|Abstract / Summary
The overall aim of this thesis was to investigate the development of specific rehabilitation and intervention in patients aged over 65 years after total hip replacement (THR) based on health status.
The project consists of 3 studies, first a description of patients ́ health status after THR, followed by a randomized clinical trial by using telephone interview and counseling postoperatively, and to test improvement in patients ́ health status after THR. Finally, to test the effect of nursing intervention by providing a measurement of patients ́ health related quality of life was carried out.
The aim of study 1 was to describe health status among patients after total hip replacement (THR) and to analyse the association between health status and gender, age, living situation and dependency on help from others. A cross-sectional study was performed that included 287 patients aged 65+, who had undergone THR within the past 12 months. Patients from five Danish counties received a mailed questionnaire assessing health status and demographic data. Short Form-36 measures eight domains of importance for health status. Of the 314 patients who received a questionnaire, 287 (91.4%) patients participated. The patients answered the questionnaire 202(120) days after surgery. Patients living alone or dependent on help from others had a significantly increased risk of having lower scores in seven of domains of health status after surgery.
In study 2 the aim was to study the effect during the first 9 months on health status of intervention by telephone interviews 2 and 10 weeks after the operation. Method: A randomised clinical trial of 180 patients aged over 65 years focusing on patients ́ health status by using SF-36 at 4 weeks pre- and 3 and 9 months postoperatively was carried out. Patients were randomised 4 weeks preoperatively to either control or intervention groups. Both groups received conventional surgical treatment, but the intervention group was interviewed by telephone 2 and 10 weeks after surgery.
The data in study 3 came from patients aged over 65 years participating in a randomised controlled trial (RCT) with a 9-month follow-up period (study 2). The aim was to compare differences in health-related quality of life expressed in quality-adjusted life years (QALYs) between patients over the age of 65 receiving conventional treatment after THA with patients having conventional treatment and telephone contact 2 and 10 weeks after surgery. It was carried out at a university hospital in Denmark from January 2005 to May 2007. Two hundred reply-paid envelopes were
prepared to randomise the population (figure 1). All together180 patients consecutively admitted to elective THR in two departments of orthopaedic surgery were allocated to the study. Both departments used the same surgical procedure for elective THR. Of the180 patients allocated to the study, 161 were included (56 men, 105 women), 19 patients (6 men, 13 women) were excluded. Mean age was 76.5 years for excluded patients and 74.9 years for the included (P value 0.270).