http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, Early Online: 1–16 ! 2014 Informa UK Ltd. DOI: 10.3109/09638288.2014.906663
REVIEW PAPER
Factors relating to perioperative experience of older persons undergoing joint replacement surgery: an integrative literature review Rosy Tay Swee Cheng1, Piyanee Klainin-Yobas1, Desley Hegney2, and Sandra Mackey3 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 2Curtin Health Innovation Research Institute, Curtin University, Perth, Australia, and 3School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW, Australia
Disabil Rehabil Downloaded from informahealthcare.com by Dicle Univ. on 11/09/14 For personal use only.
1
Abstract
Keywords
Purpose: The purpose of this literature review was to examine factors relating to the perioperative experience of older persons undergoing total hip and knee replacement surgery resulting from osteoarthritis. Method: A literature search was undertaken using databases CINAHL, PubMed, Scopus and Web of Science to provide relevant research articles. Articles were included if they examined the factors relating to the HRQOL, QOL and perioperative experience of older persons undergoing joint replacement surgery resulting from osteoarthritis. The use of Joanna Briggs Institute’s critical appraisal checklist facilitated a systematic appraisal of studies with regard to the scientific rigor of the studies. Results: Twenty-two publications were categorized into one main theme: ‘‘factors relating to perioperative experience’’ subcategorized into eight subthemes: ‘‘waiting time’’, ‘‘pain and disability’’, ‘‘mental health’’, ‘‘race/ethnicity, age and gender’’, ‘‘body image’’, ‘‘coping and social support’’, ‘‘patient education’’ and ‘‘care continuity’’. Conclusion: There is a need to conduct further research to examine the perioperative experience of older persons undergoing joint replacement surgery, in particular, the lived perioperative experience of a diverse race, ethnicity and culture in an Asian population.
Hip replacement surgery, knee replacement surgery, older adults, perioperative experience History Received 7 May 2013 Revised 15 March 2014 Accepted 17 March 2014 Published online 1 April 2014
ä Implications for Rehabilitation
Healthcare services should remain focused on reducing waiting time as prolonged waiting time for joint replacement surgery was detrimental to patients’ HRQOL. Healthcare professionals need to identify strategies to improve the perioperative pain experience through patient education on pain management and positive social support to support the process of recovery. Patients’ expectations of pain and their process of recovery were closely linked to patient education. One model of patient education that was seen to be successful and linked to good post-operative outcomes was care continuity model. Being actively involved in the care continuity results in better post-operative outcomes for the patient and their family.
Introduction The world population over 60 years of age has reached over 650 million and is forecast to rise to 2 billion by 2050. Globally, ageing is caused by longer life expectancies and exacerbated by the sharp decline in fertility rates which has reduced the proportion of young people in society [1,2]. Osteoarthritis (OA), defined by the American College of Rheumatology (ACR) as a ‘‘heterogeneous group of conditions that lead to joint symptoms and signs which are associated with defective integrity of articular cartilage, in addition to related
Address for correspondence: Rosy Tay Swee Cheng, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Tel: +65 65501336. E-mail: [email protected]
changes in the underlying bone at the joint margins [3]’’. It is a common chronic condition associated with ageing which particularly affects the joints that have been continually stressed over a person’s lifetime such as the knees, hips, fingers and lower spinal region. The condition is a major cause of deformity, morbidity, disability, loss of function and social isolation, particularly when the hip and/or knee are involved [3]. In addition, people with severe osteoarthritis (OA) experience worsening pain due to the progressive degeneration of the joints. All of these factors can affect their mobility, overall health and their social quality of life [4]. Concurrent with the increase in disease, there is also an increase in demand for Total Hip Replacement (TKR) and Total Knee Replacement (TKR) surgery. THR, otherwise known as total hip arthroplasty (THA) and TKR, otherwise known as total knee arthroplasty (TKA) are the most commonly performed orthopaedic procedures for severe knee and hip osteoarthritis.
Disabil Rehabil Downloaded from informahealthcare.com by Dicle Univ. on 11/09/14 For personal use only.
