Trần Thị Vân Anh, Nguyễn Thanh Hương, Nguyễn Xuân Thùy

Content

Preamble

Total hip arthroplasty (TPA) is optimal therapy for diseases in

the head top and femoral neck.

population aging tendency:

→ There are many patients of femoral neck fracture

and hip disease.

TPA: Technique – Quality of lide (QOL) of patients of hip

dislocation → important

The world: Numerous researches on QOL of HD patients

in USA, Australia, Greece, Italy, France, Croatia…

In Vietmale, such research has not been conducted yet.

Viet Duc Hospital: 500 TPA cases (in 2013)

Purpose

- Help patients and doctors to select the suitable therapy

- Evaluate efficiency of operation and nursing

- Determine supporting methods for nursing and treatment

BSF36 Toolkit

36 questions for 8 problems of QOL

Some international researches on QOL of the patients after

total hip arthroplasty using SF36 toolkit

The further it is after operation, the higher QOL point is

Less factors related to QOL changing point

Study combined with qualitative has not been recorded

yet

Veljko santie’(Croatia-

2012) evaluate and

compare points of QOL

02 years before and

after operation

Veljko santie’(Croatia-

2012) evaluate and

compare points of QOL

02 years before and

after operation

Henning R

Johansson (Germany

- 2010): evaluate 6,

12, 24 months before

and after operation

Henning R

Johansson (Germany

- 2010): evaluate 6,

12, 24 months before

and after operation

Alessandro Aprato (Italy

-2011) evaluate 2 years

after, compare FNF

group and degenerative

coxathroxis group

Alessandro Aprato (Italy

-2011) evaluate 2 years

after, compare FNF

group and degenerative

coxathroxis group

Research objective

Describe changes in QOL of the patients before

and after THA at Viet Duc Hospital in 2014

Đặc điểm cá nhân - Tuổi- Giới- Nơi sinh sống- Nghề nghiệp- Trình độ học vấn- Tình trạng hôn nhân- Chi phí cho bệnh tật (Có BHYT hay tự chi trả toàn bộ )

Đặc điểm cá nhân - Tuổi- Giới- Nơi sinh sống- Nghề nghiệp- Trình độ học vấn- Tình trạng hôn nhân- Chi phí cho bệnh tật (Có BHYT hay tự chi trả toàn bộ )

Yếu tố lâm sàngChẩn đoán:- Viêm thoái hóa khớpháng- Hoại tử chỏm xương đùi- Khối u ở chỏm, cổ xương đùi- Gãy chỏm hoặc cổ xương đùi- Chấn thương gây biến dạng ổ cốiThời gian mắc bệnhChỉ số mật độ xương

Yếu tố lâm sàngChẩn đoán:- Viêm thoái hóa khớpháng- Hoại tử chỏm xương đùi- Khối u ở chỏm, cổ xương đùi- Gãy chỏm hoặc cổ xương đùi- Chấn thương gây biến dạng ổ cốiThời gian mắc bệnhChỉ số mật độ xương

Sự đau đớn- Mức độ đau- Cường độ- Thời gian- Ảnh hưởng đến mất ngủ,đến dinh dưỡng

Sự đau đớn- Mức độ đau- Cường độ- Thời gian- Ảnh hưởng đến mất ngủ,đến dinh dưỡng

Yếu tố tâm lýYếu tố tâm lýDịch vụ y tếĐiều trị liên quan đến bệnh

trước và sau phẫu thuật

Dịch vụ y tếĐiều trị liên quan đến bệnh

trước và sau phẫu thuật

Khả năng vận động- Hoạt động hàng ngày- Lao động - Vận động đi lại - Sinh hoạt cá nhân

Khả năng vận động- Hoạt động hàng ngày- Lao động - Vận động đi lại - Sinh hoạt cá nhân

Hỗ trợ hàng ngày Từ gia đình, người thân và những người xung quanh

Hỗ trợ hàng ngày Từ gia đình, người thân và những người xung quanh

Dịch vụ xã hộiDịch vụ xã hội

Chất lượng cuộc sống người bệnh

(Có chỉ định phẫu thuật thay khớp háng)

Khung lý thuyết

Research methods

• Object: Hip dislocation patients at Viet Duc

Hospital, surgeons and nurses

• Time: Feb - Jun 2014

• Place: 02 Departments of Orthopaedic Sugery,

Orthopaedics Institute under Viet Duc Hospital

• Longitudinal study design: combine

quantitative and qualitative study

Sample size, collection, processing, analysis of data

Quantitative- Main purpose

04 interview with patients

02 interview with surgeons

01 discussion with nurse group

- Instruction board PVS and TLN

- bandage removal, coding, by-

subject analysis.

Qualitative-Total: 115 patients

- Interview three times:

Hospitalization, discharge and 01

month after follow-up examination.

- Data entry: Epidatta 3.0;

SPSS16.0 analyzer.

- Analysis: statistic description,

pairing test.

Study variables

Quantitative variable• Personal characteristics• Clinical characteristics• QOL point (Gross point: Min=0; Max=100)

Qualitative subject: Influence factors and solutions to QOL improvements for the patients, medical workers.

