The Effect of Mobilization Protocol Developed for Knee Arthroplasty Patients on Nursing Care-Sensitive Patient Outcomes: A Multicenter, Single-Blind Randomized Controlled Study Protocol

Abstract

Introduction: Postoperative mobilization is an important nursing care. Patients should be mobilized by following systematic steps with evidence-based data in which nurses take an active role.In this study, it was aimed to report the process of developing a mobilization protocol to be applied after knee arthroplasty and examining its effects on nursing care-sensitive patient outcomes to be applied with the protocol. Method: The research is planned to be carried out between November 2021 and November 2023. The research will be carried out in Yozgat Bozok University Medical Faculty Hospital and Yozgat City Hospital Orthopedics and Traumatology Clinic. The research will be carried out prospectively with a randomized controlled experimental research design with pre-test and post-test. According to the research criteria determined by power analysis, the research sample will conduct with 68 patients. In the implementation phase of the research, STAI State Anxiety Inventory, Visual Analog Scale, Observer mobility scale, Patient mobility scale, KOOS-Short Form of Physical Function, Orthostatic intolerance, and Orthostatic hypotension follow-up form will be applied. Results: This study is the study protocol for a single-blind randomized controlled experimental study. After the study data are collected and analyzed, the findings will be reported. Conclusion: The effectiveness of the mobilization protocol developed for knee arthroplasty patients on patient outcomes sensitive to nursing care will be evaluated.

Keywords

• Knee arthroplasty
• nursing
• mobilization protocol
• patient outcomes

Diz Artroplastisi Hastalarına Yönelik Geliştirilen Mobilizasyon Protokolünün Hemşirelik Bakımına Duyarlı Hasta Sonuçları Üzerine Etkisi: Çok Merkezli, Tek Kör Randomize Kontrollü Bir Çalışma Protokolü

Öz

Giriş: Ameliyat sonrası mobilizasyon önemli bir hemşirelik bakımıdır. Hemşirelerin aktif rol aldığı, kanıta dayalı veriler ile sistematik basamaklar takip edilerek hastalar mobilize edilmelidir. Bu çalışmada, diz artroplasti ameliyatı sonrası uygulanmak üzere bir mobilizasyon protokolünün geliştirilmesi ve protokolle birlikte uygulanacak hemşirelik bakımına duyarlı hasta sonuçları üzerine etkinliğinin incelenmesi ile ilgili sürecin raporlanması amaçlanmıştır. Yöntem: Araştırmanın, Kasım 2021-Kasım 2023 tarihleri arasında yapılması planlanmaktadır. Araştırma, Yozgat Bozok Üniversitesi Tıp Fakültesi Hastanesi ve Yozgat Şehir Hastanesi Ortopedi ve Travmatoloji Kliniğinde yürütülecektir. Araştırma ön test-son test düzende randomize kontrollü deneysel araştırma tasarımı ile prospektif olarak gerçekleştirilecektir. Örneklemini, güç analiziyle belirlenen, araştırma kriterlerine uyan 68 hasta oluşturacaktır (34 deney, 34 kontrol). Araştırmanın uygulama aşamasında STAI Durumluluk Kaygı Envanteri, Görsel Ağrı Ölçeği, Gözlemci hareketlilik ölçeği, Hasta hareketlilik ölçeği, KOOS-Fiziksel Fonksiyon Kısa Formu, Ortostatik intolerans ve Ortostatik hipotansiyon takip formu uygulanacaktır. Bulgular: Bu çalışma, tek kör randomize kontrollü deneysel çalışma için çalışma protokolüdür. Çalışma verileri toplanıp analiz edildikten sonra bulgular açıklanacaktır. Sonuç: Diz artroplasti hastalarına yönelik geliştirilen mobilizasyon protokolünün hemşirelik bakımına duyarlı hasta sonuçları üzerine etkinliği değerlendirilecektir.

