| ObjectiveTo explore the application effect of functional activity score in acute pain services in pain management after joint replacement,analyze and evaluate the advantages and disadvantages of functional activity score in pain management and develop improvement measures.Methods1.From March 2016 to May 2017,patients who underwent total knee joint replacement(TKR)and artificial half hip replacement(Hemiarthroplasty,HA)in our hospital were selected as subjects,totally 146 cases,and were divided into control group and observation group.The control group evaluated the pain of patients with TKR and HA according to the routine NRS pain score.The observation group was combined with the functional activity score(FAS)for pain assessment based on the control group.The two groups of patients were treated according to their respective pain scores.Analyze and evaluate the difference between the two groups of patients on the control of the pain values on the 1st and 2nd day after surgery,adverse reactions during analgesia management,multimodal analgesia,first ambulation,hospitalization days and the satisfaction of analgesia were analyzed and evaluated.Analysis of whether there was a difference in knee and hip function recovery(Hospital for Special Surgery Knee Score and Harris Hip Score)between the two groups at 3 days after surgery and7 days after surgery.In addition,qualitative research was conducted on nurses using the FAS scoring method,and the advantages and disadvantages of the FAS scoring method were analyzed and improvement measures were proposed.Based on the results of clinical trials combined with the nurses' viewpoint,the functional activity score of the joint surgery were improved(Joint Function Activity Score,JFAS).2.According to the improvement plan,60 patients who were diagnosed as knee osteoarthritis and underwent TKR surgery in our department from June 2017 to August2018 were studied for the reliability and validity of the study.Based on the 60 degree of joint flexion on the 3rd postoperative day,the FAS score was used as the calibration,and the intraclass correlation coefficient(ICC),content consistency reliability(Cronbach's a),and calibration validity(Pearson Correlation Coefficient),expert validation index(CVI),and sensitivity of the JFAS score were measured.Result1.Postoperative pain scores were compared between the two groups.The resting pain score,active pain score and FAS score of the observation group on the 1st and2 nd postoperative day were lower than the control group,and the difference was statistically significant(P<0.05).2.Comparison of adverse reactions during analgesia management,multimodal analgesia,first ambulation,hospitalization days and the satisfaction of analgesia between the two groups.Compared with the control group,the number of multimodal analgesia cases in the observation group was higher,first ambulation was earlier,and the satisfaction degree of analgesia was higher,the difference was statistically significant(P<0.05).However,there was no significant difference in the adverse reactions during analgesia management and hospitalization days between the two groups(P>0.05).3.Comparison of joint function between the two groups of patients during different periods of hospitalization.There was no significant difference in preoperative HSS score and Harris score between the two groups(P>0.05).The HSS score and Harris score of the observation group were higher than those of the control group at 3and 7 days after operation.The difference was statistically significant.(P<0.05).4.Qualitative research results.The quality of interviews with nurses in the aspects of the advantages of the three aspects of the refinement of the three aspects of the subject,practicability;easy to understand indicators;easy to operate.In terms of shortcomings,the four aspects of the theme are extracted,which are not practical;relatively broad,not detailed enough;and it is difficult to define the boundaries between the various indicators and fail to accurately reflect the range of joint activities.5.When the JFAS score was selected as the reference on the 3rd day after thejoint activity was 60 degrees,the clinical evaluation ICC was 0.97,the Cronbach's acoefficient was 0.97,the calibration validity(Pearson correlation coefficient)was 0.88,P<0.05,CVI was 0.92.Sensitivity was the change of JFAS pain value after intervention in patients with moderate to severe pain.The t value was 3.289,and the difference was statistically significant(P<0.05).ConclusionFAS score combined with NRS score has achieved good clinical results in postoperative pain management,but there are certain limitations.The improved JFAS score has good clinical reliability and perform an evaluation of active pain,and it is more in line with the characteristics of functional exercise after joint surgery,can be used after joint surgery such as knee joint. |
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