Research progress on self-efficacy in patients with total hip replacement

Xiao-Xiao Yang,Yuan-Yuan Chen,Fan-Jie Meng＊

1Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin 301617,China.2College of Health Engineering, Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China.

Abstract

Keywords:Total hip replacement,Psychological problems,Self-efficacy,Review

Background

With the continuous development of social economy,the increasing incidence of industrial and mining accidents, traffic accidents, osteoporosis and other reasons, hip fractures in young adults and elderly patients are becoming more and more common, which account for 7.01% of total body fractures [1].The elderly over 50 years old are the main population, hip fractures account for 23.79% of total body fractures in the elderly over 65 years of age [1].Total hip replacement (THR) is an artificial hip joint prosthesis that replaces the damaged femoral head and acetabulum of the human hip joint to relieve joint pain,correct deformities, restore and improve joint motor function.Although total hip arthroplasty has a good postoperative effect,due to the relatively large surgical trauma, and the majority of patients undergoing THR are elderly, the functional decline of various organs,postoperative complications are easy to occur, which brings a great negative effect on the psychological and physiological of patients.However, due to limited physical activity, postoperative functional recovery needs a long time, and patients are prone to a series of negative psychological problems such as depression,anxiety and lack of confidence, which seriously affect their functional recovery and quality of life [2].After THR, the patient has obvious motility symptoms of fear of movement due to pain, limb movement inconvenience and other reasons, and will show a series of manifestations such as fear of activity and fall.For people with high self-efficacy, the degree of activity and fear of fall is lower, with a good mental state.

Self-efficacy was proposed by Bandura in 1977 [3].It is derived from social cognitive theory.It is the individual's subjective judgment in a certain situation,and the individual's confidence in the ability to complete a certain behavior and achieve the expected results [4].A high or low level of self-efficacy helps determine how much effort an individual puts into a given situation, how much he or she can persevere in the face of obstacles, and how adaptive he or she is in the face of adverse conditions.The higher the self-efficacy, the greater the effort, perseverance and adaptability[5].Self-efficacy has the ability to explain,modify and predict the behavior of patients.Since Bandura put forward self-efficacy,this theory has been widely valued and applied, especially in the self-management of patients with arthritis [6],hypertension [7], diabetes [8] and other chronic diseases.At present,many scholars pay more and more attention to the research on the self-efficacy of hip replacement patients.Through these studies to understand how to improve patients' self-efficacy and reduce the fear of activity,obtain postoperative activity related knowledge, finally promote the limb functional recovery.

Factors influencing self-efficacy in patients with THR

Demographic factors

Demographic factors related to THR included age,sex,marital status, medical insurance, education, etc.Multiple studies have shown that self-efficacy of patients is negatively correlated with age, that is, with the increase of age, self-efficacy of patients gradually decreases, and self-efficacy of female patients is lower than that of male patients[9,10].Patients'self-efficacy is also related to their marital status.For patients who are married or cohabiting with others, their self-efficacy is higher, which may be related to the support and help from others.Patients are more likely to overcome difficulties when they feel the support from their family.Self-efficacy is also related to medical insurance.Compared with self-funded patients,patients with medical insurance have a higher sense of self-efficacy and cooperate with treatment more actively, which may be related to the fact that patients with relatively ordinary economic conditions need to bear greater economic pressure [11].The degree of education is positively correlated with the self-efficacy of THR patients.The higher the degree of education,the higher the sense of self-efficacy, which may be related to the patients with higher education ability to deal with problems, the ability to actively seek information related to various diseases, and the strong self-confidence.

Disease related factors

Disease related conditions include type of surgery(unilateral or bilateral), presence of other complications, postoperative time, pain, ability to care for oneself, etc.Studies have shown that unilateral THR patients have a higher sense of self-efficacy than bilateral THR patients [12].Preoperative complications of other diseases have a negative correlation with self-efficacy,and the more the number,the lower the self-efficacy, which may be related to more preoperative complications of elderly patients and a relatively high incidence of postoperative complications,resulting in patients'low enthusiasm for functional exercise and confidence in coping with difficulties [12, 13].The study of Kuan-Ting Wu [10]found that there was a significant correlation between exercise self-efficacy and postoperative time, that is,patients with longer postoperative time have a higher sense of self-efficacy.Studies have found that THR patients have a negative correlation between self-efficacy and postoperative pain.Patients with higher self-efficacy have lower pain performance,which may be because the patients with high self-efficacy have strong ability to relieve pressure and manage postoperative pain[14,15].The study of Zhou et al.[9] showed that patients' self-care ability was positively correlated with self-efficacy.Patients with better self-care ability had a relatively high level of self-efficacy, which might be related to patients with stronger self-care ability having stronger confidence in rehabilitation exercise.

