The Effect of Video-Assisted Discharge Education After Total Hip Replacement Surgery on Activities of Daily Living, Functionality and Patient Satisfaction: A Randomized Controlled Study
Phase: NA
Conditions: Total Hip Replacement, Patient Education, Patient Satisfaction, Activities of Daily Living
Sponsor: Ozum Cetinkaya Eren

Study Protocol 
Total Hip Replacement (THR) is a common surgical procedure performed in patients 
who do not respond to long-term conservative treatment to reduce high pain sensation and 
movement limitation in the joint (Li and Xu, 2018). Physiotherapy and rehabilitation routinely 
applied to regain functional independence in daily living, restore pain and joint range of motion, 
eliminate muscle weakness, regulate walking pattern, prevent falls, loosening, revision surgery 
and dislocations in the prosthesis, increase participation in activities of daily living (ADL), 
quality of life (QoL) and patient satisfaction levels after THR (Louw et al., 2013; Galea et al., 
2008). It was determined in Kennedy et al. (2017) that patients have education expectations on 
recognition of the surgical team, general information about the disease and prosthesis, 
rehabilitation, pain management, home care activities, complications, medications, ADL after 
THR surgery. At the present time, with the help of demographic changes in the society and 
patients, changes in healthcare provision, and technological approaches, discharge education 
became more effective with video assistance (Abu Abed et al., 2014). The aim of our study was 
to investigate the effect of a video-assisted discharge education program on activities of daily 
living, functionality, and patient satisfaction after total hip replacement surgery. 
Methods: 
The study was approved by the Non-invasive Clinical Researches Ethics Committee 
(60116787-020/58408) on 04.09.2018. The participants included in the study were informed 
about the study and informed consent form was signed by all participants. Our study was 
performed between September 2018 and June 2019. 
 
Of the 36 participants who met the inclusion criteria, 5 were excluded from the study 
for missing follow-ups or not wanting to participate in the study. The 31 participants included 

in the study were randomized using systematic sampling. According to last number of file 
numbers odd numbers included in the physiotherapy (PT) group (n=18), and even numbers 
included in the video-assisted discharge education (VADE) group (n=13). The first meeting 
with participants was made in the hospital room within the first 5 days after THR surgery in 
both groups. Participants and their relatives were given physiotherapy and video-assisted 
discharge education by the same physiotherapist without being told which group they were in. 
The physiotherapy program given to the PT group included breathing exercises, 
positioning, hip range of motion and strengthening exercises, and information about walking 
and ambulation. The whole program was taught verbally and practically to participants and 
their relatives. Information was given about the exercises to be added at the end of the first 
week and in the 4th week. A physiotherapy booklet prepared with the same content was given 
to the participants. The booklet was examined by the patient and relatives, and the questions 
they asked were answered by the same physiotherapist. The participants were informed that 
they should continue the exercises for 12 weeks. 
VADE group received video-assisted discharge education in addition to the 
physiotherapy program given to the PT group on the same day by the same physiotherapist. 
The VADE program included information about THR, preventive rehabilitation approaches, 
transfer activities, using stairs, self-care activities, home settings by modifying the treatment 
and discharge protocols of Lucas (2008). VADE was prepared as a presentation of written 
information and videos which is shown this information by a professional model. Video shoots 
were done by a physiotherapist experienced in the field of physiotherapy and rehabilitation after 
THR surgery. The presentation was stopped when participants have questions or have points 
were not understood and the necessary explanations were shown verbally and practically. Along 
with the physiotherapy booklet, the participants were given an educational booklet containing 
written and visual information prepared in the same content as VADE. The booklet was 

examined by the patient and relatives during VADE, and the questions they asked were 
answered by the same physiotherapist. 
Patient interviews were completed in approximately 30 minutes in the PT group and 
approximately 45 minutes in the VADE group. A healthy person was used to prevent damage 
to the hip joints of those who had undergone surgery in photographs and videos in the VADE 
and booklets. In the booklets, easily understandable sentences were used by participants and 
their relatives. Booklets were prepared in Arial font and 11-point size. All participants were 
called by phone every 15 days for 12 weeks, and their participation in the exercises and ADL 
was followed. 
Assessments were performed within the first 5 days after the THR surgery (Descriptive 
Information, Pain, Patient Satisfaction Questionnaire) in the hospital room after physiotherapy 
and VADE programs, and at the 3rd-month control (Pain, Harris Hip Score (HHS), Tampa 
Scale of Kinesiophobia (TSK), Nottingham Extended Activities of Daily Living Scale 
(NEADL), Patient Satisfaction Questionnaire) in orthopedics and traumatology clinic. 
Statistical Analysis Plan 
 
