Application Of The Self-management Approaches During Rehabilitation For The Total Knee Arthroplasty Patients

ObjectiveWe can evaluate the application value of self-management approaches in patients with the first total knee arthroplasty during rehabilitation, and analysis the effect on rehabilitation to reduce complication and improve health.MethodsA convenient sample of 80 patients with Total Knee Arthroplasty from a hospital in Zhengzhou were enrolled.They were randomly divided into two groups:one is experimental group and the other is control group.The Experimental group was given the intervention of self-management, and control group received routine care. Self-management ability, the quality of life, HSS scores, hospitalization days and days when the knee joints were flexed beyond 90 degrees were collected in due time.Statistical analysis included descriptive statistics, t test,χ2 test, nonparametric test and repeated measurement' analysis of variance.Results1. Parameters before interventionThe general data satisfy the main indications of TKA and prevalence of osteoarthritis; The mean overall self-management score was (56.69±9.48) out of 100 marks, the quality life was (91.80±14.90)out of 145 marks, and HSS score was 50.00(11.00) out of 100 marks, in general, the level of all above every index was low. By comparison, the baseline were well balanced between the two groups (P>0.05).2. Comparison of self-management before and after interventionBy comparison, there were significantly statistical differences in the date discharged from hospital,3 months after operation and 6 months after operation between the intervention and control group(P<0.05), and the intervention group scores were higher than those of the control group(P<0.05).After repeated measurement' analysis of variance, there were significantly statistical differences in group-effect, time-effect, and the effect of interation between groups and time (P<0.05).The results of pairwise comparisons follow as:For intervention group, there was no significantly different between 3 months after operation and discharged from hospital in physical activity (P>0.05), and between 6 months after operation and discharged from hospital in diet (P>0.05); rather, for control group, there was no significantly different between 3 months after operation and before intervention in diet (P>0.05), between 6 months after operation and before intervention in diet (P>0.05); between 3 months after operation and discharged in overall marks, symptoms and physical activity (P>0.05); between 6 months after operation and discharged from in physical activity and social psychological(P>0.05); and between 6 months after operation and 3 months after operation in diet (P>0.05).3. Comparison of the quality of life before and after interventionBy comparison, there were significantly statistical differences for RE, BP and MH scores in 3 months after operation between the intervention and control group (P<0.05), and the intervention group scores were higher than those of the control group (P<0.05).After repeated measurement' analysis of variance, there were significantly statistical differences in time-effect for all indexes (P<0.05), and the effect of interation between groups and time for RE and BP (P<0.05).The results of pairwise comparisons follow as:For intervention group, there was no significantly different between 3 months after operation and before intervention in GH and MH (P>0.05), between 6 months after operation and before intervention in MH (P>0.05), and between 6 months after operation and 3 months after operation in RP, RE, BP and MH(P>0.05); rather, for control group, there was no significantly different between 3 months after operation and before intervention in RP,RE,SF and MH (P>0.05), and between 6 months after operation and 3 months after operation in SF (P>0.05).4. Comparison of HSS scores before and after interventionBy comparison, there were significantly statistical differences for overall marks, Mobility, Flexion deformity, Stability and others in 3 months after operation and 6 months after operation between the intervention and control group (P<0.05), and differences for Pain and Muscle strength in 3 months, too (P<0.05). The intervention group scores were higher than those of the control group (P<0.05).After repeated measurement' analysis of variance, there were significantly statistical differences in time-effect for all indexes (P<0.05), the effect of interation between groups and time for overall marks, Function, Mobility, Muscle strength, Stability and others (P<0.05), and group-effect for overall marks, Pain, Mobility, Stability (P<0.05).The results of pairwise comparisons follow as:For intervention group, there was no significantly different between 6 months after operation and 3 months after operation in Pain, Muscle strength, Flexion deformity and Stability (P>0.05). Rather, for control group, there was no significantly different between 6 months after operation and 3 months after operation in Function (P>0.05).5. There were significant statistical differences between two groups in hospitalization days and days when the knee joints were flexed beyond 90 degrees (P<0.05).ConclusionThe self-management approaches can improve the patients'ability of self-management, ameliorate the knee function, and it can also improve the quality of life in which role emotional score, mental health score and bodily pain score increased.