Elsevier

Applied Nursing Research

Volume 29, February 2016, Pages 211-216
Applied Nursing Research

Original Article
Empowering knowledge and its connection to health-related quality of life: A cross-cultural study: A concise and informative title: Empowering knowledge and its connection to health-related quality of life

https://doi.org/10.1016/j.apnr.2015.05.004Get rights and content

Abstract

Aims

Assess the association between patient education (i.e. empowering knowledge) and preoperative health-related quality of life, 6 months postoperative health-related quality of life, and the increase in health-related quality of life in osteoarthritis patients who underwent total hip or total knee arthroplasty.

Method

This is a cross-cultural comparative follow-up study using structured instruments to measure the difference between expected and received patient education and self-reported health-related quality of life (EQ-5D) in Finland, Greece, Iceland, Spain and Sweden.

Results

The health-related quality of life was significantly increased 6 months postoperatively in all countries due to the arthroplasties. In the total sample, higher levels of empowering knowledge were associated with a higher health-related quality of life, both pre- and postoperatively, but not with a higher increase in health-related quality of life. On the national level, postoperative health-related quality of life was associated with higher levels of empowering knowledge in Finland, Iceland and Sweden. The increase in health-related quality of life was associated with levels of empowering knowledge for Greece.

Conclusions

Overall, it can be concluded that the level of empowering knowledge was associated with high postoperative health-related quality of life in the total sample, even though there is some variation in the results per country.

Introduction

Osteoarthritis (OA) is a worldwide problem, listed among the top 10 most disabling diseases in developed countries. It has an estimated prevalence of 9.6% of men and 18% of women aged 60 or older (World Health Organisation, 2014). The symptoms of OA consist of pain, fatigue, stiffness, joint deformity and loss of physical function. Regarding these symptoms, a negative impact on the quality of life is apparent (Mariconda, Galasso, Costa, Recano, & Cerbas, 2011). In the progressively aging population, the number of patients with advanced hip and knee OA undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasing (Jones et al., 2001, Rand et al., 2003, Rolfson et al., 2011, Singh, 2011).

Patient education, defined as the informing, counseling, and training of patients, has become a relevant field in nursing care in recent years. In varying countries such as Finland, Iceland and Sweden the right to patient education and information are obliged by law (Althingi, 1997, Finlex, 1992, Sveriges Riksdag, 1982). THA and TKA surgery patients need to have knowledge in order to manage their recovery at home successfully. This is especially important since the length of hospital stays is decreasing (EUROSTAT, 2012). This means that in most cases, THA and TKA surgery patients are discharged home after only a few days in hospital (Fagermoen and Hamilton, 2006, Sendir et al., 2013). In this regard, empowering patients is the main goal of patient-centered education. In empowering patient education, the educational structure and methods are based on a patient-centered approach, and patient participation is the core of these educational activities (Leino-Kilpi, Mäenpää, & Katajisto, 1999). Thus, the first essential step in empowering patients is the provision of knowledge that meets patients' expectations. The health professionals' role is to encourage patients to voice their knowledge expectations and to hear the patients' voice (Johansson Stark et al., 2014, Klemetti et al., 2014).

Previous research has stated that THA and TKA surgery patients that have received tailored information instead of the standard education, were more knowledgeable (Heikinen et al., 2008, Johansson et al., 2007) and more certain of care-related issues (Baumann, Rat, Mainard, Cuny, & Guillemin, 2011) than the control group. In addition, patients that were more satisfied with the medical information they received had higher HRQoL scores after total joint arthroplasty (Leino-Kilpi et al., 2005); and patients that had received more knowledge had higher HRQoL scores at discharge (Lawless, Greene, Slover, Kwon, & Malchau, 2012). A review of the literature by Strupeit, Buß, Arne, and Dassen (2013) shows that approximately 70% of the studies included showed no effects of nurse-delivered patient education interventions on quality of life of outpatients. It has been found that THA and TKA operations have proven to be beneficial in many domains of health related quality of life (HRQoL) (Brandes et al., 2011, Clement et al., 2011, Montin et al., 2006), up to 7 years' follow-up (Bruyère et al., 2012). However, most studies which try to uncover determinant of HRQoL focus on the postoperative HRQoL (Brooks, 1996, EuroQol_Group, 1990, Jones et al., 2003, Mahomed et al., 2002, Mariconda et al., 2011, Ryhänen et al., 2012) rather than the difference or increase in HRQoL. The increase in HRQoL can possibly be more informative since it corrects for the effect of the preoperative health status, which has been shown to be related to postoperative HRQoL (Lawless et al., 2012, Mariconda et al., 2011, Ryhänen et al., 2012). However, there is a lack of research on empowering knowledge and HRQoL in OA patients who have had a total hip or knee arthroplasty. In this study, we hypothesized that patients who receive the amount of patient education they expect to receive are more likely to be empowered. Consequently, these patients will be able to manage their condition more adequately, which in turn would lead to higher HRQoL compared to patients that have not received a sufficient amount of patient education according to their own needs or expectations. Therefore, the difference between received patient education and expected patient education will be referred to as the level of empowering knowledge.