Psychological status related factors

A number of studies have shown that negative emotions such as anxiety and depression are negatively correlated with patients' self-efficacy, that is, the more serious the patients' anxiety and depression are, the lower their self-efficacy level will be.The results of Zhang et al.[16] showed that higher self-efficacy was beneficial to patients to improve their exercise compliance, promote joint function recovery, and reduce negative emotions such as depression and anxiety.Chen et al.[17] showed that psychological resilience was positively correlated with self-efficacy,and self-efficacy was a positive factor of psychological resilience.The stronger the patient's self-efficacy, the higher the level of psychological resilience.Patients with a relatively high level of self-efficacy have a better understanding of the disease and a stronger confidence in coping with it.They can correctly view various adverse reactions caused by the operation, and then actively take effective coping measures, so they have a higher level of psychological resilience.

Research tools

At present, the universal scale is used at home and abroad:the general self-efficacy scale [18] and the specific scales for evaluating the self-efficacy of THR patients are less.Some researchers adjust other specific scales according to the research purpose, such as:①orthopedic self-efficacy scale,this scale was developed by Pellino in 1998 to evaluate the confidence of orthopedic surgery patients in completing tasks during perioperativeperiod[19];②self-efficacy rehabilitation outcome scale (SER), developed by Waldrop in 2001, measures the confidence of patients in their effective completion of rehabilitation exercises[20]; ③ arthritis self-efficacy scale, developed by Lorig is mainly used to measure patients'confidence in effective adjustment of psychological,activity and pain[21]; ④pain self-efficacy questionnaire, developed by Nicholas in 1980, was uesd to assess the confidence of patients with low back pain in achieving specific goals during pain [22]; ⑤self-efficacy expectation scale,developed by Seeman in 1999, was used to evaluate the confidence of elderly patients undergoing hip surgery to complete specific activities within the required time [23]; ⑥self-efficacy functional ability scale, which was developed by Resnick in 1998, was used to evaluate patients' confidence in their ability to perform daily activities [24].Foreign scholars believed that (SER) can be specifically used to evaluate the intervention effect of increasing self-efficacy of total hip and knee replacement patients, and it is a scale specially designed for self-efficacy of joint replacement patients.However,there are relatively few domestic studies on the use of SER.In the field of THR, the self-efficacy measurement tools in China need to be further studied.

Intervention methods for self-efficacy in patients with THR

Health Belief Model(HBM)

HBM is the main theoretical model for explaining health-related behavior through social psychology methods, often used to conduct health education and predict human health behavior [25, 26].Miao [27]divided the patients into HBM group and the control group,respectively give HBM nursing intervention and conventional HBM intervention through lecture,reading brochures, watch the multimedia way, aims to enhance the patients' health belief, let patients fully understand the importance of early postoperative rehabilitation training, and to encourage patients with early rehabilitation training.The results showed that HBM nursing model significantly improved the postoperative hip function of THR patients, and improved the self-efficacy and rehabilitation compliance.Zeng et al.[28] also found that the implementation of HBM nursing model for patients was conducive to improving patients' compliance with postoperative rehabilitation training and self-efficacy,and effectively reduced patients' anxiety, depression and other negative emotions.

Self-efficacy management

According to the formation and development of self-efficacy, self-efficacy management can be carried out from the following aspects:psychological support,direct experience, social support, and indirect experience [29, 30].Psychological support:psychological support is especially important for patients.Patients experience joint pain and limited mobility for a long time before surgery.Therefore,patients should be guided to conduct their own psychological adjustment, and detailed disease-related knowledge should be explained to patients,encouraging patients to carry out progressive rehabilitation training after surgery, so as to improve their rehabilitation and exercise compliance.Direct experience:based on the patient's own experience,divide the rehabilitation and exercise methods to be mastered into several small goals that are easy to achieve.The completion of each small goal will make the patient more confident, enhance the sense of self-efficacy, and facilitate the realization of the next goal.For the goal of successful completion, full encouragement should be given; for the failure to complete the goal, medical staff should actively discuss with patients, analyze the reasons, encourage patients to overcome difficulties, strive to achieve the goal.Indirect experience:play the role of peer education [31].The successful experience of others will affect the patients who are in the recovery period to some extent.They can invite patients with higher self-management behaviors and better recovery after joint replacement to introduce experience and experience to other patients, so that patients can learn from each other and further enhance the patient's self-confidence.Social support:family and social support are positively correlated with self-efficacy.At the same time of self-efficacy intervention, family members should participate in the whole process.Care and support from people around can increase patients'determination to overcome difficulties and enhance their self-efficacy.

Other intervention methods

Cooke [32] believe that pre-operative education encourages patients to play a central role in the rehabilitation process, promote sustainable long-term positive results,promote high-quality care and improve patients' confidence in overcoming difficulties.Dohnke [33] found that self-efficacy can be enhanced through routine multidisciplinary inpatient rehabilitation programs that include exercise therapy,occupational therapy, and patient education.Focused solution model is a kind of clinical nursing model developed according to psychology that respects and believes in individuals.The key is to fully tap the resources, advantages and potential of individuals.Zhang et al.[34] applied the focused problem-solving follow-up management model to the observation group,and continuously encouraged, empowered, explored the target,and formulated and implemented the patient.After intervention, the results showed that patients'self-efficacy score and self-care ability were significantly higher than those of the control group.It is suggested that focused solution mode can improve the self-efficacy level of THR patients, improve their self-care ability, and promote the recovery of hip function.Huang [35] carry out empowerment education for patients, and use the methods of“partnership, listening, dialogue, reflection, action and feedback” to improve patients' self-awareness of their own situation, assess the root cause of problems, set goals and design personalized self-care.The researchers provided support and counseling,encouraged patients to make self-determination, and motivated patients to participate in the action.The results showed that the self-care ability and self-efficacy of the empowerment education group participants were significantly higher than the control group,and the depression tendency was reduced.

