Patient Engagement in a Mobile App-Based Rehabilitation Program for Total Hip or Knee Arthroplasty: Secondary Data Analysis of a Randomized Controlled Trial.

BACKGROUND: Health care professionals use mobile apps to support patients' rehabilitation after total hip or knee arthroplasty. Understanding patient engagement in such mobile health interventions can help tailor these interventions to better support patients. OBJECTIVE: This study aimed to investigate patient engagement in a mobile app-based arthroplasty rehabilitation program and to investigate the association between patient engagement and their characteristics. METHODS: Data were extracted from a pool of 42 participants in the experimental arm of a randomized controlled trial that used a mobile app (WeChat [Tencent Holdings Limited])-based program to support patients' rehabilitation after total hip or knee arthroplasty. The primary outcomes were the number of days the participants accessed the program and completed recommended rehabilitation tasks. Secondary outcomes included data on the participants' posts on a discussion forum, messages sent by the participants, access to the program components, and reading and sharing the program content. Generalized linear models were used to analyze the association between patient engagement and personal characteristics. RESULTS: The participants reported in a rehabilitation diary accessing the program on a mean of 5.2 (SD 2) days per week and completing recommended rehabilitation tasks on a mean of 6.5 (SD 0.8) days per week. The majority (31/42, 74%) posted on the discussion forum, with a mean of 18.1 (SD 21.2) posts. Most participants (37/42, 88%) sent messages to health care professionals, with a mean of 14 (SD 15.9) messages. The program components were visited for a total of 525 times. The program content was read 898 times and shared 82 times in total. Generalized linear models showed that both primary outcomes, the number of days the participants accessed the program (B=6.46, 95% CI 1.98-15.35; χ21=11.1, P=.001) and the number of days they completed rehabilitation tasks (B=2.65, 95% CI 0.45-5.48; χ21=5.7, P=.02), were positively associated with having a high school education or above. In addition, the number of posts on the discussion forum was positively associated with living with family, having a high school education or above, undergoing total knee arthroplasty, having comorbidities, and the score of self-efficacy but was negatively associated with age. The number of messages sent by the participants was positively associated with having a high school education or above, having comorbidities, and the score of self-efficacy. CONCLUSIONS: Patient engagement in mobile arthroplasty rehabilitation is associated with their education level, cohabitation status, age, type of surgery, presence of comorbidities, and sense of self-efficacy. Program developers can consider these characteristics and use strategies, such as family involvement, in the design of mobile arthroplasty rehabilitation programs to enhance patient engagement in such interventions. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000867897; https://tinyurl.com/mtdw25fp.

Decision-making experiences related to mastectomy: A descriptive qualitative study.

AIM: To obtain an in-depth understanding of women's decision-making experiences related to mastectomy. DESIGN: A descriptive qualitative interview study. METHODS: Individual semi-structured interviews were conducted face-to-face with 27 Chinese women with breast cancer who underwent mastectomy at two tertiary hospitals in mainland China between September 2020 and December 2021 after obtaining the appropriate ethical approvals. Interviews were conducted in Mandarin. Data were analysed using inductive content analysis. RESULTS: Mean age of participants was 48 years (range 31-70). Most participants had low education, low monthly family income, had a partner and health insurance, had been diagnosed with early breast cancer, and had not undergone reconstructive surgery. Six categories related to decision-making experiences emerged: (1) Emotions affecting decision-making, (2) Information seeking for decision-making, (3) Beliefs about mastectomy and the breast, (4) Participation in decision-making, (5) People who influence decision-making, and (6) Post-decision reflection. Participants did not mention the role of nurses in their decision-making process for mastectomy. CONCLUSIONS: This study adds valuable insights into the limited evidence on women's experience with decision-making about mastectomy from a Chinese perspective, which is important given the continuing high prevalence of mastectomy in many regions. Future studies from other countries and ethnic groups are recommended to gain diverse knowledge. IMPACT: The findings of this study are useful for nurses and other healthcare professionals in the multidisciplinary team to better support women with breast cancer in their decision-making process regarding mastectomy. The findings could inform future interventions to support treatment decision-making and may be relevant to women living in similar socio-medical contexts to those in mainland China. REPORTING METHOD: The study was reported following the Standards for Reporting Qualitative Research checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Patients' experiences of using a mobile application-based rehabilitation programme after total hip or knee arthroplasty: a qualitative descriptive study.

