Effectiveness of the transitional care model in total knee arthroplasty patients: A randomized controlled trial.
Ayla Güllü, Betul Tosun
PMID 38989604WHAT IT FOUND
Nurse-led transitional care after knee replacement improved function and self-efficacy more than usual care at follow-up, and fewer hospital visits at a post-discharge time point.
The package included education, counselling, phone follow-up and exercise reminders.
Key findings
01Transitional care patients had lower WOMAC total scores than usual care patients at the post-discharge assessments (53.60 vs 67.97 and 31.09 vs 42.97; p<0.001 and p=0.003), meaning less pain, stiffness and function impairment.
02Transitional care patients had higher arthritis self-efficacy scores than usual care patients at the post-discharge assessments (129.69 vs 110.29 and 161.00 vs 138.51; p<0.001) on a 20-200 scale where higher is better.
03Usual care patients had a higher mean hospital admission rate than transitional care patients at a reported time point (0.14 vs 0.00; p=0.023).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The trial was conducted at a single tertiary hospital in Turkey and enrolled only patients aged 50 and over who could speak Turkish, had a smartphone, and were being discharged home, so it may not apply to younger, non-Turkish, or less digitally connected patients. Most participants were women (90%) and had middle-school education, so the sample was narrow. The pandemic prevented in-person post-discharge follow-up and may have limited communication with patients. The transitional care package combined many components, so the study cannot show which part produced the benefits. No cost analysis was performed, so the effect on healthcare costs is unknown. Self-reported outcomes may have been influenced by patients' expectations or desire to please the researcher.
Declared interests
The authors declared no conflicts of interest. The paper does not report external funding.
The easy way to misread this
Do not assume the nurse-led transitional care package will reduce all readmissions or that every component is necessary. The readmission difference was significant at a reported time point, but not at all reported time points, and the intervention bundled education, counselling, phone follow-up, exercise reminders, medication guidance and complication advice, so its separate effects cannot be identified.