| ObjectivesTo construct a functional exercise decision aids(DA)program for patients with kinesiophobia of unilateral total knee arthroplasty(TKA),to compare the differences between the experimental group and the control group in the scores of compliance with functional exercise,knee function,kinesiophobia,anxiety and depression,actual participation in treatment decisions and satisfaction with decision-making.To clarify the application effect of DA in compliance with a functional exercise,so as to provide the basis for improving the compliance of functional exercise in patients with kinesiophobia of unilateral TKA.Methods1.On the basis of evidence-based,Ottawa decision support framework and a three-talk model for shared decision making,a functional exercise DA program was initially constructed,and two postoperative rehabilitation programs were formed,which were further refined by two rounds of expert meetings.According to the inclusion and exclusion criteria of this study,156 patients with kinesiophobia who underwent unilateral TKA for the first time in a third class a hospital in Zhengzhou from January 2019 to October 2019 were divided into experimental group(78 patients)and control group(78 patients)according to time.The control group was given routine nursing and treatment intervention before and after operation,mainly including:evidence-based functional exercise programs,dietary points,etc;the experimental group was given DA intervention,three conversations between doctors and patients,assisted patients with decision-making of rehabilitation program in the form of PPT,video and manual,and played the video of functional exercise every day after operation.2.When the patient was admitted to the hospital,we used the Tampa Scale of Kinesiophobia(TSK)to evaluate whether the patient had kinesiophobia.Among the 293 patients who had undergone unilateral TKA,156 met the conditions of kinesiophobia and voluntarily participated in the study.The data were collected at the time of admission,discharge,1 and 3 months after operation by using The Exercise Adherence Rating Scale(EARS),American knee society knee score(KSS),TSK,Hospital Anxiety and Depression Scale(HADS),patients' participation in treatment decision-making questionnaire and treatment decision satisfaction scale.3.Statistical analysis was performed with IBM SPSS Statistics 21.0.The general data of patients were described by means of mean and standard deviation,frequency and percentage;if the measurement data met the normal distribution,two independent sample t-test was used;if the measurement data did not meet the normal distribution,Mann Whitney U rank sum test was used;chi square test was used for comparison of the count data;repeated measurement analysis of variance was used to evaluate the change trend of each index,the difference was statistically significant(P<0.05).Results1.A total of 143 patients were included,including 71 in the experimental group and 72 in the control group.The scores of compliance of functional exercise in two groups were compared.The scores of discharge,one month and three months after operation were analyzed.The results showed that there were time effect(F=367.103,P<0.001),intergroup effect(F=91.103,P<0.001)and interaction effect(F=8.607,P<0.001);after intervention,the scores of patients in the experimental group were better than those in the control group,and the differences were statistically significant(P<0.05).2.The scores of knee joint function of the two groups were compared.The scores of patients at admission,discharge,one month and three months after operation were analyzed.The results showed that there were time effect(F=247.530,P<0.001),intergroup effect(F=20.406,P<0.001)and interaction effect(F=9.320,P<0.001);after intervention,the scores of patients in the experimental group were better than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the knee function scores of patients in the experimental group between rehabilitation program 1 and program 2 at each time point(P>0.05).3,Comparison of kinesiophobia scores between two groups of patients.Analysis of the scores at the time of admission,discharge,one month and three months after operation showed that there were time effect(F=569.860,P<0.001),intergroup effect(F=9,989,P<0.05)and interaction effect(F=3.411,P<0.05);after the intervention,the scores of the patients in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05).4.There were a significant differences between the two groups in the scores of anxiety,actual participation in treatment decisions and satisfaction with decision-making(P<0.05),while there were no significant differences in the depression scores and total anxiety and depression scores between the two groups at discharge(P>0.05);the scores of anxiety and the actual participation in treatment decisions in the experimental group were lower than those in the control group,and decision-making satisfaction scores were higher than control group.ConclusionThe DA intervention of functional exercise can improve the compliance of postoperative functional exercise of patients with total knee arthroplasty for kinesiophobia,improve their knee function,reduce their the level of kinesiophobia,relieve their anxiety,promote patients to participate in decision-making,and increase their the satisfaction with decision-making. |
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