Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study.

BACKGROUND: Despite the overall success of total hip replacement (THR) in patients with symptomatic osteoarthritis (OA), up to one-quarter of patients report suboptimal recovery. The aim of this study was to determine whether social support and general self-efficacy predict variability in short-term recovery in a Norwegian cohort. METHODS: We performed secondary analysis of a prospective multicenter study of 223 patients who underwent THR for OA in 2003-2004. The total score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3 months after surgery was used as the recovery variable. We measured self-efficacy using the General Self-Efficacy Scale (GSES) and social support with the Social Provisions Scale (SPS). Preoperative and postoperative scores were compared using Wilcoxon tests. The Mann-Whitney U test compared scores between groups that differed in gender and age. Spearman's rho correlation coefficients were used to evaluate associations between selected predictor variables and the recovery variable. We performed univariate and multiple linear regression analyses to identify independent variables and their ability to predict short-term recovery after THR. RESULTS: The median preoperative WOMAC score was 58.3 before and 23.9 after surgery. The mean absolute change was 31.9 (standard deviation [SD] 17.0) and the mean relative change was 54.8% (SD 26.6). Older age, female gender, higher educational level, number of comorbidities, baseline WOMAC score, self-efficacy, and three of six individual provisions correlated significantly with short-term recovery after THR and predicted the variability in recovery in the univariate regression model. In multiple regression models, baseline WOMAC was the most consistent predictor of short-term recovery: a higher preoperative WOMAC score predicted worse short-term recovery (ß = 0.44 [0.29, 0.59]). Higher self-efficacy predicted better recovery (ß = -0.44 [-0.87, -0.02]). Reliable alliance was a significant predictor of improved recovery (ß = -1.40 [-2.81, 0.01]). CONCLUSIONS: OA patients' general self-efficacy and the expectation of others' tangible assistance predict recovery after THR. Researchers and clinicians should target these psychosocial factors together with the patients and their families to improve the quality of care and surgical outcomes.

Patient information and emotional needs across the hip osteoarthritis continuum: a qualitative study.

BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis worldwide, affecting a growing number of people in the ageing populations. Currently, it affects about 50 % of all people over 65 years of age. There are no disease-modifying treatments for OA; hence preference-sensitive treatment options include symptom reduction, self-management and surgical joint replacement for suitable individuals. People have both ethical and legal rights to be informed about treatment choices and to actively participate in decision-making. Individuals have different needs; they differ in their ability to understand and make use of the provided information and to sustain behaviour change-dependent treatments over time. METHODS: As a part of a larger research project that aims to develop and test a web-based support tool for patients with hip OA, this paper is a qualitative in-depth study to investigate patients' need for information and their personal emotional needs. We invited 13 patients to participate in individual interviews, which were audiotaped. The audio-tapes were transcribed verbatim and analysed using an inductive thematic analysis approach. RESULTS: The thematic analysis revealed a pattern of patients' information and emotional needs, captured in several key questions relevant to the different stages of the disease experience. Based on these results and research literature, we developed a model illustrating the patients' disease experience and treatment continuum. Six phases with accompanying key questions were identified, displaying how patients information and emotional needs arise and change in line with the progression of the disease experience, the clinical encounters and the decision-making process. We also identified and included in the model an alternative route that bypasses the surgical treatment option. CONCLUSION: Patients with hip OA are in great need of information both at the time of diagnosis and further throughout the disease development and care continuum. Lack of information may result in unnecessary and dysfunctional misconceptions, underuse of potentially helpful treatment options and uninformed decisions. Patients need continuous support from health professionals and their families in order to find and consider effective treatment strategies.

Can we trust the new generation of infrared tympanic thermometers in clinical practice?

