Symptoms And Function During The Early Recovery Period Following Orthotopic Liver Transplantation Surgery

ii ACKNOWLEDGEMENTS iv LIST OF TABLES. ix LIST OF FIGURES. x LIST OF APPENDICES. xi CHAPTER 1: INTRODUCTION. 1 Symptoms and Function Following OLT Surgery. 2 Problem Statement. 7 CHAPTER 2: LITERATURE REVIEW. 8 OLT Surgery. 8 Complications Following OLT Surgery. 9 Pain Within 3 Months Following OLT Surgery. 11 Pain at 72 Hours Postoperatively. 11 Pain Within 3 Months Following Discharge . 13 Mood Within 3 Months Following OLT Surgery. 16 Mood During Hospitalization. 17 Mood Within 3 Months Following Discharge. 18 Depressive symptoms. 18 Anxiety. 20 Negative mood states. 22 General mental health. 25 Fatigue and Fatigue Impact Within 3 Months Following OLT Surgery. 28 Function Within 3 Months Following OLT Surgery. 33 Function During Hospitalization. 34 Function Within 3 Months Following Discharge. 35 Relationships Between Pain, Mood, Fatigue, and Function. 39 Primary Caregiver Fatigue and Fatigue Impact Within 3 Months Following OLT Surgery. 43 Summary and Synthesis of Literature Review. 45 A Conceptual Model of Patient Outcomes. 48 Overview of the Model of Patient Outcomes. 48 An Adaptation of the Conceptual Model of Patient Outcomes. 51 Symptoms. 52 Function. 53 Characteristics of the environment. 53 CHAPTER 3: METHODOLOGY. 55 Purpose. 55 Primary Question. 55 Secondary Question. 55 Definition of Terms. 55 Research Design. 57 Sample and Setting. 57 Eligibility Criteria. 57 vii Methods. 58 Participant Recruitment. 58 Data Collection. 60 Baseline data collection. 60 Follow-up data collection. 60 Instrumentation. 62 Baseline demographic information. 63 Outcome measures. 63 Ethical Considerations. 69 Risks and Benefits. 70 Data Management and Security. 70 Sample Size and Data Analysis. 71 Sample Size. 71 Analysis. 72 Feasibility. 75 CHAPTER 4: RESULTS. 76 Sample. 76 Recruitment. 76 OLT Recipients. 76 Primary Caregivers. 76 Attrition. 77 OLT Recipients. 77 Primary Caregivers. 77 Baseline Characteristics. 79 OLT Recipients. 79 Primary Caregivers . 82 Description of Symptoms and Function at Baseline and Follow-Up. 83 Pain . 83 Mood. 86 Fatigue. 89 Fatigue Impact. 90 Function. 91 Caregiver Fatigue and Fatigue Impact at 4, 8 and 12 weeks following OLT Recipient’s Discharge from Hospital. 92 Fatigue. 92 Fatigue Impact. 93 Primary Research Question . 94 Relationship between pain, mood, fatigue and fatigue impact and function. 94 Secondary Research Question. 96 Relationship between the OLT Recipients’ Function and their Primary Caregivers’ Fatigue (level and impact) . 96 Summary of results. 97 CHAPTER 5: Discussion. 101 Primary Question: Relationships between OLT Recipients’ Pain, Mood, Fatigue, (level and impact) and Function at Baseline and During the first 12 Weeks Following viii Discharge. 101 Secondary Question: Relationship between the OLT Recipients’ Function and their Primary Caregivers’ Fatigue (level and impact) . 108 Trends of OLT Recipients’ Postoperative Pain, Mood, Fatigue and Function at Baseline and Follow-Up. 111 Pain. 111 Mood . 113 Fatigue. 115 Functional Status. 116 Strengths. 117 Limitations. 119 CHAPTER 6: Summary, Implications, Conclusion. 121 Implications for Research. 124 Implications for Practice. 126 Conclusion. 127 REFERENCES. 129 APPENDICES. 149