| ObjectiveTo establish a cognitive behavior program for postoperative kinesiophobia in geriatrics following unilateral total knee arthroplasty(TKA);to evaluate the difference between cognitive behavior group and standard care group in kinesiophobia,the first activity time after the surgery,knee pain,knee function,length of hospital stay and hospitalization expenses.Furthermore,to evaluate the effectiveness of this cognitive behavior program in improving knee function in TKA individuals thus provide the evidence for further study in making intervention strategies for kinesiophobia in TKAs.Method1.This trial was conducted from August 2016 to July 2017 at the Orthopedics Department in a first-class tertiary hospital in Zhengzhou,China.116 patients who met all the inclusion criteria were asked to participate in this study,after signing the informed consent,they were randomly assigned into the experimental group(cognitive behavior program)and control group(standard care).Both groups of patients subjected to the same post-operative intervention including the pain management,diet management and rehabilitation exercises during hospitalization,except for the patients in the experimental group also participated in a cognitive behavior program,which mainly consist of the cognitive assessment,cognitive reconstruction and progressive muscle relaxation training,while the patients in the control group only received the standard care.2.Patients were screened at the ward after TKA using the Tampa Scale for Kinesiophobia(TSK)to determine whether they had kinesiophobia within 24 hours after TKA,the cutoff score was set at >37.The data were collected at four time points: before intervention,discharge day,3 months and 6 months after TKA.The simplified Chinese version of TSK,the American knee society knee score(KSS)and the Numerical Rating Scale(NRS)were used to measure kinesiophobia,knee function and knee pain intensity,respectively.Moreover,the first activity time after TKA,length of hospital stay,expenses for medicine,inspection fee,treatment costs and total cost of hospitalization of all patients were calculated and recorded.3.SPSS software version 21.0 was used for statistical analyses.Continuous data are described as the mean and standard deviation if the Data conforms to normality test.For categorical variables,percentages(%)and absolute(n)frequencies are presented.Student’s t-test,Kruskal-Wallis H test and Chi-square test was used to compare the preoperative variables and baseline measures between the two groups.Repeated-measures analysis of variance was used to assess the effect of the intervention.For all analyses,P<0.05 was considered statistically significant.Results1.116 patients were recruited,58 subjects in each group at the beginning of the study.However,3 patients were withdrawn from the experimental group,and 4 in control group,all summed to create a drop-out rate in 6.03%.Finally,109 patients were enrolled in this study,with 55 in experimental group and 54 in control group.The average age of all the patients was(65.82 ±7.18)years old,the average BMI was 26.48 ± 3.74,the female accounted for 53.21%,and 92.66% are married.There was no significant difference between the two groups in scores of TSK,KSS,NRS and the other baseline data(P>0.05).2.Comparison of kinesiophobia between the experimental group and control group: the postoperative TSK scores in the two groups were evaluated within 24 hours after the TKA surgery,discharge day,3 months and 6 months after TKA,and the data were analyzed by repeated measures analysis of variance.The results showed that patients in experimental group had significant time(F=191.189,P< 0.001),group(F=64.022,P<0.001),and group-by-time interaction(F=19.022,P<0.001)effects on reducing kinesiophobia than those in control group.The difference was statistically significant in all time point after the intervention(P<0.05).3.Comparison of first activity time after TKA between the experimental group and control group: Two independent samples t-test was used to compared the two groups of patients in first activity time after TKA.As the results showed that the average first activity time after TKA in experimental group was(22.52±3.57)h,but that in control group takes much longer,with average time of(37.22±9.16)h,The difference was statistically significant(t=-11.001,P<0.001).4.Comparison of knee pain intensity between the experimental group and control group: the postoperative NRS scores in the two groups were evaluated within 24 hours after the TKA surgery,discharge day,3 months and 6 months after TKA,and the data were analyzed by repeated measures analysis of variance.The results showed patients in experimental group had significant time(F=259.214,P< 0.001),group(F=74.400,P<0.001),and group-by-time interaction(F =11.544,P<0.001)effects on alleviating knee pain than those in control group.The difference was statistically significant in all time point after the intervention(P<0.05).5.Comparison of knee function between the experimental group and control group: the postoperative KSS scores in the two groups were evaluated within 24 hours after the TKA surgery,discharge day,3 months and 6 months after TKA,and the data were analyzed by repeated measures analysis of variance.The results showed that patients in experimental group had significant time(F=426.378,P< 0.001),group(F =54.023,P<0.001),and group-by-time interaction(F =5.343,P<0.001)effects on improving knee function than those in control group.The difference was statistically significant in all time point after the intervention(P<0.05).6.Comparison of length of hospital stay and hospitalization expenses between the experimental group and control group: Two independent samples t-test was used to compared the two groups of patients in length of hospital stay and hospitalization expenses.As the results showed that the average inspection fee in experimental group was(1744.06±354.59)yuan,and that in control group was(1895.64±481.56)yuan,There was no significant difference between the two groups in average inspection fee(P>0.05);The average length of hospital stay was much shorter than that in control group,The difference was statistically significant(t=-5.274,P<0.001);The average expenses for medicine,treatment costs and total cost of hospitalization were lower than that in control group,The difference was statistically significant(P<0.05).ConclusionThe cognitive behavior program was superior to standard care in reducing postoperative kinesiophobia,first activity time after the surgery,knee pain,length of hospital stay,hospitalization expenses and in enhancing knee function in geriatrics who have kinesiophobia following unilateral total knee arthroplasty. |
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