BACKGROUND: An increasing number of patients are discharged from a total hip or knee arthroplasty with a short length of hospital stay. Technologies, such as mobile applications, are used to provide remote support to patients' postoperative rehabilitation. Patients' experiences of receiving mobile application-based rehabilitation after total hip or knee arthroplasty have not been investigated extensively. METHODS: This was a qualitative descriptive study. Twenty-five participants who had completed a mobile application-based rehabilitation programme for total hip or knee arthroplasty were recruited. Semi-structured interviews were conducted via telephone between July 2021 and January 2022 regarding the participants' experiences using the programme. All interviews were audio-recorded and verbatim transcribed. Data were analysed using inductive content analysis. The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Data analysis revealed five categories: (a) improved access to health care, (b) encouraged postoperative recovery, (c) established supportive relationships, (d) facilitated learning, and (e) future directions. CONCLUSION: The theory-underpinned mobile application-based rehabilitation programme demonstrated potential value in supporting patients' rehabilitation after arthroplasty. Nurses can consider using mobile technologies to expand their role in arthroplasty rehabilitation and improve the quality of rehabilitation care.

Decisional Conflict, Patient Involvement, and the Associated Psychological Factors Relating to Mastectomy Decisions Among Women With Breast Cancer: A Cross-sectional Study.

BACKGROUND: Most women with breast cancer in China have received a mastectomy despite emerging breast-conserving alternatives. Their decision-making relating to mastectomy is unclear. OBJECTIVE: To investigate decisional conflict, women's involvement, and psychological factors relating to mastectomy decisions. METHODS: Women with breast cancer 18 years and older who had a mastectomy were recruited from 2 hospitals in China. A conceptual framework adapted from the Ottawa Decisional Support Framework was used to guide this study. Data were collected using the 16-item Decisional Conflict Scale, the 9-item Shared Decision-Making Questionnaire, and a 19-item psychological factor list. RESULTS: A total of 304 women participated. Overall, they reported a low-level conflict and high-level involvement. "Cancer not return" was rated as the most important psychological factor influencing mastectomy decisions. Lower decisional conflict was predicted by higher involvement. Higher involvement was predicted by younger age and increased family income. CONCLUSIONS: This study is the first to demonstrate decisional conflict, involvement, and the associated factors specifically in Chinese women undergoing mastectomy. Results determined the importance of several psychological factors influencing mastectomy decisions. Future qualitative studies are required to deepen understanding of women's decision-making experiences regarding this surgery. IMPLICATIONS FOR PRACTICE: Nurses need to provide support to Chinese women in making treatment decisions, especially for older women, and those who are economically disadvantaged. Measures are needed to promote their involvement and improve their understanding of breast cancer and its treatments, which may help reduce decisional conflict, and potentially improve their satisfaction with treatment and quality of life.

The effectiveness of a mobile application-based programme for rehabilitation after total hip or knee arthroplasty: A randomised controlled trial.

