Psychological factors and experience of patients undergoing total hip replacement
This study aimed to comprehensively explore the relationship between psychological factors and pain, function and quality of life. A mixed method approach comprising two longitudinal and one cross-sectional elements, was conducted, with results being triangulated to give a multi-perspective view of the relationships. In the longitudinal elements, the questionnaire used in the quantitative phase was developed from validated tools, with cognitive interviews incorporating a think-aloud technique, used to validate the questionnaire package. Diary and interview schedules for the qualitative phase were developed from the existing literatures in this field. Additionally, a cross-sectional review of the pre-operative education programme in five centres was examined through participant observation. One-hundred and five patients scheduled for initial assessment were recruited into the quantitative phase. Of these, thirty-nine were successfully recruited to the quantitative phase and sixteen were followed up at six months post-operative. Twelve of the participants in the quantitative phase also participated in the qualitative phase, with five being successfully followed up at six months post-operative. Results indicated that pain, function and quality of life were highly associated with self-efficacy, pain catastrophising, functional expectations, pre-operative depression, post-operative anxiety and post-operative negative affect. The qualitative element identified five themes: physical symptoms; management and awareness; support; well-being; and cognitive aspects of the self-regulatory model. Evaluation of the content of the education programme identified that all information provided to the patients was in line with the guidelines. Triangulation of the mixed methods identified the congruence of major relationships between pain, function and quality of life with self-efficacy and expectations in the longitudinal elements. Self-efficacy and expectations should be considered throughout the hip surgery journey. Interventions, such as use of a reflective diary and talking to former patients who have undergone hip replacement, will enhance self-efficacy and adjustment of expectations, thus promoting better pain control, functional recovery and helping to tackle negative emotions.
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