The Current Status Of Early Ambulation And Its Influencing Factors In Patients With Total Knee Athroplasty

Background:Total knee arthroplasty(TKA)is an effective method to cure severe knee osteoarthritis.With the development of medical treatment and surgical technique,Fast-track surgery(FTS)has been developed and applied successfully in various fields.Early ambulation is an important measure of FTS.It's an important index to promote fast-track arthroplasty and improve patients' activity of daily living.Early ambulation can reduce the risks associated with bed rest such as deep vein thrombosis,pulmonary embolus,chest infection and urinary retention,increase muscle strength and stability,prevent keen joint stiffness,improve the keen joint function and reduce length of stay(LOS).In addition,early ambulation is an important project to strengthen the cooperation between doctors and nurses and improve nursing quality.Therefore,the early ambulation of TKA is noteworthy.At present,there is no unified definition of"early ambulation" at home and abroad.Under the continuous guidance of the concept of FTS,the time of early ambulation was greatly shortended.Therefore,it is necessary to investigate the status of early ambulation in patients with TKA and to analyze the influencing factors of early ambulation,so as to provide clues and basis for the clinical intervention of patients with TKA.Objective:To describe the situation of the early ambulation of patients with TKA and explore the influencing factors of early ambulation.Method:A descriptive,cross-sectional design was used in this study.Convenient sampling was adopted.From October 2016 to February 2018,220 patients with total knee arthroplasty were recruited in the orthopaedic ward of a three-level general hospital in Beijing.Using self-designed questionnaires to investigate the general situation,disease and surgical conditions,and the early ambulation of the patients.The coping style was measured by Medical Coping Modes Questionnaire(MCMQ)and the self-efficacy was measured by Self-Efficacy for Rehabilitation Outcome Sacle(SER).Univariate analysis and multivariate linear stepwise regression analysis were used to analyze the influencing factors of early ambulation of patients with TKA.Results:(1)Among 216 patients with TKA,7.4%of patients who first ambulated within 24 hours after surgery,52.3%of patients who first ambulated within 24 to 48 hours after surgery,31%of patients who first ambulated within 48 to 72 hours after surgery.The earliest time of ambulation was 7.5 hours after surgery.The first time of ambulation of patients with TKA(both unilateral and bilateral)was 2 to 3 days after surgery.The range of first time of ambulation was 3 to 20 minutes,the distance of ambulation was 0?250 meters,the scope of activities was mainly at the bedside,most of the assistants helping the patients accomplishing the first ambulation were doctors.(2)Univariate analysis showed that,compared with the control group,in the early ambulation group,the duration of the catheter,wound drainage tube and ECG Monitoring within 24 hours were shorter(p=0.011,p=0.035,p=0.032),the first straight leg raising was earlier(p=0.004),the albumin index after surgery and the level of SER were higher(p=0.005,p=0.000),the desire to ambulate was eager(p=0.012)and patients completed early ambulation more easily.(3)Multivariate linear stepwise regression analysis showed that urinary catheter extraction time,the first time of straight leg raising,catheter-free,the level of pain and fatigue within 24 hours after surgery,the level of SER,the age of patient,and the time of ECG Monitoring after surgery,were the main influencing factors of early ambulation,which explained 51.1%of the total variance of the early ambulation of patients with TKA.Conclusion:(1)The first time of ambulation was mainly 2 to 3 days in patients with TKA,only 7.4%of patients who completed ambulation within 24 hours after surgery.The activities were mostly standing by the bed and walking on the ground for the first time.(2)Urinary catheter extraction time,the first time of straight leg raising,catheter-free,the level of pain and fatigue within 24 hours after surgery,the level of rehabilitation self-efficacy,the age of patient,and the time of ECG Monitoring after surgery,were the main influencing factors of early ambulation.