الفهرس 
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Abstract
Osteoarthritis is a non inflammatory degenerative disorder of the joints accompanied by varying degrees of functional limitation and reduced quality of life. Any synovial joint can develop osteoarthritis but knees, hips and small hand joints are the peripheral sites most commonly affected. Over half of patients with osteoarthritis have severe pain which can affect every aspect of a person’s daily life, and their overall quality of life. So, pain is the most frequent reason for patients to seek for surgical intervention (total knee Arthroplasty).
Knee arthroplasty is a surgical procedure to replace the weight bearing surfaces of the knee joint to relieve pain and disability. It is most commonly performed for osteoarthritis. It consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.
Exercise is an integral and very important part of the intervention immediately after knee arthroplasty. It is useful in improving range of motion and functional abilities, and helping to prevent muscle atrophy, deep vein thrombosis (DVT) and self care limitations. So, teaching module about exercises and safe crutch walking should be started preoperatively and done immediately postoperatively on the operation day regardless of the anesthesia used.
The aim of this study was:
To determine the effect of implementing a teaching module about exercises on crutch walking, range of motion and functional abilities of patients post knee arthroplasty.
Materials and method:
The study was carried out at the inpatient units of Hadara Orthopedic and Traumatology University Hospital, Alexandria. A convenience sample of 50 adult patients (21-60 yrs) scheduled for knee arthroplasty were included and assigned alternatively into two equal groups 25 patients in each group.
Tools of the study:
Four tools were used for data collection in this study:
Tool I: Sociodemographic and Clinical Data Structured Interview Schedule:
This tool was developed by the researcher. It was divided into two main parts:
Part I: Sociodemographic data.
Part II: Clinical data.
Tool II: Knee Functional Abilities Index:
This scale was developed by Craven and Hirnle (2009) to assess daily living activities and to provide information about a person’s functional abilities.
Tool III: Numerical Pain Rating Scale:
The Numeric Rating Scale was developed by Dazines (2008) for subjective estimation of patient’s level of pain.
Tool IV: Mobility Index of the Knee:
This tool was developed to collect pertinent data and it was divided into five parts.
Part I: Range of Motion of the Affected Knee:
This part was developed by the researcher using the goniometer to measure the flexibility of the knee joint in performing the range of motion (ROM) of the affected knee as flexion and extension.
Part II: Quadriceps and Hamstring Muscle Strength Scale of the Affected Knee:
It is a Likert scale developed by Stevens et.al (2003) to assess the strength of quadriceps & hamstring muscles.
Part III: Timed Up and Go Test:
This tool was developed by Podsiadlo and Richardson (2006) to evaluate gait and balance.
Part IV: Safe Performance of Crutch Walking Observational Checklist:
This checklist was developed by the researcher for assessing accurate performance while using crutches.
Part V: Safe Environment Observational Checklist:
This tool was developed by the researcher for assessing safety of the environment while using crutches.
Data collection:
A convenience sample of 50 adult patients scheduled for a knee arthroplasty were included and assigned alternatively into two equal groups; 25 patients in each group.
• group I: study group was exposed to teaching module about exercises..
• group II: control group was exposed to routine hospital care.
The study was carried out on four phases:
1- Assessment Phase:
Initial assessment was carried out for both groups (study & control) immediately once the patients were scheduled for knee arthroplasty (preoperatively) before application of a teaching module to collect baseline data using tools I, II,III and tool IV part I& II.
2- Planning Phase:
Based on the data obtained from the initial assessment phase and review of the related literature, the teaching module was developed individually for each patient. Media used were power point, pictures and videos and a colored booklet formulated by the researcher for the patients in the study group (I).
3- Implementation Phase:
The teaching module was implemented preoperatively individually according to hospital arrangement for each patient of the study group (I) in his room in the presence of one of the patient’s family member using demonstration, redemonstration and colored booklet. The teaching module was implemented in 6 successive sessions. The first three sessions were done preoperatively and the second three sessions were done postoperatively. Each session took approximately one hour.
4- Evaluation Phase:
All patients in both groups were evaluated three times immediately before the teaching module implementation, on the day of discharge, and one month post discharge in the outpatient clinic using tools II, III and IV.
The main results of the study were:
• More than two thirds (80 %) of study group patients and more than half (68%) of control group patients were in age group 51- 60 years.
• More than two thirds (84 %) of study group patients and more than half (56%) of control group patients were females.
• More than half (52%) of study and control group patients came from rural areas.
• A high percentage (80 %) of the study group patients and more than half (52%) of the control group patients were illiterate.
• The majority (84 %) of the study group patients were housewives and (48%) of the control group patients were manual workers.
• The study group patients (40 %) stayed in hospital for 7-8 days and more than half (56%) of the control group patients stayed in hospital for 8 days.
• There was a statistical significance between the study and control group patients regarding self care activities one month post teaching (Mc P5=0.030*).
• The difference was not statistically significant between the study and control group patients regarding motor activities.
• There was a significant difference between the study and control group patients regarding flexion of affected knee pre teaching (t= 14.896, p=0.000*), pre discharge (t= 7.385, p=0.000*) and one month post teaching (t=29.829, p=0.000*).
• There was a significant difference between the study and control group patients regarding extension of affected knee pre teaching (t= 7.827, p=0.000*), pre discharge (t= 5.580, p=0.000*) and one month post teaching (t=4.710, p=0.000*).
• There was no statistically significant difference among the study and control group patients related to their muscle strength.
• The difference was statistically significant between study and control group patients related to timed up and go test one month post teaching (Mc P5=0.000*).
• The difference was statistically significant between study and control group patients related to safe crutch walking pre teaching and one month post teaching.
• The difference between the study and control group patients was statistically significant regarding safe environment pre teaching, and one month post teaching.
The main recommendations are:
1. Patients with unstable knee arthroplasty should be instructed about range of motion exercises and safe crutch walking.
2. A colored illustrated booklet about exercises and safe crutch walking should be available and distributed for patients with knee arthroplasty pre surgical interference.