2
R. T. S. Cheng et al.
The aim of the surgery is to alleviate joint pain and improve function and quality of life [5–10]. Perioperative experience of surgery for these patients involves the pre-operative, intraoperative and post-operative phases of surgical intervention. The perioperative experience commences from ‘‘the time the patient is informed of the date of the operation through the post-operative recovery phase’’ [11]. Generally, in joint replacement surgery, the recovery phase varies from a few months to about a year. It is suggested that the major motivator for surgery is the person’s ability to regain control of their body and life to pre-disease levels [12]. As joint replacement surgery becomes an accepted management and treatment strategy for osteoarthritis, it is imperative for nurses to understand the factors relating to the perioperative experience of older persons undergoing joint replacement surgery in order to maximize outcomes for patients. Enhancing knowledge of patient experience of these procedures will promote patient centred nursing practice, inform improvements in nursing education and assist in the formulation of effective nursing policy. A preliminary search of the literature found 214 studies which focused on the Health Related Quality of Life (HRQOL)/Quality of Life (QOL) and perioperative experience, however, to date there had been no synthesis of these studies. Therefore, an integrative literature review of factors relating to the perioperative experience of older patients undergoing joint replacement surgery was indicated. The specific question that underpinned this review was: What are the factors relating to the perioperative experience of older persons undergoing joint replacement surgery? The primary aim of this review was to identify the factors relating to the perioperative experience of older persons undergoing primary total hip and knee replacement surgery resulting from osteoarthritis. The secondary aim was to contribute to the evidence base in order to improve outcomes for patients undergoing these procedures.
Methods Studies were identified through an electronic search of literature from 2001 to 2012 in the databases of Cumulative Index of Nursing and Allied Health (CINAHL), PubMed, Scopus and Web of Science. The search terms used included: pre-operative experience, intraoperative experience, post-operative experience and perioperative experience, Health Related Quality of Life (HRQOL) and Quality of Life (QOL). An additional search combined initial search terms using specific terms related to joint replacement surgery: total knee replacement, total hip replacement and total joint replacement to narrow down the search. Inclusion criteria were applied as follows: (a) Older adults age 60 years and above (b) Focus on patient experience and any factors influencing patient perioperative experience of TKR and THR due to osteoarthritis (c) Included Quality of Life (QOL) and Health-related Quality of Life (HRQOL) as study variables. QOL is broadly defined as ‘‘individuals’ perception of their position in life in culture and value systems in which they live and in relation to their goals, expectations, standards and concerns’’ [13]. HRQOL encompassed aspects of quality of life that impact physical and mental health [14]. QOL and HRQOL were used interchangeably in the articles. (d) Used quantitative and/or qualitative research designs (e) Were published in English This review excluded studies that were not: (a) Primary research
Disabil Rehabil, Early Online: 1–16
(b) Peer reviewed (c) Identified as having ethical approval The database search identified 214 studies. After examination of abstracts using the inclusion and exclusion criteria and removal of duplicates, 135 studies were retrieved for review. Additionally, the reference lists of these 135 studies were checked to ascertain if any other papers could be included. Following independent review by two of the authors, 40 papers were deemed to be eligible for inclusion in the review. Eighteen papers were excluded from the review as the focus of the research was on surgery for trauma related hip and knee surgery, rheumatoid arthritis or the age of the patient was 560 years. Twenty-two papers were included in the review, of which 13 were quantitative and 9 qualitative studies (Figure 1). Studies originated from Sweden (7), UK (4), Finland (4), USA (2), Australia (1), New Zealand (1), Canada (1), Japan (1) and France (1) (see Table 1). Quality appraisal and data extraction Following identification of potential papers, we used the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklists for Cohort/ Case Control/Observational Studies under Meta Analysis of Statistics Assessment and Review Instrument (MASTARI) for quantitative studies and the Qualitative Assessment and Review (QARI) for qualitative studies to ensure methodological validity prior to inclusion in the review [35]. Two reviewers independently rated each paper on its scientific merit. The descriptive studies were evaluated based on the research methodology such as sampling, design, measurement tool and the appropriateness of the statistical analysis. The qualitative studies were evaluated for the congruency between the paradigm, methodology and method, the influence of the researcher on the research, data collection and data analysis. If the studies had not been approved by an Ethics Committee they were not included in the review. Following agreement on the included studies, we then used the QARI critical appraisal tool which included the extraction of qualitative findings. JBI defined a finding as ‘‘a conclusion reached by the researcher(s) and often presented as themes or metaphors’’ [35]. Findings were extracted from each paper and were ranked (again independently by the two reviewers) as ‘‘unsupported’’ (when the data do not support the finding; ‘‘credible’’ (logically inferred but findings can be challenged) or ‘‘unequivocal’’ (findings that are directly reported/ observed and not open to challenge) [35]. These findings were then pooled into categories (or themes). The quantitative data were appraised using MASTARI critical appraisal tool to rate the quality and the level of evidence based on JBI’s assessment tool [35]. The data were not able to be pooled, and therefore were subjected to a narrative analysis of each individual paper. From this analysis, again individually, the reviewers were able to develop themes. Where there was disagreement between the two reviewers, the third reviewer independently reviewed and provided a resolution to the dispute.
