Orthopaedic Nurses' Perceptions of Preoperative Education for Total Knee Replacement.

BACKGROUND: Limited descriptions of preoperative education programs for total knee replacement (TKR) surgery are provided in the literature, and the most effective program design is currently unknown. PURPOSE: The purpose of this qualitative study is to describe orthopaedic nurses' perceptions of preoperative education prior to TKR surgery. METHODS: Ten participants completed phone interviews and transcripts were analyzed qualitatively for themes among participants. RESULTS: Participants believed that preoperative education was a significant component impacting patient outcomes following surgery. Interprofessional preoperative education was valued, but pragmatic factors were identified as barriers to the inclusion of other disciplines within these programs. Education programs were constantly evolving on the basis of evidence-based practice and changes to orthopaedic protocols. Pragmatic factors influenced all aspects of program design, such as the timing and length of education sessions. CONCLUSIONS: Results from this study provide descriptions of factors that influence program design and can be used to restructure education programs for improved patient outcomes.

Preoperative Education for Total Knee Replacement: A National Survey of Orthopaedic Nurses.

BACKGROUND: Preoperative education aids in reducing the incidence of poor outcomes after total knee replacement (TKR) and increasing patient readiness for discharge home but is not well described in the literature. PURPOSE: The purpose of the study is to describe the current design of preoperative education for TKR across the United States. METHODS: A large, national sample of orthopaedic nurses completed an online survey to describe preoperative education at their facilities. RESULTS: Most participants provided preoperative education as part of interprofessional teams in either a group format or combined group and individual education. Verbal instruction was the most common educational delivery method, followed by written instruction. Education typically lasted between 1 and 1.5 hours, was delivered in a single session, and included a variety of topics. CONCLUSION: Results of this study describe preoperative educational practices and can support future research to improve patient outcomes following TKR surgery.

Identifying Homogeneous Outcome Groups in Adult Rehabilitation Using Cluster Analysis.

IMPORTANCE: Adults receiving occupational therapy in inpatient rehabilitation are a heterogeneous population with differing needs, outcomes, and rehabilitation processes. Outcome studies based on what works for all clients may obscure the needs of population subgroups who benefit unequally from rehabilitation services. OBJECTIVE: To identify subgroups on the basis of client satisfaction and progress in functional self-care among a diverse rehabilitation population and to understand subgroup differences in occupational therapy and rehabilitation processes and client discharge status. DESIGN: Using an existing dataset, we used K-means cluster analysis of demographics, status at admission, and the outcomes of satisfaction and change in self-care to identify five homogeneous outcome groups. Occupational therapy and rehabilitation processes and discharge status were compared across subgroups. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: The dataset included 1,099 inpatients age 18 yr and older who received occupational therapy over a 27-mo period. MEASURES: Admission measures included the Inpatient Rehabilitation Facility-Patient Assessment Instrument and self-care items of the FIM™. The Satisfaction with Continuum of Care-Revised was administered after discharge. RESULTS: Five subgroups showed statistically different patterns of medical complications, functional self-care, rates of progress, satisfaction with intervention, and course of treatment. The profile of each group suggests differing therapeutic needs. Although all groups made significant gains in functional self-care, two groups continued to need physical assistance at discharge. CONCLUSION: and Relevance: Cluster analysis proved useful in segmenting a typical heterogeneous rehabilitation population into more homogeneous subgroups to enhance understanding of clinical needs and to potentially increase the potency of outcomes research. WHAT THIS ARTICLE ADDS: This research identified subgroups within a typical population of rehabilitation clients receiving occupational therapy and identified their unique needs and outcomes using cluster analysis techniques.

Factors Influencing Discharge Readiness After Total Knee Replacement.

Total knee replacement (TKR) surgery has been found to achieve positive outcomes for many patients such as reduced pain and increased function. However, some patients experience suboptimal outcomes including falls, readmission to hospital, and reduced functional performance. Preparation for discharge after TKR surgery is often defined related to pain control, walking, knee function, and ability to climb stairs. These measures may not fully encompass aspects of recovery that impact patients' readiness for discharge after surgery. The purpose of this article is to review discharge readiness following TKR surgery and discuss factors that are known to impact preparedness for discharge.

Factors predicting client satisfaction in occupational therapy and rehabilitation.

Client satisfaction, a widely used outcome indicator of quality in health care, is inherently client centered and important in occupational therapy. We developed an instrument called the Satisfaction With Continuum of Care Revised (SCC-R) and tested a logistic regression model of satisfaction for six predictive research questions. Data collected from 769 clients from a large rehabilitation hospital using the SCC-R were paired with data that included demographics, functional status, and measures of the rehabilitation including occupational therapy. Satisfaction was stratified into two groups, satisfied and dissatisfied. The most robust and consistent predictors of satisfaction were functional status and improvements in functional status, presence of a neurological disorder, total rehabilitation hours, and admission to rehabilitation within 15 days of condition onset. The finding that improvements in functional status, especially self-care, were predictive of satisfaction is particularly relevant for occupational therapy. Implications for practice and future research are discussed.

Client-chosen goals in occupational therapy: strategy and instrument pilot.

ABSTRACT Client-centered practice and outcomes research are missions of occupational therapy. Although strategies for client goal-setting have advanced the field, the process has limitations. This study tested a self-report strategy using brief, easy to score measures. The Goals for Occupational Therapy List was completed at mostly independent intake and paired with a follow-up measure of Goal Satisfaction Rating by 40 clients in an outpatient rehabilitation center. The strategy of pairing self-report measures of goal-setting and attainment was useful for clinicians and yielded important research findings. Application to occupational therapy and future research are suggested.

The Occupational Therapy Practice Checklist for adult physical rehabilitation.

OBJECTIVE: Although the practice of occupational therapy is described in textbooks, research, and professional standards, a tool for outcomes research is needed. METHOD: The Occupational Therapy Practice Checklist (OTPC), based on the Model of Occupational Performance (Pedretti, 1996), includes domains of adjunctive, enabling, purposeful, and occupational performance. Practices are also identified by phase of therapy (early, middle, late). The OTPC was piloted with 40 adults in an outpatient physical rehabilitation center. RESULTS: The Kuder Richardson 20 coefficient of internal consistency was .91. Practices on the OTPC discriminated between clients with and without neurological disorders. CONCLUSION: The OTPC has potential for yielding knowledge about occupational therapy practice. Results of the pilot show that occupational therapy practice was not linear, as theorized, but rather a complex integration of techniques.