[[alternative]]“A New Hope for Knee”: The Processes of Total Knee Replacement among Taiwanese Middle-aged and Elderly Women

[[abstract]]背景：全膝關節置換術 (total knee replacement, TKR)是退化性膝關節炎最具成效之治療方式，除了能改善疼痛與失能外，更能增進生活品質。儘管TKR在女性病患中占很大比例，然而截至目前的研究所知仍有限。目的：本研究目的在探討台灣中老年婦女接受TKR的歷程。方法：採質性研究的紮根理論方法。以立意取樣方式，收案於台北某醫學中心骨科病房，招募40歲以上之中老年婦女為對象。資料收集方式包括：深度訪談、觀察及田野紀錄，於TKR術後三到五天及術後六到八週進行。資料分析採用紮根理論的不斷比較分析法。結果：合計20位中老年婦女接受TKR。「新膝望」是接受TKR歷程之核心主題，分為三個階段：術前、決定手術、術後，涵蓋七個類別及二十一個次類別。術前—受困疼痛的衝擊（行動受限、無法負荷工作需求、日常社交中斷、睡眠障礙）、尋求非手術療法（配合西醫保守療法、嘗試另類療法）；決定手術—內在驅力（衡量手術優勢、擔心成為家人負擔、關注身體心像改變）；外在激力（醫師的建議、親友的鼓勵、病友的影響）；術後—阻礙活動的艱難路（宛如千斤重的腿、動彈不得的膝蓋、難以展開的關節）；明確目標的復健路（把握復健黃金期、按表力行操練、努力向標竿邁進）；計畫復健的回家路（發現緩解不適法、運用復健好妙招、定期至醫院復健）。結論／實務應用：中老年婦女期望在接受TKR手術後迎向新膝望，但術後仍需努力克服復健所帶來的不適與困難。醫護人員應以開放的態度，傾聽並鼓勵婦女述說其接受TKR的歷程，並在婦女各階段提供個別性的護理指導及心理支持。同時，醫護人員不僅要依照婦女結果期望、個人特質及運用自我效能理論，提供其復健指導外，還應鼓勵主要照顧者參與婦女照護計畫，並協助及督促婦女返家後之復健執行，以提高復健的效能。此外，建立個案管理機制及術後返家後之物理治療管理，亦有助於婦女康復。關鍵字：全膝關節置換術、手術歷程、質性研究[[abstract]]Background: Total knee replacement (TKR) is the most effective treatment for knee osteoarthritis; it not only relieves pain and disability but also improve the quality of life. Although TKR surgery accounts for a large proportion of women, uptake is limited. Thus, this study aimed to explore the processes of TKR among Taiwanese middle-aged and elderly women.Methods: The study was conducted with qualitative approach in a medical center in Taipei, Taiwan. Using a purposive sampling, women aged over 40 years were recruited from the orthopedic ward. Data were collected 3 to 5 days and 6 to 8 weeks after surgery, involving in-depth interviews, observation and field records. Constant comparative analysis was employed for data analysis.Results: A total of 20 women participated in the study. A new hope for knee was the core theme for women after undergoing TKR surgery. There are three steps to receive TKR: pre-operation, decide to have a surgery and post-operation, involving 7 categories and 21 sub-categories. (1) Pre-operation: suffering from pain before surgery (restricted movement, unable to meet the demands of work, lack for social activities, and sleep interruption); seek non-surgical treatment (cooperate with a variety of conventional medicine treatments and try alternative treatments); (2) decide to have a surgery: intrinsic motivation (measuring the advantages of surgery, worry for becoming a family burden, and care about the changing of body image); and external forces (advice from doctors, encouragement from families and friends and influence from patients); (3) post-operation: the difficult journey of impeded mobility (a heavy leg, immovable knee, and inflexible joint); the rehabilitation journey with an identified goal (grasping the golden period of rehabilitation, practicing according to the rehabilitation list, and striving towards the goal); the journey of returning home for planning rehabilitation (utilizing methods to relieve discomfort, finding good coups for rehabilitation, visiting hospital regularly for rehabilitation).Conclusions/Implications for practice: Women expect to have new expectations after receiving TKR, but they are still striving to overcome difficulties from rehabilitation and discomfort symptoms. Healthcare providers should listen and encourage the women to talk about the process of receiving TKR with open minded and provide an individual teaching program with supervision and psychological support for them during every stage. In a meanwhile, healthcare providers should not only provide rehabilitation guidance with these women’s outcome expectations, personality and using self-efficacy theory but also encourage the main caregivers to participate in women’s rehabilitation programs, assist and supervise the implementation of rehabilitation after returning home to improve the effectiveness of rehabilitation. Otherwise, establishing the mechanism of case management and physiotherapy management after hospitalization are also contribute to the recovery of those women who receive TKR.Keywords: total knee replacement; surgery processes; qualitative researc