The Effect of Empowerment Program on the Self-Efficacy and Pain Control in the Patients under Arthroplasty referred to Tabriz Medical Centers 2016.

Abstract

Abstract:: Background and objectives: The knee replacement surgery, following knee osteoarthritis, is a treatment method for patients with osteoarthritis. It is associated with significant effects on limited range of motion from two perspectives: self-efficiency and motor function. Therefore, the improvement of pain and self-efficacy indices is very important. The aim of this study was to assess the effect of empowerment program on the self-efficacy and pain control in the patients under arthroplasty. We aimed to evaluate the effectiveness of empowerment on the pain control and self-efficacy of the patients undergoing total knee arthroplasty. Material and methods: This Randomized Clinical Trial was conducted on 98 patients hospitalized in the orthopedic department of Shohada and Shahid Mahallati Hospitals in 2016. The eligible patients were selected through convenience sampling then allocated into the intervention and control groups with a ratio of 1:1 using a randomized complete block design with four factors in RAS. First, the degrees of pain and self-efficacy in both groups were measured. Then, an empowerment program, based on Linton’s cognitive-behavioral model and Bandura's self-efficacy theory, was administered to the intervention group through  individual training, group discussion, practical participation and control group receive just routine-care. After intervention, pain and self-efficacy were measured again in order to collect the data with the short form McGill pain and self-efficacy questionnaires. Data were analyzed by SPSS software version 16. Findings: The two groups were similar in terms of demographic variables, baseline data of pain, and self-efficacy. The paired t-test results for intra-group comparison showed that after the intervention in the both groups, the subscales of pain (sensory-emotional components, intensity and description of pain) decreased and self-efficacy significantly increased (p<0.01). In addition, the independent t-test results for between-group comparison (intervention and control) showed no significant pre-intervention difference in terms of pain and self-efficacy (p<0.05) but the post-intervention between-groups comparison showed a significant difference in pain subscales as follows: sensory-emotional components (p<0.01, difference mean=- 2.41; 95% CI=-3.86--0.96), intensity pain (p<0.01, difference mean=- 1.57; 95% CI=-2.12--1.01), and pain description (p<0.01, difference mean=0.61; 95% CI=-1.04- -0.01). There was also a significant between-groups difference in term of self-efficacy (p<0.01, difference mean=0.98; 95% CI=0.71-1.24). The MANCOVA results showed that the effect of intervention remained significant even after the removal of confounding variables effect. In other words, between-groups comparison suggested a lower degree of pain (p<0.05) and higher level of self-efficacy in the intervention group after the implementation of  the empowerment program. Results showed that the administration of the empowerment program for the intervention group could reduce sensory-emotional component of pain by 11%, pain intensity by 33%, and pain description by 18.5% of the baseline. In addition, it improved self-efficacy in the intervention group by 286% of the baseline. Conclusion: In regard with the results empowerment program in patients 'undergoing TKA (total knee arthroplasty) as a feasible, effective and noninvasive approach, can be helpful in improving pain control and self-efficacy of patients