Results The research designs of the 13 quantitative studies which included 6 longitudinal, 3 cohort, 2 cross-sectional, 1 descriptive and 1 retrospective study were appropriate in the study of factors relating to the perioperative experience of older persons undergoing joint replacement surgery. The methodological approach of the nine qualitative studies included five hermeneutic or interpretive phenomenology, one descriptive phenomenology, one grounded theory and two studies with no specified methodology but working within a qualitative data collection framework. The thematic analysis of the qualitative and quantitative data from the studies found that factors relating to the perioperative
Perioperative experience of older persons
DOI: 10.3109/09638288.2014.906663
Cinahl-84 PubMed-90 Scopus-20 Web of Science-20
Potentially relevant papers identified by literature search n=214
Papers excluded after examination of abstract, application of inclusion/ exclusion criteria and duplicates n=79
Papers retrieved for detailed examination n=135
Disabil Rehabil Downloaded from informahealthcare.com by Dicle Univ. on 11/09/14 For personal use only.
After reference tracking from the full 135 studies n=2 added to the review
Papers assessed for methodological quality n=40
Papers included in the review n=22
Qualitative papers n=9
3
Papers excluded after independent review of authors n=97
Papers excluded for hip/knee surgery due to trauma/rheumatoid arthritis, age
REVIEW PAPER
Factors relating to perioperative experience of older persons undergoing joint replacement surgery: an integrative literature review Rosy Tay Swee Cheng1, Piyanee Klainin-Yobas1, Desley Hegney2, and Sandra Mackey3 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 2Curtin Health Innovation Research Institute, Curtin University, Perth, Australia, and 3School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW, Australia
Disabil Rehabil Downloaded from informahealthcare.com by Dicle Univ. on 11/09/14 For personal use only.
1
Abstract
Keywords
Purpose: The purpose of this literature review was to examine factors relating to the perioperative experience of older persons undergoing total hip and knee replacement surgery resulting from osteoarthritis. Method: A literature search was undertaken using databases CINAHL, PubMed, Scopus and Web of Science to provide relevant research articles. Articles were included if they examined the factors relating to the HRQOL, QOL and perioperative experience of older persons undergoing joint replacement surgery resulting from osteoarthritis. The use of Joanna Briggs Institute’s critical appraisal checklist facilitated a systematic appraisal of studies with regard to the scientific rigor of the studies. Results: Twenty-two publications were categorized into one main theme: ‘‘factors relating to perioperative experience’’ subcategorized into eight subthemes: ‘‘waiting time’’, ‘‘pain and disability’’, ‘‘mental health’’, ‘‘race/ethnicity, age and gender’’, ‘‘body image’’, ‘‘coping and social support’’, ‘‘patient education’’ and ‘‘care continuity’’. Conclusion: There is a need to conduct further research to examine the perioperative experience of older persons undergoing joint replacement surgery, in particular, the lived perioperative experience of a diverse race, ethnicity and culture in an Asian population.
Hip replacement surgery, knee replacement surgery, older adults, perioperative experience History Received 7 May 2013 Revised 15 March 2014 Accepted 17 March 2014 Published online 1 April 2014
ä Implications for Rehabilitation
Healthcare services should remain focused on reducing waiting time as prolonged waiting time for joint replacement surgery was detrimental to patients’ HRQOL. Healthcare professionals need to identify strategies to improve the perioperative pain experience through patient education on pain management and positive social support to support the process of recovery. Patients’ expectations of pain and their process of recovery were closely linked to patient education. One model of patient education that was seen to be successful and linked to good post-operative outcomes was care continuity model. Being actively involved in the care continuity results in better post-operative outcomes for the patient and their family.
