The relationship between multidisciplinary discharge outcomes and functional status after total hip replacement.

Abstract

To determine changes in functional status after primary total hip replacement and to explore the relationship between functional status and pain and mobility at time of hospital discharge. Descriptive correlational with a prospective cohort. 21 elective primary total hip arthroplasty patients, ages 40 to 78, in an academic health center. Subjects' functional status was measured using the Sickness Impact Profile and the hip outcome tool (Revised Hip Type Specification Tool 13.1), completed by face-to-face interview approximately 2 weeks prior to hospitalization. Pain and mobility were assessed at time of discharge, and the functional status measures were repeated at 3 months after hospital discharge by mail. Statistically significant changes were found for physical and psychosocial dimensions of functional status, using the Sickness Impact Profile and the hip outcome tool, between the preoperative and postoperative measures. A significant relationship between mobility and pain at the time of discharge and functional status was not established. Hospital discharge criteria related to pain and mobility should be used with caution. In addition to pain and mobility information, patient education should reflect knowledge of what can be expected by 3 months postsurgery, including expected and potential improvements in mobility, pain, and ambulation and in nonphysical dimensions, such as sleep, home management, and social interaction. Case management and discharge planning should reflect the wide variance in pain and mobility across patients at time of discharge and the expected gains in specific aspects of functional status after discharge. Research attention should be increased on the identification and application of specific discharge criteria such as pain and mobility levels, and the further development and refinement of nursing-sensitive and practical functional status outcome measures.