Maintaining Older People's Physical Function and Quality of Life between Physician-Recommended and Actual Knee-Replacement Surgery for Osteoarthritis

Project: National Science and Technology CouncilNational Science and Technology Council Academic Grants

Project Details

Abstract

Osteoarthritis (OA) is a degenerative disease commonly affecting older people. For those with OA who experience joint symptoms that substantially impact their quality of life and are refractory to non-surgical treatment, joint-replacement surgery should be considered. Many people worldwide require total joint-replacement surgery due to aging populations and lifestyle patterns contributing to greater activity and/or overweight. However, waiting lists for total joint replacement are very long, and support services for OA patients awaiting surgery are limited. Since preoperative functioning is the strongest determinant of postoperative pain and functioning, it is important to develop interdisciplinary intervention programs to maintain these patients’ preoperative function. In Taiwanese clinical settings, family members commonly insist that their older relatives receive joint-replacement surgery but the older relatives reject surgery, resulting in a tug of war until the older relative gives up. This phenomenon may be unique to Taiwan; it has not been reported in Western studies. Thus far, it is unclear why older OA patients reject surgery in Taiwan. Scheduling knee-replacement surgery at Chang Gung Memorial Hospitals takes 1-3 months. If older OA patients refuse, it can take a year or more. These older OA patients not only suffer from illness-related physical, psychological, and social distress, but also experience severe conflicts with their close family members. These stresses may aggravate older OA patients’ health and quality of life. No interdisciplinary intervention programs are currently available for older people between physician-recommended and actual knee joint-replacement surgery in western countries or Taiwan. However, to design suitable intervention programs, the needs of older people with knee OA and their family members must first be assessed. It is also important to understand the process of deciding to undergo joint-replacement surgery. To address these gaps in understanding, we propose a 3-year study in four stages. In Stage I, we will explore the lived experience of older people with knee OA, their decision-making process regarding joint-replacement surgery, and their care needs between recommended and actual knee-replacement surgery. Their family members’ caregiving experiences, decision-making process, and caregiving needs will also be explored. In Stage II, we will develop and validate two questionnaires, one to assess care needs of older people with knee OA between recommended and actual knee-replacement surgery and one to assess caregiving needs of family members in this period. In Stage III, we will explore the trajectories of physical status, cognitive function, pain, sleep quality, depressive symptoms, social support, quality of life, and care needs of older people with knee OA between recommended and actual joint-replacement surgery. We will also explore their family members’ trajectories of sleep quality, depressive symptoms, social support, quality of life, and caregiving needs. In Stage IV, we will develop and examine the feasibility of an interdisciplinary care protocol for older people with knee OA and their family members between the older person’s recommended and actual joint-replacement surgery. The study results will provide preliminary suggestions for interdisciplinary intervention protocols for older people with knee OA and their family members as well as guidelines for developing intervention programs for this group.

Project IDs

Project ID:PC10401-0764
External Project ID:MOST103-2314-B182-044-MY3
StatusFinished
Effective start/end date01/08/1531/07/16

Fingerprint

Explore the research topics touched on by this project. These labels are generated based on the underlying awards/grants. Together they form a unique fingerprint.