Introduction The world population over 60 years of age has reached over 650 million and is forecast to rise to 2 billion by 2050. Globally, ageing is caused by longer life expectancies and exacerbated by the sharp decline in fertility rates which has reduced the proportion of young people in society [1,2]. Osteoarthritis (OA), defined by the American College of Rheumatology (ACR) as a ‘‘heterogeneous group of conditions that lead to joint symptoms and signs which are associated with defective integrity of articular cartilage, in addition to related
Address for correspondence: Rosy Tay Swee Cheng, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Tel: +65 65501336. E-mail: [email protected]
changes in the underlying bone at the joint margins [3]’’. It is a common chronic condition associated with ageing which particularly affects the joints that have been continually stressed over a person’s lifetime such as the knees, hips, fingers and lower spinal region. The condition is a major cause of deformity, morbidity, disability, loss of function and social isolation, particularly when the hip and/or knee are involved [3]. In addition, people with severe osteoarthritis (OA) experience worsening pain due to the progressive degeneration of the joints. All of these factors can affect their mobility, overall health and their social quality of life [4]. Concurrent with the increase in disease, there is also an increase in demand for Total Hip Replacement (TKR) and Total Knee Replacement (TKR) surgery. THR, otherwise known as total hip arthroplasty (THA) and TKR, otherwise known as total knee arthroplasty (TKA) are the most commonly performed orthopaedic procedures for severe knee and hip osteoarthritis.
Disabil Rehabil Downloaded from informahealthcare.com by Dicle Univ. on 11/09/14 For personal use only.
2
R. T. S. Cheng et al.
The aim of the surgery is to alleviate joint pain and improve function and quality of life [5–10]. Perioperative experience of surgery for these patients involves the pre-operative, intraoperative and post-operative phases of surgical intervention. The perioperative experience commences from ‘‘the time the patient is informed of the date of the operation through the post-operative recovery phase’’ [11]. Generally, in joint replacement surgery, the recovery phase varies from a few months to about a year. It is suggested that the major motivator for surgery is the person’s ability to regain control of their body and life to pre-disease levels [12]. As joint replacement surgery becomes an accepted management and treatment strategy for osteoarthritis, it is imperative for nurses to understand the factors relating to the perioperative experience of older persons undergoing joint replacement surgery in order to maximize outcomes for patients. Enhancing knowledge of patient experience of these procedures will promote patient centred nursing practice, inform improvements in nursing education and assist in the formulation of effective nursing policy. A preliminary search of the literature found 214 studies which focused on the Health Related Quality of Life (HRQOL)/Quality of Life (QOL) and perioperative experience, however, to date there had been no synthesis of these studies. Therefore, an integrative literature review of factors relating to the perioperative experience of older patients undergoing joint replacement surgery was indicated. The specific question that underpinned this review was: What are the factors relating to the perioperative experience of older persons undergoing joint replacement surgery? The primary aim of this review was to identify the factors relating to the perioperative experience of older persons undergoing primary total hip and knee replacement surgery resulting from osteoarthritis. The secondary aim was to contribute to the evidence base in order to improve outcomes for patients undergoing these procedures.