Section snippets

Purpose

The purpose of this study was to test the hypothesis that smaller dissimilarities between expected and received knowledge (i.e., higher levels of empowering knowledge) are associated with a higher postoperative HRQoL in OA patients undergoing total hip or knee arthroplasty. The following research questions were formulated: (1) What was the possible increase in health-related quality of life? (2) What was the level of empowering knowledge? and (3) Was empowering knowledge associated with the

Study sample

The data were collected from 1,286 (n = 762, response rate = 59%) OA patients who have had a total hip or knee arthroplasty from Finland, Iceland, Greece, Spain and Sweden (during 2009–2012). This study is a part of a European project on empowering patient education for osteoarthritis patients undergoing hip or knee replacement (Valkeapää et al., 2014). The inclusion criteria for participants were the following: attending elective knee or hip replacement surgery for OA; able to understand Finnish,

Sample characteristics

The participants were on average 67.9 years old, more often female, retired, had low levels of vocational education, and underwent their first arthroplasty (Table 1).

Pre- and postoperative health-related quality of life

OA patients' HRQoL improved throughout the study population. In the total sample, after 6 months a significant increase was seen, both in the EQ-5Dindex (0.61 to 0.83, p = < 0.001) and in the EQ-5DVAS (58.5 to 69.8, p = < 0.001). The mean increase in HRQoL was 0.21 in the EQ-5Dindex score.

Every country shows this significant increase

Discussion

The aim of this study was to test the hypothesis that smaller dissimilarities between expected and received knowledge (i.e., higher levels of empowering knowledge) are associated with a higher postoperative HRQoL in OA patients undergoing a total hip or knee arthroplasty. Naturally, the HRQoL improved significantly due to the TKA and THA, which is in line with previous research (Brandes et al., 2011, Bruyère et al., 2012, Clement et al., 2011, Montin et al., 2006). What has not been proven

Conclusion and implications for practice

To conclude, this study found a positive effect of levels of empowering knowledge on the postoperative HRQoL in the total sample. On the national level, the association with postoperative HRQoL was found in most countries as well. This indicates that the HRQoL is likely to be improved by meeting patients' knowledge expectations with patient-centered education. As is well known, orthopedic hospital care periods have become shorter during the last decade. In practice, it is important that

Author contributions

K.V. and H.L.-K. were responsible for the study conception and design, K.K. for the drafting of the manuscript. K.V., E.P., and N.I., A.S., Å. J. S. performed the data collection and J.K. the data analysis. All authors K.K., H.L.-K., E.C., N.I., Å.J.S., J.K., C.L., E.P., S.S., A.S., K.V. and S.E. have made their critical revisions and approved the final version.

Acknowledgments

The study has required contribution by many people in the participating countries. We wish to thank all those who took part in this study. This study was financially supported by the following: Finland—University of Turku; the Academy of Finland; the Finnish Association of Nursing Research; the Finnish Foundation of Nursing Education; EVO funds at the Intermunicipal Hospital District of Southwest Finland; Spain—Colegio Oficial de Enfermeria de Barcelona; Sweden—the Swedish Rheumatism

References (36)

  • O. Bruyère et al.

    Health-related quality of life after total knee or hip replacement for osteoarthritis: A 7-year prospective study

    Archives of Orthopaedic and Trauma Surgery

    (2012)
  • N.D. Clement et al.

    The outcome of primary total hip and knee arhtroplasty in patients aged 80 years or more

    The Journal of Bone and Joint Surgery

    (2011)
  • EuroQol_Group

    EuroQoL- A new facility for the measurement of health-related quality of life

    Health Policy

    (1990)
  • EUROSTAT

    Data explorer - In-patient average length of stay

  • Finlex

    Act on the status and rights of patients

  • C. Gibson

    A concept analysis of empowerment

    Journal of Advanced Nursing

    (1991)
  • K. Heikinen et al.

    A comparison of two educational intervents for the cognitive empowerment of ambulatory orthopaedic surgery patients

    Patient Education and Counseling

    (2008)
  • C.A. Jones et al.

    The effect of age on pain, function, and quality of life after total hip and knee arhtroplasty

    Archives of Internal Medicine

    (2001)
  • Cited by (0)

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