title: Groningen orthopaedic exit strategy: Validation of a support program after total hip or knee arthroplasty.
abstract: OBJECTIVE
  Validation of the program theory of the Groningen orthopaedic exit strategy (GOES), a theory-driven program aiming to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay. First part of the program theory is the action theory, hypothesising that the GOES treatment positively influences the mediating variables (self-efficacy, social support, pain-coping). The second part, the conceptual theory, hypothesis a positive relationship between these variables and the outcome variables (ADL functioning, physical activity behaviour, quality of life).
  
  
  METHODS
  Patients were randomly assigned to the GOES or control groups. Questionnaires were used to assess mediating and outcome variables in 103 patients (50 GOES, 53 controls) pre-operatively, and 6 and 26 weeks post-operatively.
  
  
  RESULTS
  No difference was seen between the two groups in terms of changes between pre-operative and post-operative mediating variables (action theory). Moderate-to-large correlations explaining reasonable amount of variance (22%, 25%, 56%) were found between the mediating and outcome variables (conceptual theory).
  
  
  CONCLUSIONS
  The conceptual theory is supported; however, as the treatment did not influence the mediating variables (action theory), it has no added value in its current form.
  
  
  CONCLUSIONS
  The treatment needs to be adjusted; it is discussed that individualised treatment could be more effective.
authors.affiliation: Department of Orthopaedics, University Medical Center Groningen, University of Groningen, The Netherlands. i.scheek@orth.umcg.nl
authors.forename: Inge
authors.initials: I
authors.lastname: van den Akker-Scheek
authors.forename: Wiebren
authors.initials: W
authors.lastname: Zijlstra
authors.forename: Johan W
authors.initials: JW
authors.lastname: Groothoff
authors.forename: Jim R
authors.initials: JR
authors.lastname: van Horn
authors.forename: Sjoerd K
authors.initials: SK
authors.lastname: Bulstra
authors.forename: Martin
authors.initials: M
authors.lastname: Stevens
mesh_terms: D000046:Academic Medical Centers; D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000359:Aftercare / Q000458:organization & administration / Q000523:psychology; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000523:psychology* / Q000534:rehabilitation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000523:psychology* / Q000534:rehabilitation; D001294:Attitude to Health; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D010351:Patient Discharge; D015397:Program Evaluation; D011582:Psychological Theory; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires