全膝關節置換術後病人延遲下床活動之改善專案

Out-of-bed activities improvement project for patients with TKR

黃靜怡(Yi-Ching Huang) ； 李怡珍(Yi-Chen Lee)

《高雄護理雜誌》 35卷3期 (2018/12) Pp. 37-47

https://doi.org/10.6692/KJN.201812_35(3).0004

摘要

本專案的目的在於增強全膝關節置換術後病人的肌力，以改善延遲下床活動比率，減少住院天數。由於全膝關節置換術病人下床肌力強度不足，病人於術後第三天仍無法下床活動持續行走3公尺以上，導致延遲出院，引發本專案改善動機。經團隊運用決策矩陣提出解決辦法：1.修訂全膝關節置換術後照護衛教單、2.制定全膝關節置換術後早期復健計畫標準作業流程、3.舉辦全膝關節置換術後下床活動在職訓練、4.製作全膝關節置換術後早期復健衛教影片、5.調整輔具設定量、6.與輔助中心協調輔具租借方式。實施後病人可於術後第三天下床活動步行3公尺，延遲下床活動率由73.3%下降至9.4%。

關鍵字

全膝關節置換術 ； 下床活動 ； 早期復健計畫

並列摘要

This project aimed to improve muscle strength for patients with Total Knee Replacement (TKR) surgery and subsequently to decrease the percentage of patient's time on bed and hospital days. Seeing that weakness in the legs of patients with TKR who were not capable of walking three meters straight from the bed even on the third day after surgery caused discharge delay, this project was triggered to improve this problem. Based on our team's decision matrix, we addressed some solutions: firstly, work on amendment of TKR healthcare leaflets; secondly, stipulate SOP of TKR earlier rehabilitation program; thirdly, organize out-of-bed training activities; fourthly, make films for presenting TKR earlier rehabilitation program; fifthly, adjust the permissible level of using mobility devices; and sixthly, coordinate the rental service with mobility device center. As a result, after implementing the project solutions, patients were capable of walking three meters straight on the third day after TKR surgery and the delay in patient's movement out of bed decreased substantially from 73.3% to 9.4%.

並列關鍵字

Total knee replacement surgery ； out-of-bed activities ； earlier rehabilitation program

參考文獻

徐子雯、林彣芷、何宗翰、何啟傑、蕭珮琦、董莉貞、周偉倪(2014)．台灣老年髖骨骨折病患特色分析以及術後住院期間復健治療之使用狀況．台灣復健醫學雜誌，42(1)，63-68。

陳昕霓、蔡美菊、陳獻崴(2012)．提升人工關節置換術後病人床邊復健運動之效益．新台北護理期刊，14(2)，53-62。

廖斐瑛、歐香縫(2016)．提昇骨科下肢術後病人復健運動執行率．榮總護理，33(3)，275-282。

Khan, F., Ng, L., Gonzalez, S., Hale, T., & Turner-Stokes, L. (2008). Multid isciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy (Review). Cochrane Database of Systematic Reviews, (2), 1-55. doi:10.1002/1465 1858.CD004957.pub3.

Labraca, N. S., Castro-Sánchez, A. M., Matarán-Penarrocha, G. A., Arroyo-Morales, M., Sánchez-Joya, M. D. M., & Moreno-Lorenzo, C. (2011). Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty : Randomized clinical trial. Clinical rehabilitation, 25(6), 557-566.