Perioperative intervention to improve post-TKR support and function

描述(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)，以消除膝关节炎疼痛，尽管接受了全面的治疗，但这种疼痛仍然存在。2003年NIH TKR共识小组的结论是，TKR有效地消除了膝关节疼痛，并发症很少。与相同的手术结果和疼痛缓解相比，TKR后的功能结果仍有显著差异。估计有15%-30%的患者报告在12个月后没有临床上显著的功能改善。TKR。没有一种患者属性或手术因素能令人满意地解释这种变异。我们的初步数据表明，TKR后运动量较大和TKR前较强的情绪健康与TKR后功能的更大改善有关。基于非手术关节炎护理的证据，我们假设，旨在提高患者独立锻炼和活动的自我效能的TKR围手术期自我护理支持干预将显著提高TKR术后6个月和12个月的身体功能(通过SF-36/身体成分评分衡量)和膝关节功能(通过WOMAC评分衡量)。此外，我们假设，在TKR后8周和26周(用Stanford量表测量)增加关节炎自我效能，以及在8周和26周增加膝关节锻炼(数量、频率)和活动(平均步数/天)将与TKR后6个月和12个月功能的改善有关。这项拟议的研究将开发一项为期12个疗程的TKR前后患者干预(英语和西班牙语)，其中包含已证实的关节炎自我护理要素。电话递送将适应患者的身体限制。该计划的有效性将在外科医生盲法随机随机抽样干预(n=90)和常规护理(n=90)中进行测试。该干预是以理论为基础的，并将成功的健康行为改变干预算法和建立的关节炎自我管理策略扩展到TKR围术期患者。这项研究首次将行为科学理论扩展到TKR围手术期患者，并将慢性护理模式外推到骨科实践中。TKR围术期干预改变了TKR护理的模式，包括对独立活动和锻炼的患者自我管理支持，以确保TKR后功能和患者自主性的统一、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.