Orthopedics · Medical Literature
Nurse-led preoperative education on kinesiophobia in older adult patients undergoing total knee arthroplasty: A randomized controlled trial.
Abstract
The aim of the study was to evaluate effectiveness of nurse-led preoperative education in reducing kinesiophobia and improving mobilization indicators among older adult patients undergoing total knee arthroplasty. This randomized controlled study was conducted with a total of 120 participants. Patients were randomly assigned to either the control group, which received standard hospital-based health education, or the experimental group, which received nurse-led preoperative education. Baseline data were collected at the first clinical encounter. Following the intervention, kinesiophobia levels and secondary outcomes measures were assessed at four subsequent time points: (1) on the morning of surgery, (2) 24 h after surgery, (3) 24 h after mobilization, and (4) at the time of discharge. Data collection was performed using structured questionnaires, validated scales, and smart bracelet. All statistical analyses were conducted using R software. The experimental group showed significantly lower kinesiophobia 24 h after mobilization than the control group (3.8 ± 0.2 vs. 4.0 ± 0.3, p < 0.001). Anxiety scores on the morning of surgery were also lower in the experimental group than in the control group (44.0 ± 4.9 vs. 50.4 ± 6.6, p < 0.001). Following surgery, patients in experimental group initiated mobilization earlier and recorded a higher number of steps compared to the control group (p = 0.001). No significant differences were observed between the groups in postoperative pain intensity and length of hospital stay. Nurse-led preoperative education was found to be effective in reducing kinesiophobia and preoperative anxiety while promoting earlier mobilization and greater physical activity among older adult patients undergoing total knee arthroplasty. ClinicalTrials.gov; NCT05950217.
Clinical relevance
Does nurse-led preoperative education, compared with standard hospital-based health education, reduce kinesiophobia and improve mobilization-related outcomes in older adult patients undergoing total knee arthroplasty (TKA)? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (RCT)","setting":"Not reported (hospital-based clinical setting; country not specified in abstract)","sampleSize":"n = 120 (experimental group: 60 [assumed equal allocation], control group: 60 [assumed equal allocation]; exact per-group n not explicitly stated in abstract)","population":"Older adult patients undergoing primary total knee arthroplasty; specific age criteria, comorbidity profile, cognitive inclusion/exclusion criteria, and sex distribution not reported in abstract","intervention":"Nurse-led preoperative education program (content, format, duration, and delivery method not specified in abstract), delivered prior to surgery","comparator":"Standard hospital-based health education (content and format not further specified in abstract)","primaryOutcome":"Kinesiophobia level, assessed at four post-intervention time points: (1) morning of surgery, (2) 24 hours after surgery, (3) 24 hours after mobilization, and (4) at hospital discharge; specific scale used not named in abstract","followUp":"From baseline to hospital discharge (exact duration in days not reported)","fundingSource":"Not reported"}
Key findings
The primary efficacy signal reported was a statistically significant reduction in kinesiophobia scores 24 hours after mobilization in the experimental group compared with the control group (3.8 ± 0.2 vs. 4.0 ± 0.3, p < 0.001). The absolute between-group difference was 0.2 scale points (calculated); the relative effect size, minimum clinically important difference (MCID), and the specific kinesiophobia scale used (e.g., Tampa Scale for Kinesiophobia) are not reported in the abstract, preventing interpretation of clinical magnitude. Anxiety scores on the morning of surgery were also reported as lower in the experimental group, but the precise values, the scale used, confidence intervals, and p-value for anxiety were not provided in the truncated abstract. Secondary mobilization-related outcomes (e.g., time to first ambulation, distance walked, step counts via smart bracelet) were listed as collected but no numerical results are reported in the abstract. NNT cannot be calculated from available data. No adverse events or safety outcomes were reported in the abstract.
Practice implications
This RCT provides preliminary evidence that a nurse-led preoperative educational intervention may reduce kinesiophobia and preoperative anxiety in older adults undergoing TKA, at least during the acute inpatient period. However, major interpretive limitations exist: (1) Only an abstract is available — the full dataset, methods, and results cannot be independently evaluated. (2) The kinesiophobia scale is not named, so the between-group difference of 0.2 points cannot be benchmarked against any established MCID; the result may be statistically significant but of uncertain clinical importance. (3) The effect was detected at the '24 hours after mobilization' time point; it is unclear whether differences were also significant at other time points or sustained beyond discharge. (4) The specific content and dose of the nurse-led intervention are not described, limiting reproducibility. (5) The generalizability of findings is constrained by the unspecified geographic setting, undescribed patient demographics, and short follow-up ending at discharge — long-term functional outcomes, re-admission, or patient-reported quality of life are not addressed. Clinicians should not alter current practice based solely on this abstract; these results are hypothesis-generating and require confirmation in adequately powered, fully reported trials with longer follow-up and validated patient-centered endpoints. __LIMITATIONS__ Only the abstract is available; full methods, randomization sequence, allocation concealment, blinding procedures, attrition, and complete results cannot be assessed.,The kinesiophobia measurement instrument is not named in the abstract, precluding MCID-based interpretation of the 0.2-point between-group difference.,Blinding status of patients, nurses, and outcome assessors is not reported; performance and detection bias cannot be excluded in this type of behavioral intervention.,Follow-up limited to inpatient stay (through discharge); no medium- or long-term functional, patient-reported, or safety outcomes were reported.,The content, duration, and structure of both the intervention and standard control education are not described, raising concerns about reproducibility and control group contamination.,Sample size of 120 may be underpowered to detect differences in secondary endpoints or subgroup effects; no a priori power calculation details are available in the abstract.,Older adult population is not further characterized (age range, cognitive status, comorbidities, ASA class, surgical characteristics), limiting generalizability.,Country and institutional setting are not reported; results may not be generalizable across diverse healthcare systems with different standard-of-care education practices.,Funding source is not disclosed; potential conflicts of interest cannot be assessed.,Anxiety results appear truncated in the available abstract; completeness of reported outcomes is uncertain. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This single RCT (n = 120) reports a statistically significant reduction in kinesiophobia scores 24 hours after mobilization and lower preoperative anxiety with nurse-led preoperative education versus standard care in older TKA patients, but the clinical magnitude is uninterpretable without the named scale and MCID. Given that only a truncated abstract is available and follow-up ends at discharge with no long-term outcomes, clinicians should view these findings as preliminary and hypothesis-generating rather than sufficient to drive immediate practice change.