In fl uence of mobile education on joint function and quality of life in patients after total hip arthroplasty☆

Wen-Xi Shen,Yue-Xing Wng,Yu-Yin Ning,Jin-Xiu Peng,Heng-Qiu Wei, Kn Dun,Yn-Qiong Zhou,Chng-Shen Yun

aDepartment of Teaching,First Af fi liated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi Zhuang Autonomous Region 530000,China

bDepartment of Nursing,First Af fi liated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi Zhuang Autonomous Region 530000,China

cDepartment of Orthopedics,First Af fi liated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi Zhuang Autonomous Region 530000,China

In fl uence of mobile education on joint function and quality of life in patients after total hip arthroplasty☆

Wen-Xia Shena,Yue-Xiang Wangb,*,Yu-Yin Ningb,*,Jin-Xiu Pengb,*,Heng-Qiu Weib, Kan Duanc,Yan-Qiong Zhoub,Chang-Shen Yuanc

aDepartment of Teaching,First Af fi liated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi Zhuang Autonomous Region 530000,China

bDepartment of Nursing,First Af fi liated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi Zhuang Autonomous Region 530000,China

cDepartment of Orthopedics,First Af fi liated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi Zhuang Autonomous Region 530000,China

A R T I C L E I N F O

Article history:

6 January 2017

Accepted 24 February 2017

Available online 7 June 2017

Animated educational fi lm

Mobile education

THA

Rehabilitation guidance

Continuous nursing post-discharge

Objective:To explore the in fl uence of applying educational animated fi lm as continuous post-discharge rehabilitation guidance for patients after total hip arthroplasty(THA).

Methods:Sixty patients discharged after THA were randomly divided into two groups.Traditional methods,such as distributing manuals of rehabilitation guidance on THA and phone call follow-ups, were adopted in the control group,whereas educational animated fi lm was used as continuous rehabilitation guidance after discharge in the experimental group.Differences in recovery of hip joint function,accuracy of functional exercise,mastery of rehabilitation knowledge and quality of life between the two groups were compared.

Results:The experimental group had superior performance on all indicators compared to the control group(P＜0.05).

Conclusions:The use of educational animated fi lm as continuous post-discharge rehabilitation guidance in patients after THA achieved better effects than traditional education methods.

?2017 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

1.Introduction

Functional rehabilitation is one of the three intervention methods in orthopedic rehabilitation.1Recovery from THA requires a long time,after which patients might suffer from dif fi culties in self-care.Science-based functional exercise and rehabilitation guidance are crucial for patients to restore hip function,regain selfcare abilities and improve quality of life.2Rehabilitation after THA, however,involves professional medical knowledge that can be dif fi cult for patients to fully and correctly comprehend.Thus far,continuous rehabilitation guidance after THA has been implemented only by distributing health education manuals,3making phone calls and nursing care follow-ups,4among others,which was still notenough and lead to inadequate and improper rehabilitation exercise and decline in patients'compliance directly affecting recovery of joint function.Shen et al5provided rehabilitation guidance on THA using multimedia videos and had them played in wards,which has been shown to achieve positive effects.However, videodiscs are inconvenient for use after discharge.Instead,researchers made an educational animated fi lm that was visual,easy to popularize and accessible anytime and anywhere.The results of using these videos are reported below.

2.Research materials and methods

2.1.Research materials

A total of 60 patients,admitted to our department from June 2014 to June 2015,with necrosis of the femoral head afterTHAwereselected and assigned to the control group and the experimental group using a random number table with 30 cases in each.All surgeries in both groups were performed by 2 chief physicians under intra-spinal anesthesia.Differences in sex,age,disease progression and level of education between the 2 groups were not statistically signi fi cant(P＞0.05),and the baseline information was similar as shown in Table 1.

Table 1 Comparison of baseline information between the 2 groups.

The inclusion criteria were(1)patients with late necrosis of the femoral head treated with THA,(2)patients in stable condition after primary surgery with no possible in fl uence on physical sense and movement,and(3)patients who voluntarily joined this study with informed consent and accepted follow-up visits.The exclusion criteria were(1)patients with a history of mental or neurological diseases,drug addiction or severe cognitive impairment,(2)patients with severe complications,and(3)patients with complications producing severe impairment of important viscera.