Methods Studies were identified through an electronic search of literature from 2001 to 2012 in the databases of Cumulative Index of Nursing and Allied Health (CINAHL), PubMed, Scopus and Web of Science. The search terms used included: pre-operative experience, intraoperative experience, post-operative experience and perioperative experience, Health Related Quality of Life (HRQOL) and Quality of Life (QOL). An additional search combined initial search terms using specific terms related to joint replacement surgery: total knee replacement, total hip replacement and total joint replacement to narrow down the search. Inclusion criteria were applied as follows: (a) Older adults age 60 years and above (b) Focus on patient experience and any factors influencing patient perioperative experience of TKR and THR due to osteoarthritis (c) Included Quality of Life (QOL) and Health-related Quality of Life (HRQOL) as study variables. QOL is broadly defined as ‘‘individuals’ perception of their position in life in culture and value systems in which they live and in relation to their goals, expectations, standards and concerns’’ [13]. HRQOL encompassed aspects of quality of life that impact physical and mental health [14]. QOL and HRQOL were used interchangeably in the articles. (d) Used quantitative and/or qualitative research designs (e) Were published in English This review excluded studies that were not: (a) Primary research
Disabil Rehabil, Early Online: 1–16
(b) Peer reviewed (c) Identified as having ethical approval The database search identified 214 studies. After examination of abstracts using the inclusion and exclusion criteria and removal of duplicates, 135 studies were retrieved for review. Additionally, the reference lists of these 135 studies were checked to ascertain if any other papers could be included. Following independent review by two of the authors, 40 papers were deemed to be eligible for inclusion in the review. Eighteen papers were excluded from the review as the focus of the research was on surgery for trauma related hip and knee surgery, rheumatoid arthritis or the age of the patient was 560 years. Twenty-two papers were included in the review, of which 13 were quantitative and 9 qualitative studies (Figure 1). Studies originated from Sweden (7), UK (4), Finland (4), USA (2), Australia (1), New Zealand (1), Canada (1), Japan (1) and France (1) (see Table 1). Quality appraisal and data extraction Following identification of potential papers, we used the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklists for Cohort/ Case Control/Observational Studies under Meta Analysis of Statistics Assessment and Review Instrument (MASTARI) for quantitative studies and the Qualitative Assessment and Review (QARI) for qualitative studies to ensure methodological validity prior to inclusion in the review [35]. Two reviewers independently rated each paper on its scientific merit. The descriptive studies were evaluated based on the research methodology such as sampling, design, measurement tool and the appropriateness of the statistical analysis. The qualitative studies were evaluated for the congruency between the paradigm, methodology and method, the influence of the researcher on the research, data collection and data analysis. If the studies had not been approved by an Ethics Committee they were not included in the review. Following agreement on the included studies, we then used the QARI critical appraisal tool which included the extraction of qualitative findings. JBI defined a finding as ‘‘a conclusion reached by the researcher(s) and often presented as themes or metaphors’’ [35]. Findings were extracted from each paper and were ranked (again independently by the two reviewers) as ‘‘unsupported’’ (when the data do not support the finding; ‘‘credible’’ (logically inferred but findings can be challenged) or ‘‘unequivocal’’ (findings that are directly reported/ observed and not open to challenge) [35]. These findings were then pooled into categories (or themes). The quantitative data were appraised using MASTARI critical appraisal tool to rate the quality and the level of evidence based on JBI’s assessment tool [35]. The data were not able to be pooled, and therefore were subjected to a narrative analysis of each individual paper. From this analysis, again individually, the reviewers were able to develop themes. Where there was disagreement between the two reviewers, the third reviewer independently reviewed and provided a resolution to the dispute.
Results The research designs of the 13 quantitative studies which included 6 longitudinal, 3 cohort, 2 cross-sectional, 1 descriptive and 1 retrospective study were appropriate in the study of factors relating to the perioperative experience of older persons undergoing joint replacement surgery. The methodological approach of the nine qualitative studies included five hermeneutic or interpretive phenomenology, one descriptive phenomenology, one grounded theory and two studies with no specified methodology but working within a qualitative data collection framework. The thematic analysis of the qualitative and quantitative data from the studies found that factors relating to the perioperative
Perioperative experience of older persons
DOI: 10.3109/09638288.2014.906663
Cinahl-84 PubMed-90 Scopus-20 Web of Science-20
Potentially relevant papers identified by literature search n=214
Papers excluded after examination of abstract, application of inclusion/ exclusion criteria and duplicates n=79
Papers retrieved for detailed examination n=135
Disabil Rehabil Downloaded from informahealthcare.com by Dicle Univ. on 11/09/14 For personal use only.
After reference tracking from the full 135 studies n=2 added to the review
Papers assessed for methodological quality n=40
Papers included in the review n=22
Qualitative papers n=9
3
Papers excluded after independent review of authors n=97
Papers excluded for hip/knee surgery due to trauma/rheumatoid arthritis, age