Anahtar Kelimeler

• Diz artroplasti
• Hemşirelik
• Mobilizasyon protokolü
• Hasta sonuçları

Kaynakça

1. 1. Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. The Lancet. 2011;377(9783):2115–26.
2. 2. OECD. Hip and knee surgery. In health care activities health at a glance. OECD Indicators. OECD Publishing.2019: (pp. 133–134).
3. 3. Roberts D. Arthritis and connective tissue diseases. (Chapter 65). In: Lewis SL, Dirksen SR, Heitkemper MM, Bucher L, Harding MM, ed. Medical surgical nursing. assesment of clinical problems. 9th Ed. Elseiver Mosby; 2014. p. 1563-1574
4. 4. Eksıoglu E, Gurcay E. Rehabilitation after total knee arthroplasty. Journal of İstanbul Faculty of Medicine. 2014; 76(1):16–21.
5. 5. Jones E, Wainwright T, Foster J, Smith J, Middleton R, Francis N. A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery. The Annals of The Royal College of Surgeons of England. 2014;96(2):89–94.
6. 6. Aprato A, Baroni C, Massè, C. (2018). Rehabilitation after total hip arthroplasty: Is there an evidence. Phys Med Rehabil Res. 2018; 3(4):1-2
7. 7. Mandzuk LL, McMillan DE, Bohm ER. A longitudinal study of quality of life and functional status in total hip and total knee replacement patients. International Journal of Orthopaedic and Trauma Nursing. 2015; 97(2): 358–365.
8. 8. Xu J, Zhang J, Wang XQ, Wang XL, Wu Y, Chen CC et all. Effect of joint mobilization techniques for primary total knee arthroplasty: study protocol for a randomized controlled trial. Medicine. 2017; 96(49).

