Study On The Relationship Between Education Intensity And Patient Compliance And Completion Of Functional Rehabilitation Training After TKA

BackgroundAccording to a large number of studies,about 75%of the elderly people(?65 years old)in China suffer from osteoarthritis(mostly knee osteoarthritis).With the development of the aging population,the incidence of knee osteoarthritis(OAK)is increasing year by year,which seriously affecting the quality of life(QOL)of patients and increasing the social economic burden.In 1974,the first TKA was reported in the world.Since then,TKA has been developed rapidly as an effective treatment for OAK.In 1997,the first TKA was completed in Qilu Hospital affiliated to Shandong University,which made TKA being plant,germinate and thrive in Qilu Hospital.TKA is a common and effective intervention method.According to relevant reports,the operation volume of TKA has increased by 73%in the past 10 years.With the deepening of clinicians'understanding of TKA,more and more attention has been paid to functional rehabilitation after operation and it has been placed to an unprecedented height.However,there is a gap between the current medical status of post-operative rehabilitation and the concept of rapid rehabilitation in recent years[1].A large number of studies have shown that the participation of postoperative rehabilitation therapy can greatly improve the prognosis of patients and better goal of rehabilitation.Therefore,postoperative functional rehabilitation has attracted more and more attention of researchers,especially clinical doctors of joint surgery.TKA is the most widely used surgical treatment for end-stage osteoarthritis of the knee(OAK).TKA has a significant effect in relieving pain,restoring function and improving the quality of life.It is also considered as a safe surgical operation.At the same time,many studies at home and abroad show that early functional rehabilitation is particularly important for joint function recovery and reducing complications.In the actual clinical work,most surgeons usually focus only on surgical techniques and neglect the management of patients' perioperative period.ERAS is not embedded in every doctor's mind.In addition,the patients themselves do not pay much attention to the postoperative functional rehabilitation,which makes the rehabilitation process and efficiency often beyond the control of our orthopaedics and rehabilitation physicians.In order to make our work as perfect as possible,we have carried out the following studies in this regard in order to clarify the relationship between them and provide theoretical support and suggestions for our clinical work.Of course,not only our clinicians,but also patients should pay enough attention to functional rehabilitation after surgery.Only in this way can we get rid of the shackles of traditional concepts and truly achieve high-quality recovery of patients.MethodsThrough searching Pubmed,Embase and CNKI databases,we worked out early functional rehabilitation plan after TKA with rehabilitation physicians.From January 2017 to January 2018 in the Department of Joint Surgery of Qilu Hospital Affiliated to Shandong University,53 patients with OAK treated with TKA were selected as the study subjects.Rehabilitation education was given to the samples.The relationship between the intensity of education and the compliance and completion of patients was clarified by a cohort study.The minimum intensity of Education was obtained and the effects of gender,age,family members and BMI of patients were compared.This samples were divided into groups,analyzed and summarized the relationship between the early functional training education intensity and patients' completion degree,joint activity degree.It was concluded that the education intensity affected patients'compliance and completion degree,and then affected early functional rehabilitation treatment and prognosis after TKA,and tried to analyze the reasons for these differences.ResultsUnder the working method of this inquiry,(1)A cohort study of samples showed that the proportion of patients with high compliance and high completion increased with the increase of the number of education.In the context of our mission plan and implementation,after 4 education sessions,96.23%of the patients could enter the high compliance group,and after 6 education sessions,88.68%of the patients could reach the high completion group;(2)No matter the intensity of education,the proportion of female patients with high compliance was higher than that of male patients.The female patients were better than the male patients in the degree of completion,but the difference was not statistically significant(P = 0.988>0.05,P =0.421>0.05);(3)The patients in the age group<65 were better than those in the age group<65 in terms of compliance and completion,and the difference between the two groups was statistically significant(P = 0.045<0.05,P = 0.012<0.05);(4)patients with relatively small BMI.Indeed,the completion of functional rehabilitation training is better than that of BMI group,and the difference between the two groups has statistical significance(P = 0.021<0.05);(5)when the family members of patients are the only one,the positive significance of the family members of the same level for the patients'post-operative rehabilitation is less than that of the low-level family members,and the difference between the two groups has significant statistical significance(P = 0.045<0.05,P = 0.000).(6)When the patient's family members are not unique,the number of two or more family members has greater clinical significance for the patient's compliance after four times of education and the degree of completion after six times of education than that of one family member.There were significant differences between the two groups(compliance P-0.045<0.05,completion P = 0.000<0.05);(7)After six times of education,the number of days of ROM discharged from hospital in the High-completion group was 5.1702,and that in the low-completion group was 7.1667.There were significant statistical differences between the two groups(P = 0.001<0.05);(8)After 4-day functional rehabilitation,the ROM of the High-completion group was 82.66 degrees and increased by 41.28 degrees,while that of the low-completion group was 65.00 degrees and 34.17 degrees.There were significant statistical differences between the two groups(P=0.000<0.05,P=0.015<0.05)·ConclusionUnder the working methods of this study,(1)It is not difficult to see that with the increasing number of education,patients'compliance and completeness are increasing.From the results of the study,we can conclude that under the circumstances of our education plan and implementation,the minimum intensity of education with better compliance is four times,and the minimum intensity of education with better completion is six times.With the increase of the number of propaganda,the degree of compliance and completion will still increase,but the extent will obviously decrease.(2)For patients with persistent low compliance and completeness,adequate and special education intensity should be given in the actual clinical work,which has obtained the same early functional rehabilitation training compliance as those with high compliance;(3)The acceptance and completeness of the elderly patients(?65 years old)are lower than those of the<65 years old group,so more necessary attention and work should be given to these patients in clinical work.There is no significant difference in intensity between men and women,which is different from our clinical impression;(4)High BMI will obviously hinder the completion of fu nctional rehabilitation training for patients,so patients with high BMI need more attention and supervision;(5)For patients accompanied by only one family member,especially when the family member is the peer relatives of patients,patients need more education and attention;(6)Under this inquiry method,after six times of propaganda,the days of discharging ROM in the High-completion group were less than those in the low-completion group,and the ROM increased and ROM reached higher after four days of training(P=0.000<0.05,P=0.015<0.05).(7)The termination test showed that the results of this study had statistical significance(P=0.036<0.05,P = 0.038<0.05,P = 0.001<0.05).