Point <25 26-50 51-75 76-100

QOL Poor Average Fair Fairly good - Good

Results and discussion

General information on patients (n=115)Content Frequency Percent

Age

< 30 years 08 7,0

30 - 49 years 32 27,8

50 - 69 years 55 47,8

≥ 70 years 20 17,4

Mean age (Mean ± SD) 54,5 ± 11,98

The oldest and youngest age 19 - 87

Gender male 80 69,6

female 35 30,4

Residence Rural 71 61,7

Urban 44 38,3

Marriage status Unmarried 07 6,1

Married 99 86,1

Divorce/widowed 09 7,8

Medical insurance

With medical insurance 107 93,0

self-pay 08 7,0

Lưu Hồng Hải (2008) 54.2 years of age

Anakwe (UK- 2010) 68.0 years

of age

Veljko santie’(Croatia - 2012)

72.6

Tshonga (Greece - 2011) 74.8

Clinical characteristics (n=115)

ContentFrequenc

y Percent

Diagnosis

femoral neck fracture 35 30,4

necrosis of the femoral head 33 28,7

femoral neck disease 04 3,5

Hip osteoarthritis 43 37,4

Suffering period < 01 month 24 20,9 From 1-> less than 06 months 14 12,2 From 06-> 12 months 15 13,0 >12 months 62 53,9

Surgical methods

total hip arthroplasty 99 86,1

Bipolar hip arthroplasty 16 13,9

Mean days of treatment by clinincal features and surgical method (n=115)

Index Frequency Mean days of treatment ± SD

Diagnosis

femoral neck fracture 35 11,8 ± 4,15

necrosis of the femoral head 33 9,3 ± 3,54

femoral neck disease 4 9,0 ± 2,00

Hip osteoarthritis 43 8,9 ± 2,56

Surgical methods

total hip arthroplasty 99 9,3 ± 2,94

Bipolar hip arthroplasty 16 13,3 ± 5,02

Total 115 9,8 ± 3,26

Mean QOL point before and after operationTshonga (Greece – 2011) QOL point Before operation 29.3 and 55.1; 62.3 (after 3 , 6 months), Patient is female > 65 years of age

Mean QOL point by physical health field

Tshonga :

Before operation

29.3

After 03 months

64.4

Tshonga :

Before operation

29.3

After 03 months

64.4

Veljko santie’: Before operation

30 After 6 months 65

Veljko santie’: Before operation

30 After 6 months 65

Mean QOL point by mental health field

Veljko santie’ : Before

operation 22,2 sau 06

months 94,4

Veljko santie’ : Before

operation 22,2 sau 06

months 94,4

Tshonga Before

operation 18,3;

sau 03 months

63,1

Tshonga Before

operation 18,3;

sau 03 months

63,1

Some factors

affect the QOL

change

Treatment, care

Treatment, care

Quá tải

Quá tải

Information supply

Information supply

Surgerical technique, I have no comment but patients are overcrowded.

On some days, I have been already operated but lied with other patients in

the same bed. Being painful and overcrowde made me unable to move, but stepping out of bed may tread on

other patients; fear to be stuck, fall may dislocate the new hip that is more

miserable“

“First day after surgery, I felt too painful; using up the

analgestic, I cannot bears the pain but just wanted to

die.”

When need, it lacks; when no need, it is

redundant

“After operation, which food can I eat? What should I keep off?”

Propaganda method of medicine sector is not very good; just concentrating in some big cities

and only big hospitals can perform this surgery. A bit far from these places, in northern delta for

example, people thinks that hip dislocation is so formidable. They wonder whether they can move

if taking out their hip and replacing with a new artificial hip?” (PTV-02)

Propaganda method of medicine sector is not very good; just concentrating in some big cities

and only big hospitals can perform this surgery. A bit far from these places, in northern delta for

example, people thinks that hip dislocation is so formidable. They wonder whether they can move

if taking out their hip and replacing with a new artificial hip?” (PTV-02)

“When I did not have access or surgery, people round me said that my disease could not operated, that I had to live with such flood. That’s why I was in two minds about doing and not doing…”, “Even on that day I was ready for surgery that is scheduled, my aunt said: “Oh, my God. Please, I beg you not to have operation; if yes, you will be unable to walk, surely like me, don’t operate”.

“Will I move on my foot again? Can I do heavy works? Or “Will I get married, have sex or will there any influence, or will my hip be dislocated?”

SOLUTION-Satellite hospital, transfer of technical packaget.- Cooperate with junior hospitali.- Build more facilities

SOLUTION

Using mass media.

Develop consulting form, guidance on

monitoring and prevention from post-

operative complications

Today is the third days since my operation but nobody has guided me to practice; maybe on

weekend no rehabilitation officers is

working

SOLUTIONMonitor, control painWork assignmentTrain, develop instruction sheet …Nutrition provision

Conclusion

Change in QOL of the patients

There is change in QOL point after TPA ( Hospitalization

24.6; Discharge 39.5; Follow-up exam 61.6 ; p< 0.001)

Mean point of 8 areas rise at the time of follow-up exam

(p<0.0001).

Postoperative physical functioning reduced (35.8 to

25.5; p< 0.001)

Factors affecting the QOL change (from quantitative

results): Overload, treatment and care, information

supply to the patients.

Recommendations

Rehabilitation solution: Training the nurses in

rehabilitation knowledge; assigning the rehabilitation

technicians working on Saturdays and Sundays.

Provide meals to each patient.

Develop consulting form, guidance on monitoring and

prevention from after-TPA complications…

Continue this research for a longer period.

THANK YOU VERY MUCH12/02/14 24