Study Of Collaborative Care Model In Patients After Totalknee Arthroplasty For The Application Of Functional Exercise

Objective To apply collaborative care model on patients with total knee arthroplasty patients, bycollaborative nursing intervention in hospital and using the form of We Chatand telephone after discharged to improve the functional exercise adherence, knee joint function, ability of daily living and quality of lifeof patients with postoperative,to improve the patient’s postoperative outcome,to provide theoretical guidance for clinical nursing work.Methods 1.90 patients were selected in the Department of emergency surgery of a level three general hospital of Zhengzhou fom August 2015 to January 2016, 45 hospitalized patients in August 2015 to October 2015 were taken as control group,45 hospitalized patients from November 2015 to January 2016 were taken as intervention group. The control group were given routine nursing intervention after admission: registering to establish archives, health assessment, total knee arthroplasty treatment manual, telephone consulting.Based on the routine nursing intervention,the intervention group were given collaborative care model nursing intervention: discussing after collective teaching, evaluating and directing beside beds, holding a collective teaching before discharge to make a supplement of blind spots for patients and their family members, giving one-to-one instruction to patients;Six months telephone and We Chat personalized intervention and the group intervention after discharge. 2.Data was collected on the discharge day and the 3rd month, the 6th month after intervention including the general questionnaire, special surgical hospital knee scoring criteria(HSS),functional exercise adherence scale,short form 36 health survey question-naire(SF-36),daily activity ability scale(ADL). 3.Data was analyzed by Frequency, constituent ratios,Chi-square test, t-test, HSS,ADL, repeated measurement.Results 1. A total of 90 cases were collected in this study, each group has 45 cases. Intervention group patients 1case was lost to follow-up due to the change of contact,1case retreated from the study on his own initiative; Control group patients 2 cases retreated from the study on their own initiative, 1 case was lost to follow-up because of the aggravation. 2. The difference of HSS score between two groups on the day be hospitalized, the 3rd month and the 6th month after discharge showed statistically significant; Time effect is statistically significan(P<0.01),without considering intervention factor, the score of HSS in intervention group were improved with time. The group effect is statistically significant(P<0.01), without considering time effect, different groups patients HSS score were different(P<0.01);An interaction is exist in time effect and group effect(P<0.01). 3. The daily activity ability score of the two groups were analyzed by repeated measurement, the difference of daily activity ability score on the discharge day was not statistically significant, the score of daily activity ability 3rd month after discharge has statistically significant difference(P<0.05), the difference of 6th month after discharge score was not statistically significant; the time effect is statistically significan(P<0.01),without considering intervention factor, the score of daily activity ability changed with time; The group effect is statistically significant(P<0.05), without considering time factor, different groups patients daily activity score were different. 4. The comparison of the exercise adherence within two groups shows that the difference wasstatistically significant on the discharge day,the 3rd month and the 6th month after discharge(P<0.05). 5.The SF-36 score of the two groups were analyzed by repeated measurement, the difference of vigor was statistically significant on the discharge day;the difference of other dimensions of SF-36 was not statistically significant on the discharge day;The 3rd month, 6th month after discharge,the physical function, role-physical, body pain, general health, social function, mental health existed time effect and group effect. Vitality and role-emotional existed time effect,no group effect.Conclusions Collaborative care model can improve functional exercise adherence of patients with total knee arthroplasty, improve patients’ daily life activities ability and quality of life.