| Objective: Under the background of the fast developing mobile heath care,this research intends to investigate the current station and needs of knee-replacement patients in their personal health care participation,based on the concept of patients-participation.Meanwhile,explore and develop patient-participation protocol as well as health care strategy among knee-replacement patients for the purpose of promoting the patients with severe knee osteoarthritis to participate in the health care behavior positively so as to improve the recovery process.Besides,the study also means to combine the traditional brochure with “Yi-shu” APP(a health care related APP plateau)to implement,evaluate and verify the effect of the former protocol and strategy.Methods: 1.Cross-sectional survey of the current condition of knee joint replacement patients participating in the health care: This part selected knee arthroplasty patients in the Joint Surgery Department of four hospitals in Shanghai for cross-sectional survey using random sampling method.The "patients’ participation and intention of health-care Questionnaire " and other assessment tools were used to investigate the intention and behavior of knee-joint-replacement patients’ participation so as to reveal current health-care-participation condition of knee replacement patients to provide the basis for post-intervention.2.Qualitative study of the need for health-care-participation in the knee joint replacement patients: According to the principle of phenomenological methodology,a total of 11 patients were selected from the Joint Surgery Department in Shanghai to conduct a semi-structured interview.3.Construct the promotion protocol and intervention strategy of knee joint replacement patients’ participation: construct the promotion protocol framework of the knee joint replacement patients’ participation in the self-health care according to the qualitative interview results.Exhibit the intervention strategy according to the literature review and the theoretical analysis on the basis of the promotion protocol framework and revise the strategy program through a round of expert group meeting.4.Evaluate the effect of the promotion protocol and intervention strategy: using the experimental research method to implement the intervention and evaluate the effect.In the Changhai Hospital,the patients were grouped by the random sampling method.There were 14 patients including in the control group and 13 patients in the brochure intervention group and 11 patients in the APP intervention group finally.The general information Questionnaire,the patients’ participation and intention of health-care Questionnaire,the participating attitude Questionnaire,the knowledge of disease Questionnaire,hospital for special surgery knee score(HSS),range of joint movement(ROM),and Hamilton Anxiety Scale(HAMA)were used to evaluate the patients before and after intervention.Meanwhile,patients were followed for 2 weeks and the follow-up data were collected.Results: 1.The score of attitude towards knee joint replacement patients’ participation in the hearth care was relatively high(4.38 ± 0.43),and there was a statistically significant difference between the dimensions of participation willingness(P <0.05).At the same time,the score of willingness to participate in health care were significantly higher than those of the corresponding participating behavior scores(P <0.05).The mean score of participation in health care was 3.96 ± 0.44 points,and there was a statistically significant difference between the dimensions of the participating behavior(P <0.05).2.Knee replacement patients’ participation in health care mainly includes four participating styles and 23 specific participatory behavior during hospitalization:(1)Type of participation in the care of treatment,including 10 specific behavior: participation in environmental adaptation,participation in drug administration,participation in hospital screening,participation in self-care,participation in disease knowledge study,participation in surgery preparation,participation in surgery corporation,participation in postoperative symptom management,participation in functional exercise,participation in discharge preparation.(2)Type of participation in diagnosis and treatment decision-making,including 8 specific behaviors: participation in the selection of medical staff,participation in drug decision-making,participation in the inspection project decision-making,participation in anesthesia decision-making,participate in the choice of analgesic program decision-making,participation in surgical options decision-making,participation in prosthetic material decision-making,participation in discharge decision-making.(3)Type of participation in information interaction,including two participating behavior: the special patients’ preoperative talks and general patients’ communication between doctors and patients.(4)Type of participation in questioning supervision,including 3 participating behaviors: participation in the safety of patients,participation in medical behavior supervision requirements,participation in management promotion and recommendations.3.After a group of expert group meetings,nine senior experts including orthopedic care specialists and patients-participation specialist,in the discussion of the contents and intervention modalities of the patients-participation in the treatment of knee replacement eventually revised and formed an intervention protocol and identified the intervention in two ways as traditional brochure and mobile medical care.4.The control group(group A),brochure intervention group(group B)and APP intervention group(group C)were compared between group and within group before and after intervention.The results showed that:(1)Participating attitude: comparison within group: Wilcoxon test showed no significant difference between the three groups before and after intervention(P> 0.05);comparison between groups: results showed no significant difference(P>0.05).(2)Knowledge level score: comparison within group: results showed that three groups of patients discharged from the hospital when their knowledge was improved(P<0.05);comparison between groups: results show the difference between the two groups was statistically significant(P <0.05),meanwhile,the brochure intervention group> APP intervention group>control group.(3)Satisfaction: results showed no significant difference(P> 0.05).(4)Participating behavior: results showed that the difference of participation average score,participation in information interaction,participation in treatment care,participating appeal of three groups after the intervention was statistically significant(P <0.05),further paired comparison showed: Participatory behavior was divided into: brochure intervention group,APP intervention group> control group.(5)HSS: Comparison within groups: Paired T test results showed that the three groups function were improved after 2 weeks of knee surgery(P <0.05);comparison between groups: showed the difference between the two groups was statistically significant(P <0.05),what’s more,intervention group,APP intervention group> control group.(6)HAMA: comparison within group: paired T test results showed that: the anxiety degree of three groups were reduced after 2 weeks of knee surgery(P <0.05).Comparison between groups: showed difference between the two groups was statistically significant(P <0.05),besides,the brochure intervention group and the APP intervention group<control group.(7)ROM: Comparison within group: Pair T test results showed that the joint activity of three groups were improved after discharge(P <0.05);comparison between groups revealed there was no significant difference in the degree of joint activity between the three groups(P> 0.05).(8)Rehabilitation follow-up: The results implicated that the three groups of patients in the time of ROM to 90 degrees,daily functional exercise duration,medication compliance(the number of forgetting medication every week),rehabilitation and the difference of emotional state was statistically significant(P <0.05).There was no significant difference in the frequency of pain,pain score and quality of life(P> 0.05).Conclusion: 1.The willingness to participate in health care is relatively high,however the level of patients participating behavior is lower than willingness.In clinical reality the willingness of patients with joint replacement participate in health care is not fully realized and the level of patients participating behavior in health care needs to be improved.2.The Participation behavior of Knee joint replacement patients during hospitalization is rich: the participation of patients during hospitalization was principle treatment care participation,followed by treatment diagnosis decision-making participation then supplemented by the participation of information and participation in the supervision of participation.3.Health care promotion strategies for joint replacement patients’ participation can effectively improve the level of patients’ participation,knowledge and knee function status.Above all,intervention programs can promote the behavioral changes of patients’ participations,disease-related knowledge,rehabilitation and rehabilitation of patients.It can also help to reduce the patient’s anxiety.Traditional brochure version and mobile medical intervention program both have advantages and disadvantage: on the on hand tradition program can more effectively improve the level of knowledge of patients with knee replacement than APP program,on the other hand APP can promote rehabilitation and medication compliance compliance but the effect depending on the different patients,at the same time Mobile medical care in the future need to further optimize the use of experience among older people. |
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