The Effect of Video-Assisted Discharge Education After Total Hip Replacement Surgery
Condition: Total Hip Replacement; Patient Education; Patient Satisfaction; Activities of Daily Living
Study type: Interventional

Summary: 
      Abstract Objective: The aim of this 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 (THR) surgery.

      Methods: This study included 31 participants who were randomly divided in the physiotherapy
      (PT) group (n=18), and the video-assisted discharge education (VADE) group (n=13). Both
      groups received a physiotherapy program. VADE group was additionally received VADE program.
      In both groups, all education programs were given face to face. Data were collecting using
      visual analog scale (VAS), Harris Hip Score (HHS), Nottingham Extended Activities of Daily
      Living Scale (NEADL), Tampa Scale of Kinesiophobia (TSK) and Patient Satisfaction
      Questionnaire at 1st week and 3rd month.

      Practice Implications: The current study has contributed to the development of video-assisted
      health technologies.
    

Detailed description: 
      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:

      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
    

Intervention name(s): Video-Assisted Discharge Education (VADE); Physiotherapy (PT) Program
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Video-Assisted Discharge Education (VADE): Information about THR, preventive rehabilitation approaches, transfer activities, using stairs, self-care activities.; Physiotherapy (PT): Breathing exercises, positioning, hip range of motion and strengthening exercises, and information about walking and ambulation.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study included 31 participants who were randomly divided in the physiotherapy (PT) group (n=18), and the video-assisted discharge education (VADE) group (n=13). Both groups received a physiotherapy program. VADE group was additionally received VADE program. The physiotherapy program included breathing exercises, positioning, hip range of motion and strengthening exercises, and information about walking and ambulation. 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). The whole program was taught verbally and practically and a physiotherapy booklet prepared with the same content was given to the participants and their relatives.
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Patient education; Function; Kinesiophobia; Total Hip Replacement