| Objective:1.Construction of an outcome expectancy management program for patients undergoing total knee arthroplasty;2.To evaluate the effect of the outcome expectancy management program on the level of outcome expectancy,functional exercise compliance,knee function,degree of achievement of outcome expectancy and satisfaction in patients undergoing knee arthroplasty.Methods:1.Construction of an outcome expectancy management program for patients undergoing total knee arthroplasty.(1)Develop a literature search strategy and search and analyze literature that is expected to be relevant as a result;(2)Using a purposive sampling method,11 patients who underwent total knee arthroplasty in the Department of Bone and Joint Surgery in a tertiary care hospital in Henan Province from November 2021 to December 2021 were selected for semi-structured interviews,The use of the Colaizzi 7-step analysis method for summarizing information and refining themes;(3)Constructing a first draft of an outcome expectancy management program for total knee arthroplasty patients based on a theoretical framework,literature review,and qualitative studies.A revised draft of the outcome expectation management program administration was determined through 2 rounds of Delphi expert correspondence and pre-experimentation by 16 experts.2.Application of an outcome expectancy management program for patients undergoing total knee arthroplasty.In this study,a non-contemporaneous controlled class experimental research method was adopted.To facilitate the selection of 86 patients with knee arthroplasty from March 2022 to June 2022 in the first ward of the Department of Osteoarthroplasty of a tertiary care hospital in Zhengzhou City as study subjects.Patients who met the inclusion exclusion criteria from March 2022 to April 2022 were included as the control group according to the time of patient admission and received usual care.Patients who met the inclusion and exclusion criteria from May to June 2022 served as the trial group and implemented an outcome expectancy management program based on usual care.Follow-up and evaluation of patients at admission,before surgery,on the day of discharge,1 month after surgery,and 3 months after surgery.Hospital for Special Surgery Knee Replacement Expectations Survey,the Orthopedic Functional Exercise Adherence Scale,the American Hospital for Special Surgery Knee Score,and the Patient Satisfaction Scale were used to evaluate the effectiveness of the intervention in both groups.Data were entered using SPSS 25.0 software,and statistical descriptions,chi-square tests,Fisher’s exact probability method,two independent samples t-test,Mann—Whitney U rank sum test,repeated measures ANOVA and generalized estimating equations were used for statistical analysis of the data with a two-sidedα=0.05 test level.Results:1.Construction of an outcome expectancy management program for patients undergoing total knee arthroplasty.(1)The literature study summarizes and analyzes the"target population,intervention content,intervention duration,length,frequency,and study outcomes"of outcome expectancy management;(2)In-depth interviews with 11 patients,the patients’experience of outcome expectancy management was categorized into 3 themes and 9 subthemes,including formation and establishment of preoperative outcome expectancy(somatic symptom distress,information-influenced disease perception,extrinsic factor drive),problems and coping in outcome expectancy management(outcome expectancy bias,problem-centered coping,emotion-centered coping),and needs in outcome expectancy management(information support,medical support,social support);(3)The positive coefficients of the 2 rounds of expert correspondence are100%,and the expert authority coefficients are divided into 0.86 and 0.93.In the 2nd round of correspondence,the Kendall’s W for all levels of indicators were 0.344,0.230,and 0.305,respectively(P>0.05)The final outcome expectancy management program for patients undergoing total knee arthroplasty contained 5 level 1 entries,13 level 2 entries,and 32 level 3 entries.2.Application of an outcome expectancy management program for patients undergoing total knee arthroplasty.A total of 3 cases were lost to the study,2 patients in the control group withdrew from this study,and 1 patient in the pilot group was excluded for low intervention cooperation,resulting in a total of 83patients completing the study,42 in the pilot group and 41 in the control group.The differences in baseline information(general information,outcome expectancy scores,knee HSS scores,and patient satisfaction)between the two groups were not statistically significant(P>0.05).(1)Two independent samples t-test was performed for HSS-KRES scores in both groups.The results showed that the HSS-KRES score of patients in the test group(60.64±3.88)was lower than that of the control group(63.10±3.15)before surgery,and the difference was statistically significant(P<0.001).(2)Repeated measures ANOVA on functional exercise compliance scores at different time points in both groups showed statistically significant(P<0.05)differences in between-group effects(F=82.01,P<0.001),time effects(F=40.77,P<0.001)and interaction effects(F=13.99,P<0.001).(3)Repeated measures ANOVA of HSS scores at different time points in both groups showed statistically significant differences in group effects(F=18.45,P<0.001),time effects(F=573.01,P<0.001)and interaction effects(F=13.26,P<0.001).(4)The results of the t-test analysis of two independent samples showed that the degree of achievement of outcome expectations was significantly higher in the test group(69.53±6.90)%than in the control group(59.64±6.54)%at 1 month postoperatively and in the test group(98.40±5.78)%at 3 months postoperatively than in the control group(94.39±5.54)%,and all differences were statistically significant(P<0.001).(5)Generalized estimating equation analysis of patient satisfaction scores in both groups showed that the between-group effect(Wald~2 P)=7389.77,P<0.001),time effect(Wald~2(P)=49.3,P<0.001)and interaction effect(Wald~2(P)=78.82,P<0.001)differences were statistically significant.Conclusion:The outcome expectancy management program for total knee arthroplasty patients helps to rationalize the level of patient outcome expectations,which can improve patient compliance with functional exercise,knee function,and patient satisfaction,and promote the achievement of patient outcome expectations,and has a certain reference value for subsequent clinical research on interventions related to outcome expectations to enhance patient experience. |
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