Effects Of Discharge Planning In Rehabilitation For Total Hip Arthroplasty Patients

Objective. This study aims to understand the needs of total hip replacement(THR) patients during the short-term rehabilitation process and analyze the potential problems. According to the dynamic changes in the rehabilitation process, we formulated appropriate discharge plans and further explore their effects on the self-care knowledge level, Harris hip scores and ADL of the first-time THR patients.Methods. This study was divided into two consecutive phases. In the first phase, with the phenomenological qualitative research methods as a guide, we used the purposive sampling method to select the first-time THR patients in two hospitals of the Suzhou city. By establishing inclusion and exclusion criteria, 15 first-time THR patients with semi-structured interviews were selected as subjects, and their personal data were analyzed using Colaizzi seven steps method. The results of qualitative research served as a basis for developing interventions in the discharge plan. In the second phase, 150 first-time unilateral THR patients were selected as research subjects. Then a randomized controlled trial was carried out with 75 cases as the intervention group and the control group respectively. Routine orthopaedic nursing was provided to the intervention group and control group. In the intervention group, patients also received some patient-centered intervention measures, including self-care knowledge, technology ability and psychological coping. The intervention process was divided into two parts. Patients were supported by individualized information and received the corresponding guidelines in the hospital. After discharge, patients received regular telephone and outpatient follow-ups. Self-care knowledge scale, Harris hip scores and activities of daily living scale were the main evaluation tools. We evaluated the effect of the intervention one month, three months and six months after discharge respectively. All database entry used the Epidata 3.1 software and statistical analysis was conducted using SPSS16.0.Results. Qualitative results showed that the first-time THR patients’ needs included sleep, pain control, sports activities, sexual life, home-based care and security, self-esteem, sense of belonging and self-actualization needs in the first phase. The results of intervention survey in the second phase indicated the follwing:(1) Self-care knowledge level: the knowledge score level of the intervention group was higher than that of the control group. One month after discharge, self-care knowledge level rose the fastest; three months after discharge, the mean scores were the highest with the two groups; six months after discharge, the knowledge score slightly decreased. Self-care knowledge level in the intervention group significantly increased compared with the control group(P<0.01).(2) Harris hip scores: HHS was evaluated using an independent sample t-test. HHS of the intervention group was higher than that of the control group one month, three months and six months after discharge, and submenu scores varied differently. The difference was statistically significant(P <0.05) between the two groups.(3) Activity of Daily Living(ADL) Scale: Baseline and ADL one month after discharge of the two groups were compared using repeated variance analysis, which indicated no statistical significance(P>0.05). However, three months and six months after discharge, ADL of patients in the intervention group significantly enhanced compared with the control group(P<0.01).Conclusions. The qualitative part of the study showed that THR rehabilitation needs more within six months after discharge,. It also suggested lack of self-care knowledge, lack of functional training, home-based care and security hazards, social function deficiency and so on. To overcome these problems, we should develop appropriate discharge planning interventions to improve THR patients’ self-care knowledge, promote the recovery of hip function and improve thier activity of daily living. This study has good feasibility and validity. Therefore, its findings can be further applied in the region.