- Title
- The effectiveness of a mobile app-based rehabilitation programme for patients after total hip or knee arthroplasty: a mixed methods study
- Creator
- Wang, Qingling
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: The rapid increase in total hip or knee arthroplasty procedures worldwide is challenging the provision of postoperative rehabilitation services, especially in countries like China where rehabilitation facilities and qualified healthcare professionals are lacking. Healthcare professionals, including nurses, are seeking innovative approaches to address the challenges, such as patients who live in rural or remote areas having difficulties accessing rehabilitation services. One approach may be the use of information and communication technologies, such as mobile applications, to provide remote support for patient rehabilitation. However, there is limited evidence on the effectiveness of mobile application-based rehabilitation for arthroplasty due to the methodological limitations and lack of psychological outcomes in previous studies. Thus, this research project was conducted to develop and evaluate the effectiveness of a mobile application-based rehabilitation programme on physical and psychological outcomes in patients after total hip or knee arthroplasty to promote and implement evidence-based practice in arthroplasty telerehabilitation. Aims: The present study was conducted in China to investigate the effectiveness of mobile application-based rehabilitation in patients after total hip or knee arthroplasty. It had the following aims: 1) To understand patients’ needs for rehabilitation services delivered via mobile applications after total hip or knee arthroplasty, the findings of which were used to inform the development of a mobile application-based arthroplasty rehabilitation programme; 2) To evaluate the effectiveness of a newly developed mobile application-based rehabilitation programme for patients after total hip or knee arthroplasty on patients’ self-efficacy, physical function, pain, levels of anxiety and depression, and health-related quality of life; and 3) To investigate patients’ experiences using the newly developed mobile application-based rehabilitation programme, such as satisfaction, perceived benefits and weaknesses of this programme, and suggestions for improvement. Designs and methods This research project employed a mixed methods experimental approach that included two study phases. In the first phase of the study, a qualitative descriptive study was conducted among 20 patients who were discharged from a total hip or knee arthroplasty. Semistructured interviews were used to obtain an in-depth understanding of patients’ needs for the future use of mobile applications to conduct arthroplasty rehabilitation. Interview records were transcribed verbatim and analysed using inductive content analysis. Based on the findings from the phase one study and results of the literature review, guided by Bandura’s self-efficacy theory and the Illeris model for learning, a research team consisting of nursing researchers, an arthroplasty surgeon, a physiotherapist, and a senior orthopaedic nurse designed a mobile application-based rehabilitation programme for patients after total hip or knee arthroplasty. In the second study phase, a randomised controlled trial was conducted to evaluate the effectiveness of this newly developed mobile application-based rehabilitation programme on patients’ self-efficacy, physical function, pain, levels of anxiety and depression, and health-related quality of life. Eighty-six patients undergoing total hip or knee arthroplasty were randomly assigned to either the experimental (n = 43) or control group (n = 43) using a computerised random number generator. The experimental group received usual care plus the newly developed mobile application-based rehabilitation programme, while the control group received usual care only. Outcomes were evaluated at the baseline and 6 and 10 weeks after hospital discharge. Primary outcomes were the changes from baseline to 6 weeks after discharge in patients’ self-efficacy (measured using the Self-Efficacy for Rehabilitation Outcome Scale) and physical function (measured using the Hip Disability and Osteoarthritis Outcome Score Physical Function Short Form and the Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form respectively). The repeated measured data were analysed using generalised estimating equations. A process evaluation was conducted for the trial: a qualitative descriptive study was conducted to collect data about patients’ experiences using the programme, and data on the safety, engagement, and fidelity of the intervention were collected through a questionnaire booklet, the application, and a written rehabilitation diary. Two English–Chinese bilingual supervisors guided the candidate to conduct qualitative interviews in Chinese and translate the findings into English. Qualitative and quantitative findings were then integrated to discuss the effects of mobile application-based rehabilitation in arthroplasty. Findings: Data analysis in the phase one qualitative study revealed four categories: (a) assisting rehabilitation self-management, (b) facilitating peer support, (c) facilitating contact with healthcare professionals, and (d) supporting emotional well-being. The findings informed the rationale, applicable theories, and 10 key components for the development of a mobile application-based rehabilitation programme for patients after total hip or knee arthroplasty. The results of the randomised controlled trial showed that the newly developed mobile application-based rehabilitation programme had potentially positive effects on patients’ self-efficacy, physical function, levels of anxiety and depression, and health-related quality of life. At 6 weeks after hospital discharge, the experimental group showed statistically significant improvements compared to the control in scores of self-efficacy (adjusted mean difference = 0.72, 95% CI 0.31 to 1.14, P < .001) and physical function (adjusted mean difference = 4.57, 95% CI 1.24 to 7.90, P = .007). At week-10 follow-up, the experimental group had statistically significant improvements in scores of self-efficacy (P < .001), anxiety (P = .015), depression (P = .012), and health-related quality of life (P = .018) compared to the control group. In the process evaluation, patients (n = 25) reported positive experiences using the programme, such as improving access to health care, encouraging postoperative recovery, establishing supportive relationships with healthcare professionals and other patients, and facilitating patients’ learning of rehabilitation instructions. No complications occurred related to the intervention. Most participants used the programme components such as the discussion forum (72.1% used) and messaging (86.0% used). Conclusions: This research project makes an original contribution to knowledge as it has: (a) demonstrated the development of a mobile application-based rehabilitation programme for arthroplasty which was based on theories, patients’ perceived needs, and literature review; (b) provided robust evidence from a rigorously designed randomised controlled trial that a theory-underpinned mobile application-based rehabilitation programme had the potential to improve patients’ health outcomes; (c) expanded existing knowledge on the effectiveness of mobile application-based rehabilitation for arthroplasty by incorporating psychological outcomes and process evaluation data; (d) preliminarily discussed the role of nurses in mobile application-based rehabilitation for arthroplasty, which may lead nurses to reflect on expanding their role and contribution to telerehabilitation care. The study findings not only provide evidence for Chinese policymakers and administrators in the decision to implement mobile arthroplasty rehabilitation but also have value for health services in other countries/regions where nurses are actively involved in the development and implementation of telerehabilitation programmes. Multicentre trials with long-term follow-ups, such as 6 and 12 months, are recommended to obtain more comprehensive evidence on the effectiveness of mobile application-based arthroplasty rehabilitation. Implementation research is also suggested in future to effectively integrate mobile application-based arthroplasty rehabilitation into practice settings.
- Subject
- total hip arthroplasty; total knee arthroplasty; rehabilitation; mobile application; mixed methods study
- Identifier
- http://hdl.handle.net/1959.13/1507225
- Identifier
- uon:55990
- Rights
- Copyright 2023 Qingling Wang
- Language
- eng
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