Evaluation of person-centred care after hip replacement-a controlled before and after study on the effects of fear of movement and self-efficacy compared to standard care.
BACKGROUND
The goal of total hip arthroplasty (THA) is optimal pain relief and a normalized health-related quality of life. Anxious patients describe more pain and more difficulties than non-anxious patients during rehabilitation after THA. The aims of the present study were twofold: (1) to identify vulnerable patients using the general self-efficacy scale (GSES) and the Tampa scale for Kinesiophobia (TSK), and (2) to evaluate if person-centred care including the responses of the instruments made rehabilitation more effective in terms of shortening hospital length of stay.


METHODS
The design of the study was quasi-experimental. Patients scheduled for THA, a control group (n = 138) and an intervention group (n = 128) were consecutively recruited. The intervention was the provision of person-centred care which was designed to reduce the negative effects of low self-efficacy and high levels of pain-related fear of movement.


RESULTS
Patients with low GSES in the intervention group had shorter length of stay (LoS) by 1.6 days (95 % CI 0.16-3.15) p-value 0.03. Patients with high TSK in the intervention group had shorter LoS by 2.43 days (95 % CI 0.76-4.12) p-value 0.005. For patients who had both, the reduction of LoS was 2.15 days (95 % CI 0.24-4.04) p-value 0.028.


CONCLUSIONS
The GSES and the TSK instrument were found useful as tools to provide information to support patients which reduced the LoS by 1.67 days in the whole intervention group (95 % CI 0.72-2.62) p-value 0.001. More importantly, vulnerable patients such as ASA group 3 probably gained the most from the extra support, they had a reduction with 6.78 days (95 % CI 2.94-10.62) p-value 0.001.
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE 405 30 Gothenburg, Sweden ; Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden ; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
Lars-Eric
LE
Olsson
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE 405 30 Gothenburg, Sweden ; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
Elisabeth
E
Hansson
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE 405 30 Gothenburg, Sweden ; Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
Inger
I
Ekman
ASA classification; General self-efficacy; Health plan; Nursing care; Person-centered care; Person-centred care; Planned surgery management; Rehabilitation; Tampa Scale of Kinesiophobia; Total hip replacement