2.2.Multimedia production

The research team consisted of 2 chief physicians,2 associate chief physicians,3 chief nurses,2 associate chief nurses,and 2 supervisor nurses,all of whom had at least a bachelor's degree.The program started with a script written by the research team,in which rehabilitation guidance,functional exercise techniques and matters needing attention in daily life were incorporated.Then,the script was fi nalized to one relatively comprehensive and complete piece after numerous discussions and approval by dozens of experts.At last,it was produced into an educational animated fi lm, taking daily life post-discharge after THA as the main story line.A middle-aged,approximately 50,cartoon character was developed through whose life the fi lm aimed to show patients functional exercise techniques,using crutches/walker and walking up and down stairs,correct postures,movements to avoid,training methods for changing posture from lying to standing,standing to sitting then walking,proper movements of sitting,standing, walking,lying,fetching,getting in and out of bed,crossing over obstacles,squatting,taking bus,putting on and taking off clothes, going to toilet,bathing and matters needing attention in daily life. Almost every possible aspect of daily life was involved to direct patients into correct functional exercises and everyday activities after discharge.To be applicable to various multimedia devices, such as portable VCD player,tablets,and momo3 or mobile phones, mp4 players,and mp5 players,the fi lm was put on DVD discs and transferred to corresponding video forms including avi,mov,mpge, fl v,rm,rmvb,dat,wmv,mtv,mp4 and awf.

2.3.Intervention methods

The same THA treatment,nursing care and health education programweregiventothe2groupsduringhospitalization.Thehealth education program included distribution of health education materials(rehabilitation manual on THA)to patients immediately after admission,organization of intensive education twice(before surgery and before discharge),arrangement of routine education 3 times by nurses in charge,and provision of education at any time during daily treatment and nursing care.Phone call follow-ups were made 4 weeks after discharge,and an evaluation was performed 12 weeks after discharge at the return visit,in which every relevant indicator was assessed.Functional exercises were monitored with a functional exercise diary distributed to each group,which was composed of the date and the to-do list of exercises that were documented by a check mark.Nurses in charge were responsible for completing the form every day after supervising patients in their exercises.

The control group was instructed to take the health education manual home for continuous study,and patients in the experimental group took home the educational animated fi lm.Nurses in charge were responsible for putting the fi lm in their mobile terminals,teaching them how to use it to help with exercise and determining how well they understood the fi lm to ensure that they were able to use it skillfully.

2.4.Evaluating indicator

Hip joint function;compliance with functional exercises; mastery of rehabilitation exercise skills;NHP health status.

2.5.Evaluation methods

2.5.1.Evaluation of effectiveness of postoperative functional

exercise

Evaluations were performed by 2 associate chief physicians on the research team 12 weeks after discharge at the return visit in accordance with Harris scoring criteria,6in which joint function, pain,range of joint motion and joint deformity are scored.The total score was 100 points,joint function(including gait and functional activities)accounted for 47 points,pain for 44 points,range of joint motion for 5 points,including adduction,bending,outreach and internal and external rotation,and joint deformity counted for 4 points.The higher one scored,the better the hip joint functioned.

2.5.2.Evaluation of compliance with functional exercises

There is still no uniform standard at home or abroad for evaluation of compliance with functional exercises.Therefore,after evaluating the literature from Cheng et al,7this paper used 3 aspects,including number of exercises,exercise initiative and task completion,to assess compliance,and scored participants from low to high as 1,2,3,4.The counts of completion,voluntary exercise and exercise up to a stipulated time were recorded,and those with 75-100%,50-69%,25-49%and below 24%in each category were, respectively,scored as 4,3,2,and 1,for a total score of 12 points. The higher one scored,the better the compliance with functional exercises.The daily functional exercise forms were collected and analyzed at the return visit.

2.5.3.Evaluation of mastery of rehabilitation exercise skills

As demonstrated in the questionnaire,rehabilitation exercise skills were divided into 5 categories(movements of sitting, standing,lying and walking,use of walker,rehabilitation exercises,daily activities and self-care abilities),and 19 items in total were evaluated for a total score of 100 points.The evaluation was performed by an associate chief physician on the research team 12 weeks after discharge at the return visit,and grades of 90-100 points were excellent,80-89 were good,70-79 were average,and below 70 was poor.NHP8evaluation of health condition.

The evaluation included 6 health indicators of pain,energy, sleeping condition,activity,emotional response,and social segregation and was completed by two researchers 12 weeks after discharge at the return visit,in which uni fi ed instruction was used to make sure all patients could fully understand.The lower one scored,the better the health status.