In the statistical analysis of data obtained in this study, Windows-based SPSS (IBM 
SPSS Statistics, Version 24.0, Armonk, NY, USA) package program was used. It was 
calculated that the number of patients included in our study was 89% power and 95% 
confidence for each group. Continuous variables were expressed as a mean ± standard deviation 
or as a median (minimum-maximum values), and categorical variables as a number and percent. 
Analytical (Kolmogorov-Smirnov/Shapiro-Wilks test) and visual (Histogram and probability 
graphs) methods were used to test the conformity of data for normal distribution. When the 
parametric test assumptions were provided, Independent Sample T-Test was used to compare 
independent group differences; when the parametric test assumptions were not provided, Mann 

Whitney-U test was used to compare independent group differences. In the dependent group 
analyzes; when the parametric test assumptions were provided, Paired Sample T-Test was used; 
when the parametric test assumptions were not provided, Wilcoxon Test was used. Chi-Square 
Analysis and Fisher Exact Test were used compare differences between categorical variables. 
The statistical significance level was assumed at p < 0.05 in this study. 
Results 
 
A total of 31 patients, aged between 25 and 70 years (PT Group=55.33 ± 11.83 years, 
VADE Group=49.61±9.52 years) were included in this study. There was no significant 
difference in age, body mass index, daily work and standing times between the two groups (p> 
0.05). Other demographic characteristics of the patients are presented in Table 1.  
 
When the patients' pain perception levels were compared within the group, a statistically 
significant decrease in sleep, rest, and activity were detected between the 1st week and 3rd-
month evaluations in both groups (p<0.05). There was a statistically significant difference 
between groups in scores on resting pain levels in the 1st week and on resting and activity pain 
levels in the 3rd month in favor of the VADE group (p<0.05) (Table 2). 
 
While no difference was found between the groups in the pain levels sub-parameter of 
HHS (p>0.05), there was a statistically significant difference in favor of the VADE group in 
function, absence of deformity and ROM scores and total scores (p<0.05). When GYA levels 
were examined, no significant difference was found in the sub-parameters of NEADL in favor 
of the VADE group (p>0.05), except for the movement score (p<0.05). According to the results 
of TSK, the level of kinesiophobia of the VADE group was found to be statistically significantly 
lower than the PT group (p<0.05) (Table 3). When patient satisfaction levels were compared, 
there was a statistically significant difference between groups on scores of all parameters in the 

1st week and 3rd month significantly higher scores were seen in the VADE group versus to PT 
group (p<0.05) (Table 4). 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
Table 1. Demographic Data of Patients  
Variables 
PT Group (n=18) 
VADE Group (n=13) 
p 
x̄ ±SD 
x̄ ±SD 
Age (years) 
55.33±11.83 
49.61±9.52 
0.16a 
BMI (kg/m2) 
26.86±2.68 
26.07±2.50 
0.41a 
Daily Working Times 
2.00±3.67 
5.15±5.28 
0.11b 
Variables 
PT Group 
VADE Group  
  
p 
n 
% 
n 
% 
Sex 
 
 
 
 
 
Female 
12 
66.7 
9 
69.2 
1.00d 
Male 
6 
33.3 
4 
30.8 
Use of Cement 
 
 
 
 
 
Cemented 
6 
33.3 
3 
23.1 
0.69d 
Cementless 
12 
66.7 
10 
76.9 
Dominance on Upper Extremity 
 
 
 
 
 
Right 
16 
88.9 
12 
92.3 
1.00d 
Left 
2 
11.1 
1 
7.7 
Dominance on Lower Extremity 
 
 
 
 
 
