混合式衛教對全膝關節置換術老年病人疼痛及關節角度之成效

Effects of a Hybrid Health Education Program on Pain and Knee Angle in Elderly Patients After Total Knee Replacement Surgery

背景：全膝關節置換術病人術後仍存在疼痛及膝關節角度受限，一般出院衛教成效有限。
目的：混合式衛教對全膝關節置換術病人疼痛及膝關節角度之成效探討。
方法：單盲隨機控制組試驗，方便取樣選取北部某區域教學醫院骨科病房單側全膝關節置換術老年病人為研究對象，收案52人，隨機分派二組，每組各26人，實驗組接受混合式衛教，居家復健運動每日2次，每次15分鐘，共16週；控制組則接受常規衛教。資料收集時間為手術前及術後第1週、第6週、第12週、第16週，收案日期自2020年11月15日至2022年1月13日。
結果：共完成實驗組22人，控制組26人。介入混合式衛教第16週之成效，廣義估計方程式分析結果顯示，二組比較，實驗組的「現在的疼痛」於第12週（β= -1.43, p = .025）及第16週（β= -1.52, p = .014）達顯著差異；過去1週「最嚴重疼痛」於第12週（β= -1.40, p = .041）及第16週（β= -1.55, p = .024）達顯著差異；過去1週平均疼痛於第16週（β= -1.24, p = .035）達顯著差異及伸膝角度於第16週（β= -5.52, p = .033）達顯著差異。
結論／實務應用：本研究結果指出老年病人於膝關節置換術後接受混合式衛教，能強化動機執行居家復健，改善術後疼痛及伸膝角度。建議本研究發展的衛教內容及方式可納入出院衛教計畫及進行長期追蹤其成效。

Background: Patients experience pain and limited knee angle after total knee replacement (TKR) surgery. The effectiveness of routine discharge health education remains limited.
Purpose: This study was designed to assess the effect of hybrid health education on postoperative pain and knee angle in patients with TKR.
Methods: A single blind and randomized controlled trial study was used. Fifty-two patients with TKR were randomly assigned to either the experimental group (n = 26), which received standard care with hybrid health education and performed the multimedia-guided intervention for 30 min per day for 16 weeks, or the control group (n = 26), which received routine care only. The data collection times were at pretest (preoperative) and at the 1st week, 6th week, 12th week, 16th week after surgery.
Results: A total of 22 patients in the experimental group and 26 patients in the control group completed this study. After the 16-week hybrid health education intervention, the results of generalized estimating equations analysis showed that pain in the experimental and control groups differed significantly at week 12 (β= -1.43, p = .025) and week 16 (β= -1.52, p = .014); worst pain in the past week had significantly improved at week 12 (β= -1.40, p = .041) and week 16 (β= -1.55, p = .024); average pain over the past 1 week had significantly improved at week 16 (β= -1.24, p = .035); and knee extension angle had significantly improved at week 16 (β= -5.52, p = .033).
Conclusion/ Implications for Practice: The results of this study showed that elderly patients who received hybrid health education after TKR had significantly improved postoperative pain and knee angle and that degree of improvement in the experimental group was better than in the control group. It is recommended that the content and methods of hybrid health education developed in this study be incorporated into discharge interventions and that long-term outcomes be tracked for reference.