Perioperative intervention to improve post-TKR support and function

描述（由申请人提供）：每年有超过350，000名成年人选择初次全膝关节置换术（TKR）手术，以消除尽管进行了全面的药物治疗但仍持续存在的膝关节炎疼痛。2003年NIH TKR共识小组得出结论，TKR有效消除膝关节疼痛，并发症少。与统一的手术结果和疼痛缓解相反，TKR后的功能结果仍然存在显著差异。据估计，15- 30%的患者在术后12个月没有临床显著的功能改善。TKR。没有一个患者属性或手术因素能令人满意地解释这种变化。我们的试验数据表明，TKR术后运动量越大，TKR前情绪健康越好，TKR术后功能改善越大。基于非手术关节炎护理的证据，我们假设旨在增强患者独立运动和活动自我效能的围TKR自我护理支持干预将显著增加6个月和12个月时的TKR后身体功能（通过SF-36/身体成分评分测量）和膝关节功能（通过WOMAC评分测量）。此外，我们假设TKR术后8周和26周关节炎自我效能的增加（通过斯坦福大学量表测量）以及8周和26周膝关节运动（数量、频率）和活动（平均步数/天）的增加与TKR术后6个月和12个月功能的改善相关。拟议的研究将开发一个12个疗程的TKR前后患者干预（英语和西班牙语），其中包括已证实的关节炎自我护理元素。电话递送将照顾病人的身体限制。将在外科医生设盲的随机对照试验（RCT）中对该计划的有效性进行测试，该随机对照试验将分层随机样本分配至干预组（n=90）和常规治疗组（n=90）。该干预是基于理论的，并将成功的健康行为改变干预算法和已建立的关节炎自我管理策略扩展到围TKR患者。这项研究是第一个将行为科学理论扩展到围手术期TKR患者，并将长期护理模式外推到骨科实践。TKR围手术期干预改变了TKR护理模式，包括患者自主活动和锻炼的自我管理支持，以确保TKR术后功能和患者自主性的均匀、最佳改善-TKR的最终目标。

DESCRIPTION (provided by applicant): More than 350,000 adults elect primary Total Knee Replacement (TKR) surgery each year to eliminate knee arthritis pain that persists despite comprehensive medical treatment. The 2003 NIH TKR Consensus Panel concluded that TKR effectively eliminates knee pain with few complications. In contrast to the uniform surgical outcomes and pain relief, significant variation remains in functional outcome after TKR. An estimated 15-30 percent of patients report no clinically significant functional improvement at 12 months after. TKR. No one patient attribute or surgical factor satisfactorily accounts for this variation. Our pilot data documents that higher quantities of post-TKR exercise and stronger pre-TKR emotional health are associated with greater improvement in function after TKR. Based on evidence in non-surgical arthritis care, we hypothesize that a peri-TKR self-care support intervention designed to enhance patient self-efficacy for independent exercise and activity will significantly increase post-TKR physical function (measured by SF-36/ Physical Component Score) and knee function (measured by WOMAC score) at 6 and 12 months. In addition, we hypothesize that increased arthritis self-efficacy at 8 and 26 weeks post-TKR (measured by Stanford scale) and increased knee exercise (quantity, frequency) and activity (mean steps/day) at 8 and 26 weeks will be associated with improved 6 and 12 month function after TKR. The proposed research will develop a 12- session pre and post-TKR patient intervention (English and Spanish) incorporating proven arthritis self-care elements. Telephone delivery will accommodate patients' physical limitations. The program's efficacy will be tested in a surgeon blinded RCT allocating a stratified random sample to intervention (n=90) and usual care (n=90). The intervention is theory-based and extends successful health-behavior change intervention algorithms and established arthritis self-management strategies to the peri-TKR patient. This research is the first to extend behavioral science theory to the peri-operative TKR patient and extrapolates a chronic care model to orthopedic practice. This peri-TKR intervention changes the paradigm for TKR care to include patient self-management support for independent activity and exercise to assure uniform, optimal improvement in post- TKR function and patient autonomy- the ultimate goals of TKR.