Right 
12 
66.7 
10 
76.9 
0.69d 
Left 
6 
33.3 
3 
23.1 
Affected Extremity 
 
 
 
 
 
Right 
8 
44.4 
7 
53.8 
0.60c 
Left 
10 
55.6 
6 
46.2 
Education level 
 
 
 
 
 
Illiterate 
3 
16.7 
1 
7.7 
- 
Primary school 
7 
38.9 
4 
30.8 
- 
Middle School 
2 
11.1 
1 
7.7 
- 
High school 
4 
22.2 
4 
30.8 
- 
Associate degree  
1 
5.6 
1 
7.7 
- 
Undergraduate degree 
1 
5.6 
2 
15.4 
- 
Profession 
 
 
 
 
 
Retired 
5 
27.7 
3 
23.07 
- 
Housewife 
7 
38.8 
3 
23.07 
- 
Worker 
2 
11.1 
2 
15.3 
- 
Officer 
1 
5.5 
1 
7.6 
- 
Teacher 
1 
5.5 
1 
7.6 
- 
Farmer 
2 
11.1 
- 
- 
- 
Artisan 
- 
- 
1 
7.6 
- 
Cleaning staff 
- 
- 
1 
7.6 
- 
Chef 
- 
- 
1 
7.6 
- 
PT: Physiotherapy, VADE: Video-assisted discharge education, BMI: Body Mass Index, kg: kilogram, m: meter, 
p<0.05: statistically significant difference, n: Sample size, x̄ : mean, SD: standard deviation, pa: Independent 
Sample T-Test, pb: Mann Whitney-U test, pc: Chi-Square Analysis, pd: Fisher Exact Test 
 
 
 
 
 

 
Table 2. Comparison of Pain Levels of Patients 
 
VAS (In-group) 
PT Group 
  
p 
1st week 
3rd month 
x̄ ±SD 
x̄ ±SD 
Sleep 
5.54±2.69 
3.06±2.28 
0.008a* 
Rest 
6.97±1.72 
3.86±2.05 
0.000c* 
Activity 
8.54±1.51 
5.98±2.24 
0.000a* 
 
VAS (In-group) 
VADE Group  
 
p 
1st week 
3rd month 
x̄ ±SD 
x̄ ±SD 
Sleep 
5.5±2.01 
2.09±2.26 
0.000a* 
Rest 
4.8±2.67 
2.02±1.51 
0.005a* 
Activity 
7.13±2.42 
3.78±2.38 
0.002a* 
VAS (Between groups) 
PT Group 
VADE Group 
p 
Median (min-max) 
Median (min-max) 
Sleep 
1st week 
4.9 (0-10) 
5.4 (2.7-9.5) 
0.96a 
3rd month 
2.5 (0-8.8) 
1.5 (0-7.4) 
0.13b 
Rest 
1st week 
6.8 (4.2-10) 
5 (0-8.9) 
0.01a* 
3rd month 
3.45 (4-8.40) 
1.8 (0-4.5) 
0.01a* 
Activity 
1st week 
8.9 (4.6-10) 
7.4 (3-10) 
0.13b 
3rd month 
5.5 (2.2-10) 
3.5 (0-7.5) 
0.01a* 
PT: Physiotherapy, VAS: Visual Analog Scale, VADE: Video-assisted discharge education, min: Minimum, max: 
Maximum, p<0.05: statistically significant difference, x̄ : mean, SD: standard deviation, pa: Paired Sample T-Test, 
pb: Mann Whitney-U test pc: Wilcoxon Test 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
Table 3. Comparison of Hip Function, Activities of Daily Living and Kinesiophobia 
 
