Home-based Rehabilitation Adherence And Its Influencing Factors Among Patients Who Underwent Total Knee Arthroplasty

ObjectiveTotal knee arthroplasty(TKA)is an effective method for the treatment of end-stage osteoarthritis,and it' s important to adhere to perfom rehabilitation program.Patients are often perform rehabilitation program at home after TKA,so it is critical to have good adherence of rehabilitation training at home.The overall object of this study was to develop the home-based rehabilitation adherence scale for patients who undergoing total knee replacement and test the reliability and validity,and investigate the changes of adherence and analyze the influencing factors.The specific research objectives include1)to develop the home-based rehabilitation adherence scale;2)test its reliability and validity;3)investigate the adherence level within 3 months postoperative,and describe the longitudinal changes;4)try to analyze the influencing factors of adherence under the influence of timeMethodsIn this study,the home-based rehabilitation adherence scale for patients who underwent total knee arthroplasty was developed via experts consultation and the reliability and validity was tested.The level and changes of home-based rehabilitation adherence was investigated through longitudinal study design.The influencing factors were analyzed by cross-sectional survey under the influence of time1)Scale was developed and tested.Home-based rehabilitation adherence scale was developed based on the rehabilitation adherence conceptual framework,the home rehabilitation program,and related literature,including the physical exercise adherence,actively seek advice adherence,exercise supervision adherence and exercise precautions adherence.Two rounds of expert consultation were conducted via Delphi method to form the rehabilitation adherence questionnaire,and the content validity of the questionnaire was analyzed.The scale including four dimensions and twenty items was investigated to 176 patients who underwent total knee arthroplasty,and the structural validity and content consistency reliability were tested by combining project analysis and exploratory factor analysis2)Longitudinal study of adherence.We investigated patients who meet eligibility criteria using the convenience sampling method in a third-grade hospital in Shanghai.And the suvey was at 3 weeks postoperative(T1),5 weeks postoperative(T2),7 weeks postoperative(T3),3 months postoperative(T4)via telephone follow-up.We analyze the data from different time points through repetitive measure analysis of variance,and describe the changes usind the the line chart3)Analysis of influencing factors.General information and uncertainty in illness were investigated at T0,social support and self-efficacy were investigated at T1.The influence factors were analyzed by generalized estimating equationResults1)Scale reliability and validity test results.The home-based rehabilitation adherence scale was formed covering 11 items from three dimensions,namely physical exercise adherence,actively seeking advice adherence and exercise supervision adherence,with a cumulative variance contribution rate of 69.855%.The positivity of experts in the two rounds was 84.62%and 81.82%.The coordination coefficient of experts in two rounds was 0.201,0.332,and the expert authority coefficient was 0.839.The I-CVI was 0.889?1.000,and S-CVI was 0.978.The total Cronbach's coefficient of the questionnaire was 0.850,the Cronbach's coefficient of the three dimensions was 0.747?0.885,and the correlation coefficient between each dimension and the total score was 0.622?0.8652)Adherence longitudinal results.66 cases were followed up 3 months postoperative,and scores at the four time points were 28.86±6.38,32.27±4.78,29.85±4.57,27.92±6.02 respectively,which were at the medium level.Moreover,it showed a trend of ascend first and then decend.Exercise supervision adherence score was the highest at different time points,and actively seeking advice adherence score was the lowest3)Influencing factors.The uncertainty in illness,self-efficacy and social support scored 59.56±9.52.,89.23±12.60 and 31.62±6.21 respectively.The marital status,living pattern,self-efficacy and social support are the influencing factors based on GEE analysis during three months postoperative.And for every unit of change in self-efficacy and social support,adherence changed by 0.105 and 0.217 units.Patients with spouses,patients living with spouses or patients living with spouses and children have higher adherence in home rehabilitation programConclusionThe scale has high reliability and validity and it can be used to measure home-based rehabilitation adherence among patients who underwent total knee arthroplasty.Home-based rehabilitation adherence maintained a medium level and remain a trend of ascend and then descend during three months after total knee arthroplasty,and its influencing factors included self-efficacy,social support,and marital status and living pattern.Patients had higher adherence rate of exercise supervision at different time points postoperative,lower adherence rate of physical exercise,and the lowest rate of actively seeking advice adherence Uncertainity in illness and self-efficay stayed a medium level.