The quality of recovery on discharge from hospital, a comparison between patients undergoing hip and knee replacement - a European study.

To describe and compare the quality of recovery on discharge from hospital among patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today's shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with quality of recovery at discharge from hospital. A descriptive, comparative study including 12 hospitals in 5 European countries; Cyprus, Finland, Greece, Iceland and Sweden. Consecutively included patients responded on: health-related quality of life, and emotions before surgery and at hospital discharge; quality of recovery, patient satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total, 865 patients were included (hip n = 413, knee n = 452). In the dimension of pain, patients undergoing hip replacement had significantly better quality of recovery compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer quality of recovery. Fulfilment of knowledge expectations has a limited effect on quality of recovery. Greater satisfaction with care predicted better quality of recovery. Negative preoperative emotions were related to poorer quality of recovery. For both kinds of arthroplasty, greater satisfaction with care was associated with better quality of recovery. The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

Johansson Stark Å ，Charalambous A ，Istomina N ，Salanterä S ，Sigurdardottir AK ，Sourtzi P ，Valkeapää K ，Zabalegui A ，Bachrach-Lindström M ... -  《-》

Spouse-related factors associated with quality of recovery of patients after hip or knee replacement - a Nordic perspective.

Today's shorter hospital stays mean that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the healthcare staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be the primary caregivers as their relationship with the patient is more interdependent than that of other family members or caregivers. The aim was to describe spouse-related factors that were associated with patients' quality of recovery on discharge from hospital after elective hip or knee replacement. The design was prospective, descriptive and comparative, with two measurements, before arthroplasty and on discharge. Two Finnish, three Icelandic and two Swedish university or community hospitals. The sample consisted of spouses and patients. The inclusion criteria were as follows: age ≥18 years, ability to complete the questionnaires, and ability to understand Finnish/Icelandic/Swedish. The patients were asked to identify one family member. Spouses were those defining themselves as a wife, husband or cohabiting partner. Out of 463 spouses, 306 (66%) were included. The mean age of the included spouses was 64 years and 54% of them were females. Self-reported instruments were used on expected and received knowledge, access to knowledge, emotional state and quality of recovery. If the spouses were or had been employed in healthcare or the social services, their partner had greater quality of recovery (p = 0.006). Spouses experiencing negative emotions had partners who experienced lower quality of recovery (p <0.001). Spouses who felt that nurses had enough time for them (p = 0.044) and explained matters concerning their family members' care and treatment (p = 0.011) had partners who experienced greater quality of recovery. Spouses' emotional state played an important role in the patients' quality of recovery (QoR), with uncertainty and depressive state as the main predictors. The importance of nurses explaining matters sufficiently to spouses was emphasized, while spouses' fulfilment of knowledge expectations was not associated with patients' recovery.

Stark ÅJ ，Salanterä S ，Sigurdardottir AK ，Valkeapää K ，Bachrach-Lindström M ... -  《-》

Fulfilment of knowledge expectations among family members of patients undergoing arthroplasty: a European perspective.

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach.

Sigurdardottir AK ，Leino-Kilpi H ，Charalambous A ，Katajisto J ，Stark ÅJ ，Sourtzi P ，Zabalegui A ，Valkeapää K ... -  《-》

Early recovery following lower limb arthroplasty: Qualitative interviews with patients undergoing elective hip and knee replacement surgery. Initial phase in the development of a patient-reported outcome measure.

To explore the patients' perspective of surgery and early recovery when undergoing lower limb (hip or knee) arthroplasty. Lower limb arthroplasty is a commonly performed procedure for symptomatic arthritis, which has not responded to conservative medical treatment. Each patient's perspective of the surgical process and early recovery period impacts on their quality of life. Open, semistructured qualitative interviews were used to allow for a deeper understanding of the patient perspective when undergoing a hip or knee arthroplasty. Following ethical approval, 30 patients were interviewed between August and November 2016 during the perioperative period while undergoing an elective hip or knee arthroplasty (n = 30). The interviews were performed between the day of surgery and a nine-week postoperative clinic appointment. Data were analysed using an in-depth narrative thematic analysis method. NVivo qualitative data analysis software was used. Seven main themes evolved from the interviews: "improving function and mobility", "pain", "experiences of health care", "support from others", "involvement and understanding of care decisions", "behaviour and coping" and "fatigue and sleeping". The early postoperative recovery period is of vital importance to all surgical patients. This is no different for the orthopaedic patient. However, identifying key self-reported areas of importance from patients can guide clinical focus for healthcare professionals. To have specific patient-reported information regarding key areas of importance during the perioperative phase is invaluable when caring for the orthopaedic surgical patient. It gives insight and understanding in to this increasing population group. This study has also served as a starting point in the development of a questionnaire which could be used to assess interventions in the lower limb arthroplasty population. These results will influence both items and content of the questionnaire.

Strickland LH ，Kelly L ，Hamilton TW ，Murray DW ，Pandit HG ，Jenkinson C ... -  《-》

The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty -- a Nordic perspective.

To describe the possible differences between knowledge expectations and received knowledge of patients undergoing elective knee arthroplasty in Iceland, Sweden and Finland and also to determine the relationship between such a difference and both background factors and patient satisfaction with care. Knee arthroplasty is a fast-growing and a successful treatment for patients with osteoarthritis. Patient education can improve surgery outcomes, but it remains unknown what knowledge patients expect to receive and actually acquire during the perioperative period and what factors are related to that experience. Descriptive, prospective survey. In total, 290 patients answered questionnaires about their expectations (Knowledge Expectations of hospital patients - scale) before surgery and about received knowledge (Received Knowledge of hospital patients - scale) and satisfaction with hospital care (Patient Satisfaction Scale) at discharge. Sociodemographics, clinical information, accessibility to knowledge from healthcare providers (Access to Knowledge Scale), and preferences for information and behavioural control (Krantz Health Opinion Survey) were collected as background data. Patients' knowledge expectations were higher (mean 3·6, SD 0·4) than their perception of received knowledge (mean 3·0, SD 0·7). Multiple linear regression analysis showed that access to knowledge, information preferences and work experience within health- or social care explained 33% (R²) of the variation in the difference between received and expected knowledge. Patients reported high satisfaction with their care except regarding how their family was involved. Patients undergoing knee arthroplasty receive less knowledge than they expect, and individual factors and communication with healthcare providers during hospitalisation are related to their experience. The content of patient education and family involvement should be considered in future care. The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

Ingadottir B ，Johansson Stark A ，Leino-Kilpi H ，Sigurdardottir AK ，Valkeapää K ，Unosson M ... -  《-》