BACKGROUND: Total hip arthroplasty and total knee arthroplasty are widely performed worldwide. Patients undergoing total hip or knee arthroplasty are often discharged after a short hospital stay. Using information and communication technologies, such as mobile applications, to provide rehabilitation services remotely may be a strategy to support patients' postoperative recovery. OBJECTIVE: This study aimed to evaluate the effectiveness of a rehabilitation programme delivered via a mobile application among Chinese patients after total hip or knee arthroplasty. DESIGN: Randomised controlled trial. SETTING: A teaching hospital in Shanghai, China. PARTICIPANTS: Eighty-six patients who received a unilateral primary total hip or knee arthroplasty. METHODS: The participants were recruited in the hospital and randomised into either the experimental or control group. Once discharged from the hospital, the control group (n = 43) received usual care, and the experimental group (n = 43) received usual care plus a 6-week mobile rehabilitation programme. Outcomes were assessed three times: the day before hospital discharge and 6 and 10 weeks after discharge. Primary outcomes were the changes in scores of self-efficacy and patient-reported physical function from baseline to 6 weeks post-discharge. Secondary outcomes included changes in scores of pain, depression, anxiety, and health-related quality of life. Data were analysed using generalised estimating equations. RESULTS: At 6 weeks after hospital discharge, the experimental group showed statistically significant improvements compared to the control in scores of self-efficacy (adjusted mean difference = 0.72, 95% CI 0.31 to 1.14, P < .001) and patient-reported physical function (adjusted mean difference = 4.57, 95% CI 1.24 to 7.90, P = .007). The between-group difference in self-efficacy probably reached clinical significance. At week-10 follow-up, the experimental group had statistically significant improvements in scores of self-efficacy (adjusted mean difference = 0.64, 95% CI 0.33 to 0.95, P < .001), health-related quality of life (adjusted mean difference = 0.06, 95% CI 0.01 to 0.10, P = .018), anxiety (adjusted mean difference = -0.51, 95% CI -0.91 to -0.10, P = .015), and depression (adjusted mean difference = -0.37, 95% CI -0.66 to -0.08, P = .012). The between-group difference in self-efficacy and health-related quality of life may be clinically significant. CONCLUSION: Mobile application-based rehabilitation demonstrated potentially positive effects on patients' self-efficacy, patient-reported physical function, health-related quality of life, and levels of anxiety and depression. TRIAL REGISTRATION: Registered with the Australian New Zealand Clinical Trials Registry on 6 July 2021 (ACTRN12621000867897).

The effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty: A systematic review and meta-analysis of randomised controlled trials.

INTRODUCTION: The aim of this review was to systematically evaluate the available evidence on the effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty regarding pain, range of motion, physical function, health-related quality of life, satisfaction, and psychological well-being. METHODS: This was a systematic review with meta-analysis based on the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Studies published in English or Chinese were searched using defined search periods, databases, and search terms. Two reviewers assessed independently the quality of studies. RevMan 5.3 was used for meta-analysis. Heterogeneity was assessed using the χ2 and I2 statistic. A random effect model and mean difference (MD) with 95% confidence interval (CI) was adopted. Standardised mean difference (SMD) was used if the outcome was measured by different scales. RESULTS: Eleven studies with 1020 participants were analysed. Compared to face-to-face rehabilitation, internet-based telerehabilitation showed no significant difference in outcomes of pain (SMD-0.11, 95% CI-0.32 to 0.10), range of motion in flexion (MD 0.65, 95% CI-1.18 to 2.48) and extension (MD-0.38, 95% CI-1.16 to 0.40), patient-reported physical function (SMD 0.01, 95% CI-0.15 to 0.17), health-related quality of life (SMD-0.09, 95% CI-0.26 to 0.07), satisfaction (SMD-0.04, 95% CI-0.21 to 0.14), and psychological well-being (SMD 0.10, 95% CI-0.13 to 0.33). Internet-based telerehabilitation showed better outcomes in physical functional tests (SMD-0.54, 95% CI-1.08 to-0.01). DISCUSSION: This review suggests that internet-based telerehabilitation has comparable effectiveness to face-to-face rehabilitation on rehabilitation outcomes among patients after total joint arthroplasty.

The effectiveness of social media intervention in people with diabetes: An integrative review.

AIM: This integrative review aimed to synthesise the available quantitative and qualitative studies on the effectiveness of diabetes self-management education (DSME) delivered through social media on glycaemic control (HbA1c), knowledge, health-related quality-of-life (HRQoL), anxiety, depression and self-efficacy in people with diabetes mellitus. BACKGROUND: DSME is the main component of diabetes management which contributes to behavioural changes and the improvement of metabolic control and self-monitoring skills. Due to limited face-to-face access to healthcare services, social media has increasingly been used to deliver DSME for people with diabetes. However, there is a paucity of reviews addressing the effectiveness of using social media in delivering DSME. DESIGN: An integrative review was conducted based on Whittemore and Knafl's (2005) methodology. METHODS: The following databases were searched for relevant studies published between 2000 and 2020: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, PsycINFO, EMBASE, EMCare and Google Scholar. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The PRISMA checklist for systematic reviews was used. RESULTS: A total of 13 studies met the inclusion criteria and were included in this review. Facebook and WhatsApp were the most common social media platforms used to deliver DSME intervention. Nurses were the most frequent DSME providers. The duration and content of DSME in the reviewed studies varied. Consistent positive outcomes were found on glycaemic control, diabetic knowledge and self-efficacy. No studies considered the effect of DSME on HRQoL, anxiety and depression. CONCLUSIONS: Social media DSME can be effective in reducing HbA1c levels, increasing diabetic knowledge and self-efficacy. Further studies are needed to examine the effectiveness of using social media to deliver DSME intervention on HRQoL, anxiety and depression. RELEVANCE TO CLINICAL PRACTICE: This review provides nurses and healthcare professionals with evidence to support the use of social media to deliver DSME for people with diabetes. DSME delivered via social media supported by nurses would overcome limitations of face-to-face delivery such as geographical distance, travelling time, or other limited resources by patients with diabetes.