2.6.Statistical methods

SPSS 11.5 statistical software was used to perform Chi-square tests to analyze categorical data,mean±SD to describe measurement data,t-tests to analyze measurement data.Signi fi cant differences were indicated when P＜0.05.

3.Results

3.1.Comparison of effect on functional exercise 12 weeks after surgery(Table 2)

3.2.Comparison of compliance with functional exercise 12 weeks after discharge

Patients'compliance was accessed by researchers at the followup visit 12 weeks after discharge.The results showed that compliance with functional exercises were higher in the experimental group than in the control group(P＜0.05),as shown in Table 3.

3.3.Comparison of mastery of rehabilitation exercise skills 12

weeks after discharge

Results showed that mastery of rehabilitation exercise skills in the experimental group was signi fi cantly superior to that of the control group(P＜0.05),as shown in Table 4.

3.4.Evaluation of health status by NHP scale

Results showed that NHP scores in the experimental group 12 weeks after discharge were signi fi cantly better than that of the control group,and the difference was statistically signi fi cant (P＜0.05),as shown in Table 5.

4.Discussion

4.1.Contribution of mobile education to recovery of joint function after THA

As shown in Table 2,Harris scores of hip function in the experimentalgroupwereobviously higherthanthoseinthecontrolgroup(P＜0.001).Regular exercise for joint function and proper activities in daily life could increase muscle strength,improve hip joint function and reduce risk of complications.9Rehabilitation exercise after THA required very professional medical skills.If used incorrectly,excessively or insuf fi ciently,patients were prone to suffer from loosening and wear of prosthesis,dislocation of hip joint, fracture,or displacement of rotation center,for which reasons the whole process should be under professional instruction.However, in China to date,professional rehabilitation guidance after THA is performed only during hospitalization,and rehabilitation after discharge is under no professional management.What's more,recovery from THA is a long-time process,generally 4-6 months, duringwhichpatientshavetodomostoftherehabilitationexercises themselves at home and yet often do not continue or complete exercises correctly.Thankfully,this animated fi lm,covering every possible aspect of postoperative life,could provide patients the same professional medical guidance afterdischarge as medical staff did,in which training methods were vividly introduced step-bystep,accelerating recovery of hip joint function.

Table 3 Comparison of functional exercise compliance[n(%)].

4.2.Improvement in compliance with functional exercise by educational animated fi lm

Symptoms such as pain,reduction in range of joint motion and joint dysfunction might appear after THA.In telephone follow-ups, patients tended to complain of pain,troubles in wearing trousers and socks,dif fi culties in climbing stairs,limping and inability to care for themselves,all of which could cause decline in patients' compliance.Yu et al10reported that after THA,the incidence of late complications was as high as 25%in patients with poor compliance. In these circumstances,educational animated fi lms,as a form of art, were fun and relaxing for patients and thus took initiative to imitate.Additionally,it added fun to rehabilitation exercises and also alleviated pain.Making such tedious and professional knowledge simple and interesting could make it better understood and accepted.What's more,it was motivating and turned passive education into active learning by providing learning opportunities anytime and anywhere.Families could take part in the process as well,enhancing the intervention effect of family nursing and improving patient compliance.The results shown in Table 3 indicate that patient compliance in the experimental group was signi fi cantly higher than that of the control group(P＜0.05).

4.3.Improvement in functional exercise skills through continuous education with an educational animated fi lm

As shown in Table 4,12 weeks after discharge,patients'mastery offunctionalexerciseskillsintheexperimentgroupwassigni fi cantly better than that of the control group(P＜0.05).Patients needed a long rehabilitation period after THA.On one hand, due to shortage of medical resources or for fi nancial and family reasons,they could not remain in the hospital until completely recovered.11Outside the hospital,on the other hand,it was also impossible for them to have medical staff accompanying them all the time.In such cases,mobile education could provide patients at home with professional and standard rehabilitation guidance.With repeated learning,patients were able to grasp the correct functional exercise methods and were aware of matters needing attention in daily life.

Table 2 Comparison of hip joint function after surgery by Harris score.

Table 4 Comparison of mastery of rehabilitation exercise skills[n(%)].

Table 5 Evaluation of health status by NHP scale.

4.4.Improvement in all health indicators and quality of life by mobile education after THA

Mobile education conformed to the self-care concept of Orem's theory.The fi lm compensates for the nurse and not only improved patients'self-nursing abilities and nursing skills but also enhanced their sense of self-responsibility and self-concept and increased the level of rehabilitation knowledge,12thus speeding up recovery. Moreover,it helped to maintain harmonious family relations and improve quality of life by having families participate.As shown in Table 5,indicators such as pain,energy,sleep,activity,emotional response,social segregation and others in the experimental group were better than that of the control group(P＜0.05),and the difference was signi fi cant.

