The Construction And Practice Research Of Early Mobilization Program On Patients Following Total Knee Arthroplasty

Background:Total knee arthroplasty(TKA)is the standard treatment for end-stage knee osteoarthritis,which is on the rise globally and is expected to become the most common elective surgery in decade.Early mobilization is an important part of enhanced recovery after surgery(ERAS).With the application of ERAS in joint arthroplasty,early mobilization after TKA has gradually attracted attention.Studies have found that early mobilization can promote the recovery of knee joint function,reducing postoperative complications and decreasing length of stay.However,the clinical situation is not very ideal.Although the importance of early mobilization has been proved,the ralated guidelines also emphasis the need of early mobilization,there is no uniform definition and specific implementation methods for early mobilization in current studies,and also lack of a specific,operable practice program for clinical practice.Therefore,the purpose of this study is to establish an evidence-based early mobilization program on patients following TKA,and preliminarily evaluate its implementation effect,so as to standardize the early mobilization process for TKA patients,and promote their early recovery.Objective:To construct the early mobilization program on patients following TKA and then evaluate its clinical effects.Methods:1.The construction of the early mobilization program.From October 2018 to May 2019,the framework and the first draftof the program was constructed on the basis of literature review.Two rounds of Delphi expert consultations were conducted among 15 experts and then formed the final version of early mobilization program on patients following TKA.2.The evaluation of the clinical effect on early mobilization program.This study is a quasi-experimental study.From May 2019 to November 2019,convenient sampling was adopted to recruit the subjects of the intervention group from the orthopedic department of a third-grade class-A hospital in Beijing.The historical control group was TKA patients in the same ward from January 2017 to December 2017.The subjects in the control group received routine perioperative care.And the intervention group received routine care and early mobilization program.The situation of the first time mobilization after TKA,active straight leg raising within postoperative 24 hours,knee range of motion at discharge were recorded.Results:1.The construction of the early mobilization program.A total of 9 literatures were included in the literature review,and 17 pieces of evidence were obtained.After two rounds of Delphi consulting,the final program consists of 5 first-level indicators,19 second-level indicators and 104 third-level indicators,including introduction,preoperative health education,preoperative method guidance,postoperative early mobilization,and postoperative rehabilitation exercise.2.Clinical effect of the early mobilization program.Data were collected from 95 subjects in the intervention group and 100 in the control group.The results show that:(1)The first time of mobilization in the intervention group was earlier than that in the control group(P<0.05).(2)There were statistically significant differences between the two groups in the mobilization mode,range of motion,distance of motion,main auxiliary of motion,and whether or not indwelling wound drainage tube(P<0.05).Compared with the control group,patients in the intervention group had a larger range of mobilization,a longer distance of walking,a higher proportion of patients who did not need assistance and a higher proportion of patients with no drainage tube during the first time mobilization.(3)The proportion of patients in the intervention group who completed active straight leg raising within 24 hours was higher than that in the control group(P<0.05).At discharge,98.9%of the patients had knee range of motion exceed 90°.(4)On postoperative day one,there was no statistically difference between the two groups in the pain degree of activity pain,the swelling of the knee,and the occurrence of adverse events during the first mobilization(P>0.05).Conclusion:1.In this study,the early mobilization program consists of two intervention stages:pre-operation and post-operation.Preoperative intervention includes health education,method guidance;postoperative intervention includes the guidance of early mobilization and rehabilitation exercise.2.For the patients received TKA,the implementation of early mobilization program can advance the time of mobilization after TKA,expand the range of mobilization and increase the walking distance during the first mobilization after TKA.At the same time,it didn’t increase the incidence the postoperative pain and postoperative adverse events.