9. 9. Pelt CE, Anderson MB, Pendleton R, Foulks M, Peters CL, Gililland JM. Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing. Arthroplasty Today. 2017;3(1):45–9.
10. 10. King L. Developing a progressive mobility activity protocol. Orthopaedic Nursing. 2012;31(5):253–62.
11. 11. Pashikanti L, Von AD. Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature. Clinical Nurse Specialist. 2012;26(2): 87-94.
12. 12. Yager M, Stichler J. The Effect of Early Ambulation on Patient Outcomes for Total Joint Replacement. Orthopaedic Nursing. 2015;34(4):197–200.
13. 13. Guerra ML, Singh PJ, Taylor NF. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clinical rehabilitation. 2015; 29(9):844-854.
14. 14. Yakkanti RR, Miller AJ, Smith LS, Feher AW, Mont MA, Malkani AL. Impact of early mobilization on length of stay after primary total knee arthroplasty. Annals of Translational Medicine.2019;7(4):69–9.
15. 15. Chua MJ, Hart AJ, Mittal R, Harris IA, Xuan W, Naylor JM. Early mobilisation after total hip or knee arthroplasty: A multicentre prospective observational study. PLOS ONE. 2017;12(6):e0179820.
16. 16. Epstein N. A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures. Surgical Neurology International. 2014;5(4):66.
17. 17. Morris BA, Benetti M, Marro H, Rosenthal CK. Clinical practice guidelines for early mobilization hours after surgery. Orthopaedic nursing. 2010; 29(5):290-316.
18. 18. Kalisch BJ, Lee S, Dabney BW. Outcomes of inpatient mobilization: a literature review. Journal of Clinical Nursing. 2013;23(11-12):1486–501.
19. 19. Emma E. Improved Outcomes Associated With an Early Mobilization Protocol Among Hip and Knee Replacement Patients. The George Washington University Doctoral thesis. 2017
20. 20. Chen AF, Stewart MK, Heyl AE, Klatt BA. Effect of Immediate Postoperative Physical Therapy on Length of Stay for Total Joint Arthroplasty Patients. The Journal of Arthroplasty. 2012;27(6):851–6.
21. 21. Rodts MF, Glanzman R, Gray A, Johnson R, Viellieu D, Hachem F. Measuring Outcomes in Orthopaedics. Orthopaedic Nursing. 2014;33(6):331–9.
22. 22. Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586–6. 23. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869–9.
23. 24. Faul F, Erdfelder E, Buchner A, Lang A. G*Power Version 3.1.7 [computer software]. Uiversität Kiel, Germany. 2013
24. 25. Low PA, Tomalia VA. Orthostatic Hypotension: Mechanisms, Causes, Management. Journal of Clinical Neurology. 2015;11(3):220.
25. 26. Berlowitz D, Parker V, M E, Niederhauser A, Silver J, Logan C, et al. Preventıng Pressure Ulcers In Hospıtals: A Toolkit for Improving Quality of Care Preventing Pressure Ulcers in Hospitals 2011. Available from: https://www.ahrq.gov/sites/default/files/publications/files/putoolkit.pdf
26. 27. Lee Y. Orthostatic hypotension in older people. Journal of the American Association of Nurse Practitioners. 2013;25(9):451–8.
27. 28. Evans S. Progressive Mobility Protocol for Orthopaedic Medical-Surgical Patients (Doctoral dissertation, Carlow University). 2019
28. 29. Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996; 46(5):1470-1470.
29. 30. Jans Ø, Bundgaard-Nielsen M, Solgaard S, Johansson PI, Kehlet H. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty. British Journal of Anaesthesia.2012;108(3):436–43.
30. 31. Labraca NS, Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Sánchez-Joya M del M, Moreno-Lorenzo C. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: randomized clinical trial. Clinical Rehabilitation. 2011;25(6):557–66.
31. 32. Perruccio AV, Stefan Lohmander L, Canizares M, Tennant A, Hawker GA, Conaghan PG, et al. The development of a short measure of physical function for knee OA KOOS-Physical Function Shortform (KOOS-PS) – an OARSI/OMERACT initiative. Osteoarthritis and Cartilage. 2008;16(5):542–50.
32. 33. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Ou. Arthritis Care & Research. 2011;63(S11):S208–28.
33. 34. Gul ED, Yilmaz O, Bodur H. Reliability and validity of the Turkish version of the knee injury and osteoarthritis outcome score-physical function short-form (KOOS-PS). Journal of Back and Musculoskeletal Rehabilitation. 2013;26(4):461–6.
34. 35. Heye ML, Foster L, Bartlett MK, Adkins S. A preoperative intervention for pain reduction, improved mobility, and self-efficacy. Applied Nursing Research. 2002;15(3):174–83.
35. 36. Ayoğlu, T. Cerrahi girişim öncesi verilen eğitimin hastaların öz-etkililik algısına ve iyileşme sürecine etkisi. İstanbul Üniversitesi: Sağlık Bilimleri Enstitüsü, Hemşirelik Doktora Tezi. 2011
36. 37. Oner N, Le Compte A. Durumluk-Sürekli kaygı envanteri elkitabı 20. Basım. Boğaziçi Üniversitesi Yayınları. 1985. s.3-5.
37. 38. Öztaş B, Kara B, Zengin H, Güçlü A, On B. Simülasyon laboratuvarında verilen eğitimin hemşirelik öğrencilerinin intravenöz kateterizasyon becerisine etkisi. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2022; 9(1): 17-23.
38. 39. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17:45-56.
39. 40. Aslan FE. Ağrı değerlendirme yöntemleri. C.Ü. Hemşirelik Yüksek Okulu Dergisi 2002; 6:9-16
40. 41. Harvey CV, David J, Eckhouse DR, Kurkowski T, Mains C, Roberts D. The National Association of Orthopaedic Nurses (NAON) Scope and Standards of Orthopaedic Nursing Practice, 3rd Edition. Orthopaedic Nursing. 2013;32(3):139–52.