Readiness For Hospital Discharge After Total Knee Arthroplasty In Patients With Knee Osteoarthritis:A Study Of Current Status And Influencing Factors

Objective:Based on Galvin et al.’s definition of readiness for hospital discharge(RHD)and Meleis’theory of transformation,this study aims to determine the current status of RHD in patients with knee osteoarthritis after total knee arthroplasty(TKA)and to analyze the factors influencing it.In order to raise the awareness of clinicians and nurses about RHD and to develop individualized,scientific discharge plans for patients.Meanwhile,structural equation model(SEM)is used to investigate how these factors interact to influence RHD,which provides a basis for clarifying nursing priorities and rationalizing healthcare resources,thus improving patients’ RHD.Methods:This study is a cross-sectional study.From January to August 2022,post-TKA patients were conveniently selected for this study in the Department of Bone and Joint Surgery at two tertiary a-level hospitals in Jinan,Shandong Province,with data collected on the day of patients’discharge.The readiness for hospital discharge scale(RHDS)was used to assess patients’ RHD.The general information questionnaire,numeric rating scale(NRS),quality of discharge teaching scale(QDTS),self-efficacy for rehabilitation outcome scale(SER),knee osteoarthritis disease knowledge questionnaire,post-operative pain control knowledge questionnaire and social support rating scale(SSRT)were used to assess factors associated with patients’ RHD.Excel software was used to integrate the data,while SPSS 26.0 software was used for statistical description and statistical extrapolation of the data,including t-test,ANOVA,non-parametric test,Pearson correlation analysis and multiple linear regression analysis.Finally,Mplus 8.3 software was applied to fit the SEM,which was tested and validated by the Bootstrap method(a=0.05).Results:1.A total of 339 post-TKA patients with knee osteoarthritis are included in this study.The QDTS score is(143.05±7.25),the SER score is(81.44±6.15),the disease knowledge score is(10.50±2.23),the pain control knowledge score is(26.84±4.90),the SSRT score is(39.64±5.47),the RHDS score is(92.12±6.43).And 38 patients have a low level of RHD,accounting for 11.2%of the total.2.Multiple linear regression analysis shows that age.residence,education level,knee pain level during sleep,quality of discharge teaching,self-efficacy for rehabilitation,pain control knowledge,and social support are the major influence factors of RHDS scores in post-TKA patients with knee osteoarthritis,and the fit of the regression model is 66.8%.3.The SEM constructed based on the results of the multiple linear regression analysis has a good model fit(χ2/DF=2.02,RMSEA=0.055,CFI=0.979,TLI=0.954,SRMR=0.045),and the p-value for each path was significant.Age,residence,education level,knee pain level during sleep,quality of discharge teaching,self-efficacy for rehabilitation,pain control knowledge,and social support all have a direct effect on RHD,of which education level,knee pain level during sleep,quality of discharge teaching and pain control knowledge also have an indirect effect on RHD.Conclusions:1.The RHDS score in post-TKA patients with knee osteoarthritis is moderate,while 11.2%(38/339)of patients are not ready on the day of discharge.It suggests that physicians and nurses should focus on assessment and intervention for patients’ RHD.2.Multiple linear regression analysis shows that age,residence,education level,knee pain level during sleep,quality of discharge teaching,self-efficacy for rehabilitation,pain control knowledge,and social support are significant influence factors of RHD in post-TKA patients with knee osteoarthritis.That is,the older,solitary,less educated,deeper knee pain level during sleep,lower quality of discharge teaching scores,poorer self-efficacy for rehabilitation,lower pain control knowledge scores,and less social support,the worse the RHD of patients.3.Physicians and nurses should focus on low-educated patients,and reducing their knee pain levels during sleep.Also,when providing health education,attention should be given to enriching one’s discharge teaching skills and methods,adding pain control knowledge to improve patients’ RHD.