AIMS AND OBJECTIVES: To explore the reliability and validity of the new generation of infrared tympanic thermometers, comparing with rectal and core temperature, and to decide their applicability to clinical practice. BACKGROUND: Digital contact thermometers for rectal measurements and infrared tympanic thermometers are the most common way to measure patients' temperature. Previous studies of the infrared tympanic thermometers revealed misdiagnosis, and validity of early models was questioned. DESIGN: Reliability and validity study. METHODS: Temperature was measured with two infrared tympanic thermometers brands in both ears and compared with rectal temperature twice a day at the ward (n = 200). At the intensive care unit, patients (n = 42) underwent the same measurement procedures every fourth hour for 24 hours. In addition, core temperature was measured. Statistical analyses included descriptive and mixed models analyses. RESULTS: Ward: Infrared tympanic thermometers measured the temperature lower than the rectal temperature. Descriptive statistics indicate higher variation in temperature measurements made in the ear. No statistically significant difference in temperature was found for left ear vs. right ear. Intensive care unit: The mean rectal temperature was higher than the mean core and ear temperature. Mixed models analyses of the temperatures at the ward and the intensive care unit showed the same overall trends, but with less discrepancy between the two infrared tympanic thermometers brands, compared with the rectal temperature. Only rectal temperature measurements differed significantly from the core temperature. CONCLUSION: Our study shows good reliability using the new generation of infrared tympanic thermometers. We found good agreement between core and infrared tympanic thermometers at the intensive care unit, but the measuring inaccuracy for infrared tympanic thermometers was greater than expected. RELEVANCE TO CLINICAL PRACTICE: The new generation of infrared tympanic thermometers may be used in clinical practice, but it is important to do repeatedly measurements if there is discrepancy between the temperature and the observation of the patient condition.

Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery.

BACKGROUND: Pain is a cardinal symptom of osteoarthritis (OA) of the hip and important for deciding when to operate. This study assessed the internal consistency reliability, validity and responsiveness of the Brief Pain Inventory (BPI) among patients with OA undergoing total hip replacement (THR). METHODS: We prospectively included 250 of 356 patients who were accepted to the waiting list for primary THR surgery. All participants responded to the BPI, WOMAC and SF-36 at baseline and 1 year after surgery. RESULTS: Internal consistency reliability (Cronbach's α) was >0.80 for the BPI, the WOMAC and five of the eight SF-36 scales The pattern of associations of the two BPI scales with corresponding and non-corresponding scales of the WOMAC and SF-36 largely supported the construct validity of the BPI. The responsiveness indices for change from baseline to 1 year after THR ranged from 1.52 to 2.05 for the BPI scales, from 1.69 to 2.84 for the WOMAC scales, and from 0.25 (general health) to 2.77 (bodily pain) for the SF-36 scales. CONCLUSIONS: The BPI showed acceptable reliability, construct validity and responsiveness in patients with OA undergoing THR. BPI is short and therefore is easy to use and score, though the instrument offers few advantages over and duplicates scales of more comprehensive instruments, such as the WOMAC and SF-36.

Cutpoints for mild, moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery.

BACKGROUND: Cutpoints (CPs) for mild, moderate and severe pain are established and used primarily in cancer pain. In this study, we wanted to determine the optimal CPs for mild, moderate, and severe pain in joint replacement surgery candidates with osteoarthritis (OA) of the hip or knee, and to validate the different CPs. METHODS: Patients (n = 353) completed the Brief Pain Inventory (BPI), the WOMAC Arthritis Index, and the SF-36 health status measure. Optimal CPs for categorizing average pain with three severity levels were derived using multivariate analysis of variance, using different CP sets for average pain as the independent variable and seven interference items from the BPI as the dependent variable. To validate the CPs, we assessed if patients in the three pain severity groups differed in pain as assessed with WOMAC and SF-36, and if BPI average pain with the optimal CPs resulted in higher correlation with pain dimensions of the WOMAC and SF-36 than other CPs. RESULTS: The optimal CPs on the 0-10 point BPI scale were CP (4,6) among hip patients and CP (4,7) among knee patients. The resulting pain severity groups differed in pain, as assessed with other scales than those used to derive the CPs. The optimal CPs had the highest association of average pain with WOMAC pain scores. CONCLUSION: CPs for pain severity differed somewhat for patients with OA of the hip and knee. The association of BPI average pain scores categorized according to the optimal CPs with WOMAC pain scores supports the validity of the derived optimal CPs.