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. 2022 Apr 29;12(5):719.
doi: 10.3390/jpm12050719.

The Effects of a Patient-Specific Integrated Education Program on Pain, Perioperative Anxiety, and Functional Recovery following Total Knee Replacement

Cheng-Jung Ho  1   2   3   4   5 , Yen-Ti Chen  6   7 , Hung-Lan Wu  8 , Hsuan-Ti Huang  1   2   3   4 , Sung-Yen Lin  1   2   3   4
Affiliations

The Effects of a Patient-Specific Integrated Education Program on Pain, Perioperative Anxiety, and Functional Recovery following Total Knee Replacement

Cheng-Jung Ho et al. J Pers Med. .

Abstract

The perioperative care of patients undergoing total knee arthroplasty (TKA) affects functional recovery and clinical outcomes. This study aims to introduce a patient-specific integrated education program (IEP) into the TKA clinical pathway and to evaluate patient outcomes between the intervention and control groups. We performed a two-site, two-arm, parallel-prospective controlled trial. The experiment group received an IEP incorporating verbal preoperative education, prehabilitation, multidisciplinary personalized rehabilitation during hospitalization, and supervised self-executed home-based exercise after discharge. The control group received regular TKA clinical care. We monitored the pain intensity, anxiety scores, and functional scores at six time points from the pre-operation interview to 3 months post-operation. The pain score was significantly decreased in the IEP group during hospitalization (p < 0.01) and before discharge (p < 0.05). The anxiety status was also improved after intervention in terms of state and trait anxiety inventory scores (p < 0.001) during hospitalization. The patient-reported (WOMAC) or physician-reported (American Knee Society Score) functional scores (p < 0.01 at most of the time points) all improved significantly under hospitalization. We found that the patient-specific IEP combining preoperative education, prehabilitation, the in-hospital group education class, and postoperative care navigation is effective in reducing postoperative pain, decreasing perioperative anxiety, and facilitating functional recovery following TKA.

Keywords: integrated education; knee osteoarthritis; prehabilitation; total knee arthroplasty.

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Conflict of interest statement

Sung-Yen Lin. or any member of their immediate family have no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Detailed flowchart of the IEP (integrated education program).
Figure 2
Figure 2
Time course of mean change in pain intensity from baseline to each checked time point (* p < 0.05, ** p < 0.01.)
Figure 3
Figure 3
Time course of mean change in anxiety state from baseline to each checked time point: (a) state anxiety (State-Trait Anxiety Inventory, STAI-S), (b) trait anxiety (State-Trait Anxiety Inventory, STAI-T). (* p < 0.05, *** p < 0.001).
Figure 4
Figure 4
Time course of mean change in American Knee Society Score (AKS) from baseline to each checked time point. (* p < 0.05, ** p < 0.01).
Figure 5
Figure 5
(a) Time-course of mean change in WOMAC from baseline to each time point. (b) The absolute WOMAC score at each time point in both groups. (* p < 0.05, ** p < 0.01; *** p < 0.001).
Figure 5
Figure 5
(a) Time-course of mean change in WOMAC from baseline to each time point. (b) The absolute WOMAC score at each time point in both groups. (* p < 0.05, ** p < 0.01; *** p < 0.001).
See this image and copyright information in PMC

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