Rehabilitation of Patients After THR - Based on Patients´Selfrated Health
Condition: Total Hip Replacement
Study type: Interventional
Phase: Phase 1

Summary: 
      Objective: The investigators hypothesized that all areas of health status after total hip
      replacement could be improved in patients aged over 65 years and over by using telephone
      support and counselling 2 and 10 weeks after surgery compared with a control group receiving
      conventional care and treatment.

      Design: A randomised clinical trial focusing on patients' health status by using SF-36 at 4
      weeks pre- and 3 and 9 months postoperatively was carried out. Sample: 180 patients aged 65
      and over were randomised 4 weeks preoperatively to either control or intervention groups.
      Measurements: Both groups received conventional surgical treatment, but the intervention
      group was interviewed by telephone 2 and 10 weeks after surgery. Patients were given
      counselling within eight main dimensions with reference to their postoperative situation.

      Key-words: THR - elderly patients - health status - postoperative support - counselling
    

Detailed description: 
      Primary outcome: the physical dimensions in health status. The intervention could lead to an
      improvement of 50% in the physical health score on the SF-36 questionnaire.

      Theoretical frame of reference: the nursing intervention in this study was based on the
      Murray and Maslow's theories of motivation combined with Piaget's theory of development in
      which the main goal is to promote and maintain patients' active involvement in their own
      care.

      Intervention: All patients received the standard postoperative procedure in the hospital,
      which means discharge after 5-7 days and a clinical control in the outpatient department
      after 3 months. But the intervention group also received telephone support and counselling 2
      and 10 weeks after surgery. The intervention was performed by the same nurse using a
      structured interview guide to identify the patients' perceptions of their current situations
      and need for further support and counselling of importance to their health status. Together
      the patients and the nurse assessed the patients' situation and areas of improvements. The
      assessment focused on eight main dimensions referring to the patients' situation after Total
      Hip Replacement (THR). (1) Wellbeing. (2) Expectations as to PF after surgery. (3)
      Expectations as to PF compared with those before surgery. (4) Symptoms (pain, leg-oedema,
      vertigo, sleep disturbance, nausea and other concerns) and (5) Problems with eating and
      appetite. (6) Fluid intake. (7) Ability to follow prescribed activity and exercise. (8) Need
      of support from family. For each of the problems identified,individual solutions were
      suggested and practical counselling was given by the investigator.

      Statistical analysis: Data were processed by using the statistical program Statistical
      Package for Social Sciences (SPSS) version 13.0 (Boston, MA, USA). Ratio-scaled data from
      both groups (intervention and control) were compared by using parametric methods if data were
      normally distributed, but if not, nonparametric methods were used. Nominal scaled data were
      compared by using the chi-square test or using 95% CI around the association measure.

      Categorical variables were compared using Pearson's chi-square test if appropriate. For
      continuous data, changes within the groups were analysed by using a paired t-test. Groups
      were compared using an unpaired t-test (for normally distributed data). p < 0.05 were
      considered statistically significant.
    

Intervention name(s): counselling and support after discharge from hospital
Intervention type(s): Other
Intervention description(s): patients were contacted by telephone 2 times after discharge from surgery by a specialist nurse, who followed an interview guide due to nursing-rehabilitation after THR
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Supportive Care
Keywords: Rehabilitation; RCT; User Involvement; Self-Rated Health