HHS 
PT Group 
VADE Group 
  
p 
x̄ ±SD 
Median 
(min- max) 
x̄ ±SD 
Median 
(min- max) 
Pain  
28.44±13.38 
30 (10-44) 
35.84±8.84 
40 (20-44) 
0.135b 
Function  
29.22±10.22 
29.5 (11-47) 
40.07±5.80 
39 (29-47) 
0.002a* 
Absence of Deformity 
1.50±1.20 
1 (0-4) 
3.15±0.80 
3 (2-4) 
0.000b* 
ROM 
4.57±0.62 
4.8 (2.5-5) 
4.92±0.10 
4.95 (4.69-5) 
0.034b* 
Total  
63.74±23.49 62.72 (23.5-98) 83.99±12.46 
81.8 (66.85-100) 
0.004b* 
NEADL 
PT Group 
VADE Group 
p 
Median (min-max) 
Median (min-max) 
Movement 
13 (5-18) 
16 (7-18) 
0.038b* 
Kitchen Activities 
12 (3-15) 
15 (7-15) 
0.106b 
Housework 
11 (2-15) 
13 (9-15) 
0.146b 
Leisure-time 
Activities 
12 (5-18) 
15 (4-18) 
0.352b 
Total 
47.5 (17-66) 
59 (41.64) 
0.170b 
TSK 
PT Group 
VADE Group 
p 
x̄ ±SD 
x̄ ±SD 
Total 
48.05±6.59 
39.38±8.13 
0.003a* 
PT: Physiotherapy, VADE: Video-assisted discharge education, ROM: Range of motion, HHS: Harris Hip Score, 
NEADL: Nottingham Extended Activities of Daily Living Scale, TSK: Tampa Scale of Kinesiophobia, min: 
Minimum, max: Maximum, p<0.05: statistically significant difference, x̄ : mean, SD: standard deviation, pa: 
Independent Sample T-Test, pb: Mann Whitney-U test.

Table 4. Comparison of Patient Satisfaction Levels 
 
Patient Satisfaction Questionnaire (In-group) 
PT Group 
  
p 
1st week 
3rd month 
x̄ ±SD 
x̄ ±SD 
Surgical Procedure 
5.15±2.56 
5.77±2.29 
0.123a 
Physiotherapy or VADE Program 
6.38±2.93 
6.87±2.46 
0.273a 
ADL and Prevention Protocols 
6.06±2.66 
7.01±2.34 
0.028a* 
Transfer Activities 
6.67±2.20 
6.85±2.24 
0.705a 
Home Settings 
6.17±2.16 
6.62±2.12 
0.201a 
 
Patient Satisfaction Questionnaire (In-group) 
VADE Group 
 
p 
1st week 
3rd month 
x̄ ±SD 
x̄ ±SD 
Surgical Procedure 
8.35±1.51 
8.62±1.12 
0.615a 
Physiotherapy or VADE Program 
9.12±0.89 
9.46±0.64 
0.279a 
ADL and Prevention Protocols 
8.96±1.34 
9.48±0.52 
0.251a 
Transfer Activities 
9.13±1.06 
9.72±0.36 
0.091c 
Home Settings 
8.57±1.95 
9.52±0.55 
0.068c 
Patient Satisfaction Questionnaire (Between groups) 
PT Group 
VADE Group 
p 
Median (min-max) 
Median (min-max) 
Surgical Procedure 
1st week 
5.6 (0.4-8.9) 
8.5 (4.7-10) 
0.000a* 
3rd month 
5.7 (1.2-8.5) 
8.6 (6.8-10) 
0.000a* 
Physiotherapy or VADE Program 
1st week 
7.2 (0-10) 
9.3 (7.2-10) 
0.001a* 
3rd month 
7.2 (2.3-10) 
9.6 (8.2-10) 
0.001b* 
ADL and Prevention Protocols 
1st week 
6.2 (0-10) 
9.6 (6-10) 
0.000b* 
3rd month 
7.3 (2.8-10) 
9.5 (8.5-10) 
0.001b* 
Transfer Activities 
1st week 
6.5 (3.3-10) 
9.5 (6.3-10) 
0.001b* 
3rd month 
6.95 (2.4-10) 
10 (9-10) 
0.000b* 
Home Settings 
1st week 
63.5 (26-96) 
92 (31-100) 
0.001b* 
3rd month 
71 (30-96) 
97 (83-100) 
0.000b* 
PT: Physiotherapy, VADE: Video-assisted discharge education, min: Minimum, max: Maximum, ADL: Activities of daily living, p<0.05: statistically significant difference, x̄ : 
mean, SD: standard deviation, pa: Paired Sample T-Test, pb: Mann Whitney-U test pc: Wilcoxon Test