-based care programme can promote physical and mental health of patients, and the programme is worthy of being applied to community caring.
|
PDF Full Text Request