Date of Award

2023

Degree Name

Master of Nursing (Research)

Schools and Centres

Nursing and Midwifery

First Supervisor

Dr Gail Ross-Adije

Second Supervisor

Professor Leanne Monterosso

Third Supervisor

Professor Caroline Bulsara

Fourth Supervisor

Professor Max Bulsara

Abstract

Background

The current trend to reduce the length of stay for patients undergoing total knee arthroplasty, together with the steadily increasing number of procedures being performed, has impacted on the functional independence goals expected by patients and the ability of nurses to deliver adequate education prior to discharge. Over the past 10 years length of stay has reduced from 7-10 days to 3-4 days and patients are expected to largely self-manage their post-operative rehabilitation and optimise their functional outcomes.

Patient feedback confirmed that patients do not feel ready for discharge and lack the ability to self-manage some activities of daily living (ADL) such as dressing, bathing, toileting and transferring. The overall aim of this study was to identify the range of functional ADL deficits that total knee arthroplasty patients experience in the 12 months post-operatively and develop recommendations to support self-management of identified ADL deficits post discharge.

Aim

To describe the trends in activities of daily living over a 12-month post-operative period and their relationship with self-reported global health status in patients who have undergone total knee arthroplasty.

Method

This study used multiple validated tools to assess functional independence, ADL trends and perceived global health status in 267 patients over the 12 months post total knee arthroplasty at a large Western Australian private tertiary hospital.

Results

While the study found a decrease in ADL scores from baseline at the one-month timepoint, the scores gradually improved from the two-month time point and remained steady throughout the remainder of the study. The Oxford Knee Scores and EuroQol visual analogue scale (EQ-VAS) scores demonstrated a positive improvement from baseline to the 12-month time point post-surgery. A positive relationship between self-reported health status using EQ-VAS and ADLs was reported as measured by the Katz Index of Independence in Activities of Daily Living Scale and the Lawton Instrumental Activities of Daily Living Scale.

Conclusion

In response to these findings, targeted evidence-based education should be developed to address the identified ADL deficits post total knee arthroplasty thus promoting self-care and optimising functional outcomes and reducing potential longer-term complications.

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