5.Conclusions

The best recovery of function in the affected limb is the key to operative success in THA.However,recovery is only guaranteed by effective health education throughout the whole process.Any improvement in guidance for functional exercise methods is bound to affect nursing quality and ef fi ciency.As for patients,the use of an educational animated fi lm that provided professional and standard guidance at home was similar to having medical staff around.With rapid development of digital media devices and support for advanced communication technology,mobile education aimed at offering support to any learners at anytime and anywhere has become a new research fi eld in education technology in recent years.13By applying mobile education as a nursing intervention outside the hospital,problems such as incorrect mastery of rehabilitation knowledge and skills as well as the incidence of complications due to insuf fi cient nurse-care support could be effectively solved,thus promoting rehabilitation of limb function and improving quality of life.

Con fl icts of interest

All contributing authors declare no con fl icts of interest.

1.Zhuo DH.The concepts and new trends of orthopaedic rehabilitation.Chin J Orthop Trauma.2003;5:242-244(in Chinese).

2.Sun JM,Yang GJ,Yang Y.Effectiveness of comprehensive rehabilitation intervention strategy to improve the function level of the patients after total hip replacement.Orthopaedics.2015;6:94-97(in Chinese).

3.Luo YL,Ye ZY,Fan JS,Zhang JR,Guo JX,Xiang RY.Application of“four in one”health education model in rehabilitation training after total hip replacement. Chin J Pract Nurs.2009;25:32-33(in Chinese).

4.Hu X.Experiences of phone call follow-up in health education for discharged orthopedic patients.Chin J Osteoporos.2012;6:555-556(in Chinese).

5.Shen WX,Ning YY,Zhou YQ,Duan K.Research on application of mobile education in rehabilitation exercise of patients after total hip arthroplasty.Chin Nurs Res.2012;12:56-57(in Chinese).

6.Shi HY,Mau LW,Chang JK,et al.Responsiveness of the Harris HipScore and SF-36: fi ve years after total hip arthroplasty.Qual Life Res.2009;18:1053-1060(in Chinese).

7.Cheng H,Zhang JF,Ren QH.Investigation compliance of early postoperative functional exercise for patients with hip replacement.Nurs J Chin People's Liberation Army.2010;27:431-432(in Chinese).

8.Hunt SM,McKenna SP,McEwen J,Williams J,Papp E.The Nottingham health pro fi le:subjective health status and medical consultations.Soc Sci Med A. 1981;15:221.

9.Tugay N,Akarcali I,Kaya D,Tugay BU,Atilla B,Tokgozoglu AM.High independence level in functional activities reduces hospital stay after total hip arthroplasty regardless of pain intensity.Saudi Med J.2004;25:1382-1387.

10.Yu YH,Chen AC,Hu CC,Hsieh PH,Ueng SW,Lee MS.Acute delirium and poor compliance in total hip arthroplasty patients with substance abuse disorders. J Arthroplasty.2012;27:1526-1529.

11.Qin GR.Literature review of continued care for patients discharged from hospital and its development tendency.J Nurs Sci.2012;2:89-91(in Chinese).

12.Wang SM.Application of self-care theory Orem in rehabilitation of total hip replacement.Today Nurse.2013;3:35-36(in Chinese).

13.Zhang P.Development and perspective of mobile education.China Educ Tech Equip.2011;4:21-22(in Chinese).

How to cite this article:Shen W-X,Wang Y-X,Ning Y-Y,et al. In fl uence of mobile education on joint function and quality of life inpatientsaftertotalhiparthroplasty.ChinNursRes. 2017;4:71-74.http://dx.doi.org/10.1016/j.cnre.2017.02.002

22 November 2016

☆This project was supported by Scienti fi c Research Program of the Guangxi Zhuang Autonomous Region HealthandFamily Planning Commission(No. Z2014113)and Scienti fi c Research Program of Education Department of Guangxi Zhuang Autonomous Region(No.LX2014177).

*Corresponding authors.

E-mailaddresses:1148667857@qq.com(Y.-X.Wang),1372471513@qq.com (Y.-Y.Ning),993407841@qq.com(J.-X.Peng).

Peer review under responsibility of Shanxi Medical Periodical Press.

in revised form