Effect of self-efficacy on rehabilitation behavior and outcome in patients with THR

Impact on activity capacity

THR patients' compliance to rehabilitation and exercise decreased due to postoperative pain and limb dysfunction,resulting in decreased activity ability[36].Rehabilitation exercise self-efficacy refers to the degree of confidence that patients can effectively complete various rehabilitation exercise programs.A number of researchers conducted a correlation study between the self-efficacy level of THR patients and the joint function of patients.It was found that joint function has a significant positive predictive effect on exercise self-efficacy, which shows that the joint function in patients with the better,to be able to finish the exercise program more confidence, self-efficacy level is relatively high [37, 38].Hu et al.[39]randomly divided 64 patients into the experimental group and the control group.The control group was given routine nursing care and health education after orthopedic surgery; the experimental group was given nursing measures to enhance patients' self-efficacy on the basis of the control group.The results showed that the Harris score at 1 and 3 months after the operation was significantly higher than that of the control group.It showed that the application of self-efficacy theory can fully mobilize the self-potential of elderly patients after THR,increase self-confidence,improve the effect of functional exercise and improve hip function.Dohnke [33] found that the higher the perception of disability,the higher the level of self-efficacy,the more patients may put more effort into exercise, in which case the patient may gain more muscle strength,so that increased joint stability and increased mobility.

Impact on mental state

Kuan-Ting [10] showed that social support is a factor influencing the self-efficacy of THR patients.There is a significant positive correlation between self-efficacy and social support, and it is a strong predictor of the psychological status of patients with THR.It improves patients' self-efficacy and provides corresponding social support, which helps prevent negative emotions of patients.Magklara [40] believed that negative emotions were correlated with lower psychological well-being, while general self-efficacy beliefs were positively correlated with psychological well-being.Patients with high self-efficacy also have higher psychological well-being, and the mental health of patients undergoing joint replacement is related to the preoperative cognitive and emotional response to the disease.Zhang et al.[16] conducted self-efficacy intervention on the basis of routine nursing in the observation group, and evaluated the intervention effect two weeks later.The results showed that the level of self-efficacy was significantly improved after the intervention, and the scores of anxiety and depression were significantly lower than those of the control group, suggesting that self-efficacy intervention could effectively improve the psychological state of THR patients.

Impact on quality of life

Studies have shown that self-efficacy can predict the quality of life of patients with THR.Zhan [41]conducted a correlation study on the self-efficacy and quality of life of patients with THR, showing that they are positively correlated, and can improve the quality of life of patients by implementing self-efficacy intervention.Pan et al.[22] performed self-efficacy intervention on patients based on routine nursing.The self-efficacy assessment was performed using the orthopedic self-efficacy scale three months after surgery.The results showed that intervention could mobilize patients' potential, improve their physical and mental health, restore joint function, improve rehabilitation training ability and quality of life

Deficiency and prospect

The research on self-efficacy in THR started late.At present, the research on self-efficacy of patients with hip replacement in China has the following deficiencies.①There is a lack of targeted self-efficacy measurement tools.At present,at home and abroad,the general self-efficacy scale is used to measure the self-efficacy of patients with THR, and the specificity scale is relatively small,so need more actively research aiming at the localization of THR patients self-efficacy measuring tool, module, more scientific and professional assessment level of self-efficacy and its changes in patients with THR.② The study of influencing factors is not comprehensive.The sense of self-efficacy is mainly established through personal experience of success or failure,alternative experience,verbal persuasion, and physical and emotional states.At present, research in China mainly focuses on the impact of sociodemographic characteristics (such as age, gender, education, etc.) and social support on the self-efficacy of patients undergoing THR.Whether alternative experiences, physiological and emotional states play a role in patients'self-efficacy needs further exploration.③ Formulate practical interventions.Because the patient's self-efficacy gradually changes with the changes of the environment and individuals,it is in a dynamic change, it is necessary to formulate feasible intervention plans for patients, apply the self-efficacy theory to treatment and rehabilitation exercise, so as to form a correct coping style for patients and promote their recovery.

In summary, the positive effect of self-efficacy on the activity ability, psychological state and quality of life with THR patients has been recognized by many researchers, and how to better combine self-efficacy theory with intervention measures to alleviate patients'pain and functional recovery is still the research goal of many scholars.Given the predictive value of self-efficacy for health improvement, greater efforts should be made to improve self-efficacy during THR and subsequent rehabilitation[42].