| Objective(s):The relevant evidence of screening,evaluation,intervention and management of frailty in geriatric surgical patients at domestically and overseas was systematically searched and summarized,and a management scheme for frailty patients with hip replacement was constructed based on the theory of frailty integration model combined with literature research and Delphi expert letter consultation.To verify the clinical effect of the management scheme for elderly patients with hip replacement.Methods:Part Ⅰ:Many guidelines and other studies outside the guidelines on the identification,evaluation,treatment,and management of elderly surgical patients both domestically and overseas were rigorously searched by a research team.The quality of the included guidelines were evaluated according to the JBI2017 guidelines evaluation tool AGREEⅡ,Other studies outside the guidelines included were evaluated and graded using the JBI2016 literature authenticity evaluation approach and the JBI2014 evidence recommendation and grading method.After analysis and summary,the entry content of the scheme was extracted,and the first draft of the management plan for older patients with frailty after hip replacement was formed after refining and summarizing the content of each item of the extracted scheme.Part Ⅱ:Experts in orthopedic clinical,orthopedic rehabilitation,orthopedic nursing and other fields were invited to evaluate and modify the feasibility and operability of the first draft of the plan through two rounds of Delphi expert consultation to form a management plan for older patients with frailty after hip replacement.Part Ⅲ:80 patients who were admitted to a Class Ⅲ Category A hospital in Kunming,Yunnan Province,Using practical survey techniques from March to November 2022 and meeting the inclusion and exclusion criteria.According to the time of their arrival,the patients were separated into two groups:the study group and the usual control group.The individuals in the control groups followed standard diagnostic therapeutic,treatment,and care following hip replacement procedures by medical staff;however,patients in the study group gained confirmatory testing.treatment and care of hip replacement by medical staff,while the study group’s patients received diagnosis,care,and therapy in accordance with the pertinent content of the management plan for elderly patients with hip replacement frailty on the basis of conventional diagnosis,treatment and care.The general data of patients in the control group and the study group were collected by a self-designed general information questionnaire reviewed by experts.Functional Recovery Scale(FRS),grip strength,Nutritional Risk Screening-2002(NRS-2002)and Tilburg Frailty Indicator scale(TFI)of the older patients were collected at admission,1 day before discharge,1 month and 3 months after operation,and the data were analyzed by t test,X~2 test and repeated examination analysis of variance.To prove the effectiveness of the management program for older patients with hip replacement for frailty in reducing the symptoms of frailty and accelerating the recovery of daily activities in older patients with hip replacement.Results:Part Ⅰ:The relevant studies were included,and their quality were evaluated,after searching both domestic and foreign databases.The studies contained 17 guidelines,6 expert consensus articles,12 systematic reviews,11 randomized controlled papers,1 quasi-experiment study,4 cross-sectional studies,and 2 meta-analyses.The members of the study team revised,sorted,and summarized the included literature material to produce the draft of the management plan for older patients with hip replacement weakness,which includes 4 first-level items,12 second-level items,and 64 third-level items.Part Ⅱ:The mean scores of importance and operability for each item of the scheme were>3.5,and the variation coefficients of importance and operability for each item were<0.25 in the two rounds of expert letter consultation.The effective recovery rates of questionnaires were 93%and 79%.The management plan for older patients with frailty after hip replacement was developed,with 5 first-level items,15 second-level items,and 85 third-level items,taking into account the views and opinions of specialists.Part Ⅲ:There were no statistically significant variations in demographic or socioeconomic status prior to the intervention,and the outcomes for the two groups were comparable,as were the Functional Recovery Scale(FRS),grip strength,Nutritional Risk Screening-2002(NRS-2002),and Tilburg Frailty Indicator scale(TFI).After hip replacement,The Nutritional Risk Screening-2002(NRS-2002)score and the Tilburg Frailty Indicator scale(TFI)scores of the patients in the two groups 1 just before discharge,1 month,and 3 months after operation both were lower than they had been before the operation,however,both the grip strength and the Functional Recovery Scale(FRS)scores were higher than they had been prior to the operation.At each time point following the the study group’s Tilburg Frailty Indicator scale(TFI)scores were significantly lower than those of the control group(P<0.05),and 3 months following surgery,the study group’s Nutritional Risk Screening-2002(NRS-2002)scores were lower than those the control group(P<0.05).At 1day before discharge,1 month following surgery,and 3 months later,the study group’s Functional Recovery Scale(FRS)scores and grip strength were considerably higher than those of the control group(P<0.05).Repeated measures analysis of variance showed that the scores of Functional Recovery Scale(FRS)(F=997.361,P<0.001),grip strength(F=210.790,P<0.001),Nutritional Risk Screening-2002(NRS-2002)(F=145.368,P<0.001)and Tilburg Frailty Indicator scale(TFI)(F=123.918,P<0.001)at different time points in the two groups of elderly patients with frailty after hip replacement were significantly different.Among them,the scores of the Nutritional Risk Screening-2002(NRS-2002)and the Tilburg Frailty Indicator scale(TFI)showed a decreasing trend with the extension of time point.Functional Recovery Scale(FRS)scores and grip strength showed an upward trend with time.In the time-group interaction,there were significant statistical differences(P<0.05)inside the Functional Recovery Scale(FRS)scores(F=21.899,P<0.001),grip strength value(F=20.613,P<0.001),the Nutritional Risk Screening-2002(NRS-2002)scores(F=4.990,P=0.007)and Tilburg Frailty Indicator scale(TFI)scores(F=13.146,P<0.001)between the two groups.The results showed that there were differences between the two groups in the change trend of Functional Recovery Scale(FRS)scores,grip strength value,the Nutritional Risk Screening-2002(NRS-2002)scores and the Tilburg Frailty Indicator scale(TFI)scores with time and the influence of intervention factors.After the intervention,the study group’s increase in Functional Recovery Scale(FRS)scores and grip strength value was significantly higher than that of the control group,and the study group’s decrease in Nutritional Risk Screening-2002(NRS-2002)scores and Tilburg Frailty Indicator scale(TFI)scores were considerably greater than that of the control group.Conclusion(s):1.The treatment plan for older patients with hip replacement can give an evidence-based practical framework for orthopedic clinical nursing based on the best evidence integration,together with current clinical situation and the judgment opinions of relevant specialists.2.Clinical management of the treatment program for older patients with hip arthroplasty can successfully relieve severe symptoms and enhance recovery of daily life function in elderly patients with hip arthroplasty. |
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