| ObjectiveBased on the multidimensional rehabilitation needs of total knee replacement patients and the Information-Motivation-Behavior Skill Model(IMB)theory,this study constructed rehabilitation and exercise programs for total knee replacement patients suitable for China’s national conditions.The preliminary application effect of the scheme is verified.The aim is to improve patients’ compliance with postoperative exercise,optimize postoperative rehabilitation effect,and provide reference for clinical medical staff to conduct rehabilitation exercise guidance.Methods1.Based on the literature review and the concept of IMB,the functional rehabilitation intervention program for TKA patients was preliminarily constructed.Delphi expert letter consultation method was adopted to conduct two rounds of expert letter consultation among17 experts in this field.The research team modified and adjusted the intervention program based on expert opinions and pre-test feedback,and formed a formal IMB based functional rehabilitation intervention program for patients with total knee arthroplasty.2.According to the order of hospitalization time,112 patients who met the inclusion and exclusion criteria in a tertiary grade A hospital in Qingdao from November 2019 to August 2020 were selected and divided into 2 groups.Fifty-six hospitalized patients from November 2019 to March 2020 were selected as the control group.A total of 56 hospitalized patients from April 2020 to August 2020 were selected as the intervention group.The control group adopted conventional nursing mode,and the intervention group adopted functional rehabilitation nursing mode based on IMB.The differences in knee function,self-efficacy,social support and exercise compliance were compared between the two groups.SPSS 22.0software was used for statistical analysis.Statistical methods such as t-test,paired t test,chi square test and repeated measure of variance analysis were used to evaluate the application effect of rehabilitation exercise program based on IMB model for total knee replacement patients.Results1.IMB based rehabilitation exercise program for total knee arthroplasty patients was constructed.In the two rounds of Delphi experts’ consultation,the positive coefficients of experts were 94.44% and 100% respectively.The authority coefficients of expert were 0.81 and 0.83.The coefficient of variation(CV)ranged from 0.05 to 0.18.Kendall’s W of the two rounds of expert letter consultation were 0.205 and 0.248,respectively,with statistically significant differences(P<0.05).2.Implement IMB based rehabilitation exercise program for patients with total knee arthroplasty.(1)There were no statistically significant differences in knee score,self-efficacy and social support scores between the two groups before surgery(P>0.05),indicating comparability.(2)At 1 month and 3 months after surgery,the compliance score of functional exercise in the intervention group was higher than that in the control group,the difference was statistically significant(P<0.05).Paired t-test showed that the compliance score of functional exercise in both groups at 3 months after surgery was lower than that at 1 months after surgery(P<0.05).(3)The main effect of HSS score at different time points,the main effect of HSS score between the two groups and the interaction effect were statistically significant(P<0.05).At1 and 3 months after surgery,HSS scores of intervention patients were higher than those of control group(P<0.05).HSS scores in both groups were higher at 1 and 3 months postoperatively than before(P<0.05),and higher at 3 months postoperatively than 1 month postoperatively(P<0.05).(4)The time main effect,inter-group main effect and interaction effect of social support scores in the two groups at different time points were statistically significant(P<0.05).At 1and 3 months after surgery,the scores of social support in intervention patients were higher than those in control group(P<0.05).There was no significant difference in the scores of social support in the intervention group 1 month after surgery and before surgery(P=0.087),and the scores of social support in the intervention group 3 months after surgery were lower than that 1 month after surgery(P<0.05).In the control group,the scores of social support 1and 3 months after surgery were lower than those before surgery(P<0.05),and the scores of social support 3 months after surgery were lower than those 1 month after surgery(P<0.05).(5)The time main effect,inter-group main effect and interaction effect of Self-efficacy scores in the two groups at different time points were statistically significant(P<0.05).Selfefficacy scores of the intervention group were higher than those of the control group at 1 and3 months after surgery(P<0.05).Self-efficacy scores in both groups were lower at 1 and 3months after surgery than before surgery(P<0.05),and higher at 3 months after surgery than at 1 month after surgery(P<0.05).ConclusionsDelphi experts demonstrated that the rehabilitation exercise program based on IMB is feasible and practical,which can improve compliance with rehabilitation exercise,improve knee function,enhance self-efficacy,and mobilize the social support of rehabilitation training. |
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