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Patient Engagement And Coaching After Total Joint Replacement (TJR)

Patient Engagement And Coaching After Total Joint Replacement (TJR)

Total Joint Replacement (TJR) surgery is one of the most common surgeries during old age. Surgery is the beginning of long-term care for a patient undergoing a joint replacement. Most of the time patients lack postoperative-care information and end up causing irreplaceable harm to themselves.

Successful healing and prevention of complications depend on the active patient and family participation. It requires a comprehensive learning plan covering pain management, physical therapy, anticoagulation, and signs and symptoms of postoperative complications.

With the increasing day care surgeries and reduced length of stay at the hospital, self-care is inevitable and highly recommended for a better operative outcome (Loft, McWilliam, & Ward-Griffin, 2003; Prouty et al., 2006). Proactive reaching out to the patient in the comfort of their home is more effective than waiting for patients to call.

Research indicates that patients do not realize the importance of discharge education until they are in the home environment (Bostrom, Caldwell, McGuire, & Everson, 1996). Hence, there is a need for additional reinforcement of teaching after discharge (Davison, Moore, MacMillan, Bisaillon, & Wiens, 2004).

Discharge telephone calls provide an opportunity for effective symptom management (Czarnecki, Garwood, & Weisman, 2007) and have been used to evaluate and proactively address complications (Dutkiewicz, 2010). Studies around the world illustrate the benefits of Nurse-led follow-up call and pain coaching in patients with Total joint replacement surgeries.

A 2014 publication in Evidence-Based Practice Project Reports by Jones, Laurie J., “The Effect of Telephone Follow-Up on Pain Experienced by Patients After Knee Replacement Surgery” (2014). Evidence-Based Practice Project Reports signifies the importance of structured telephonic support by nurses for patients who had gone knee replacement surgery.

Mazaleski(2011) states that patients and families who attended preoperative educational classes feel anxious about the surgical procedure and don’t think ahead to the postoperative recovery period.

Providing contact information to the patient for questions and concerns does not always work. Barksdale and Backer (1998) found that most patients did not take the initiative to contact their healthcare providers with questions or for clarification regarding their plan of care. A study by Czarnecki et al. (2007) also demonstrated the reluctance of patients to contact a healthcare provider once they were home. More importantly, findings suggest that patients with the greatest need for support are least likely to initiate contact with their healthcare provider. Costa et al. (2011) reported that patients felt medication questions, for example, could be left unanswered until the doctor’s appointment weeks later.

Postoperative care gap is identified after the patient reach home and is faced with the realities of adjusting to the home environment. Many a time, patients don’t think of questions they want to ask until discharged. The patients usually lack knowledge and would rarely reach out for help. The problems of postoperative patients are multidimensional and require complete attention. Many studies conclude that post-discharge phone calls provide education at a time when it is most meaningful for patients and their families. Combining minimally invasive techniques with a holistic postoperative program will yield more rapid recovery.


  1. Chen M, Li P, Lin F. Influence of structured telephone follow-up on patient compliance with rehabilitation after total knee arthroplasty. Patient preference and adherence. 2016;10:257-264. doi:10.2147/PPA.S102156.
  2. Unfulfilled Expectations After Total Hip and Knee Arthroplasty Surgery: There Is a Need for Better Preoperative Patient Information and Education. Tilbury C, Haanstra TM, Leichtenberg CS, Verdegaal SH, Ostelo RW, de Vet HC, Nelissen RG, Vliet Vlieland TP. J Arthroplasty. 2016 Oct;31(10):2139-45. doi: 10.1016/j.arth.2016.02.061. Epub 2016 Mar 17.
  3. The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med. 2006 Jan;34(1):128-35. Epub 2005 Oct 11.