Impact of Nurse-Led Education on Postoperative Recovery in Orthopedic Patients

Thesis Abstract

Postoperative recovery after orthopedic surgery is significantly influenced by patient engagement, self-management, and adherence to rehabilitation protocols, yet optimal strategies to sustain these behaviors in hospital and early home settings remain inadequately defined. This study addresses the gap by evaluating the effectiveness of nurse-led education on improving functional recovery, pain management, and adherence to postoperative rehabilitation among orthopedic patients. The aim is to determine whether a structured, nurse-delivered educational intervention enhances postoperative outcomes compared with standard care. Specific objectives include (1) assessing changes in functional mobility as measured by the Timed Up and Go test and Harris Hip/Knee scores at discharge and six weeks post-surgery; (2) evaluating pain trajectories using the Numeric Rating Scale (NRS) across the first six weeks postoperatively; (3) examining adherence to prescribed physiotherapy regimens and home exercise programs via patient diaries and nurse-verified logs; (4) exploring patient knowledge and self-efficacy related to postoperative care using the Self-Efficacy for Managing Chronic Disease 6-Item Scale adapted for postoperative contexts; and (5) identifying mediating factors such as health literacy, social support, and discharge planning quality that influence recovery outcomes. A parallel-group randomized controlled trial will be conducted in two tertiary orthopedic centers, enrolling 260 adult inpatients aged 40–85 scheduled for hip or knee arthroplasty or fracture fixation. Participants will be randomly allocated to either the nurse-led education intervention plus standard care (n=130) or standard care alone (n=130). The intervention comprises a structured education program delivered by trained orthopedic nurse educators over three sessions preoperative risk communication and expectations, postoperative pain and wound care management, and structured home-based rehabilitation with outcome monitoring. Intervention fidelity will be ensured through standardized curricula, clinician checklists, and periodic supervision. Data collection will utilize validated instruments, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for function, the Visual Analogue Scale for pain, the Mini-Mental State Examination to screen cognitive suitability, and patient-reported diaries for adherence. Data will be collected at baseline (pre-surgery), at hospital discharge, and at six weeks postoperatively. Quantitative analyses will employ intention-to-treat principles. Descriptive statistics will summarize baseline characteristics. Inferential analyses will include repeated-measures ANOVA to compare functional and pain outcomes over time between groups, mixed-effects models to account for clustering by center, and multiple linear regression to identify predictors of recovery, adjusting for covariates such as age, sex, comorbidity, and type of surgery. Mediation analysis using bootstrapping will test whether health literacy and self-efficacy mediate the relationship between education and recovery outcomes. Qualitative components will be embedded through semi-structured interviews with a purposive subsample (n=40) of participants from both arms to explore perceived barriers and facilitators to adherence; thematic analysis will be conducted to triangulate quantitative findings and elucidate mechanisms of effect, guided by the Health Belief Model and Social Cognitive Theory. Expected findings anticipate that nurse-led education will significantly improve functional mobility and reduce pain trajectories, increase adherence to rehabilitation protocols, and enhance postoperative self-efficacy and health literacy. It is hypothesized that improvements will be mediated by enhanced patient knowledge, confidence in performing exercises, and effective discharge planning. The study will contribute to knowledge by providing robust evidence on the effectiveness and mechanisms of nurse-led educational interventions in orthopedic recovery, informing clinical guidelines, discharge planning, and policy development for postoperative care. The main conclusion is that structured nurse-led education augments postoperative recovery, with recommendations including integration of formal nurse education programs into standard perioperative pathways, routine assessment of health literacy and self-efficacy, and expansion of post-discharge telephonic or digital follow-up to sustain adherence and functional gains.