Mobile rehabilitation support versus usual care in patients after total hip or knee arthroplasty: study protocol for a randomised controlled trial.

BACKGROUND: The global increase in total hip or knee arthroplasty has led to concern about the provision of postoperative rehabilitation. Telerehabilitation may be a strategy to meet the patients' requirements for rehabilitation after arthroplasty. This study aims to investigate the effectiveness of a telerehabilitation programme delivered via the mobile application WeChat in patients after total hip or knee arthroplasty on the following outcomes: self-efficacy, physical function, pain, depression, anxiety and health-related quality of life. METHODS: This is a single-centre, single-blinded, parallel-group, superiority randomised controlled trial conducted in Shanghai, China. Eighty-four eligible participants who undergo primary total hip or knee arthroplasty will be recruited preoperatively in a university teaching hospital and randomly assigned to the experimental or control group with their informed consent. Once discharged, the control group (n = 42) will receive the usual care provided by the hospital. The experimental group (n = 42) will receive usual care and a 6-week mobile application rehabilitation programme that consists of physical exercises and techniques for enhancing participants' self-efficacy for rehabilitation. Baseline assessments will be conducted on the day before hospital discharge, and outcome assessments will be conducted 6 and 10 weeks postoperatively. The primary outcomes are changes in self-efficacy and physical function 6 weeks postoperatively, and the secondary outcomes include pain, depression, anxiety and health-related quality of life. The approach of a generalised estimating equation will be used to analyse the effect of the intervention on outcomes at a significance level of 0.05. DISCUSSION: This study is the first of its kind conducted in China to incorporate self-efficacy and learning theories as a framework to guide the development of a mobile application rehabilitation programme after arthroplasty. This study will contribute to the knowledge about the effectiveness of mobile application-based rehabilitation among patients after total hip or knee arthroplasty. If the findings are positive, they will support the implementation of mobile application-based rehabilitation in practice, which may potentially increase the accessibility of rehabilitation services as well as patient adherence to rehabilitation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000867897 . Retrospectively registered on July 6, 2021.

Decision-making about mastectomy among Chinese women with breast cancer: a mixed-methods study protocol.

INTRODUCTION: The prevalence of mastectomy in China is higher than its Western counterparts. Little is known about whether Chinese women with breast cancer have been involved in the decision-making process of mastectomy, the level of decisional conflict, their perceptions of mastectomy and the factors that influence them to undergo a mastectomy. This protocol describes a mixed-methods study that aims to provide an in-depth understanding of decision-making about mastectomy among Chinese women with breast cancer. METHODS AND ANALYSIS: A three-phase, sequential explanatory mixed-methods design will be adopted. The first phase is a retrospective analysis of medical records to determine the current use of mastectomy. The second phase is a cross-sectional survey to examine women's perceptions of involvement, decisional conflict and the factors influencing them to undergo a mastectomy. The third phase is an individual interview to explore women's decision-making experiences with mastectomy. Quantitative data will be analysed using descriptive statistics, t-test, Fisher's exact test, χ2 test, analysis of variance, Pearson's correlation and logistic regression. Qualitative data will be analysed by the inductive content analysis. ETHICS AND DISSEMINATION: Ethical approvals for this study have been obtained from the human research ethics committees of the University of Newcastle, Australia, Zhongshan Hospital Xiamen University, China, and the First Affiliated Hospital of Xiamen University, China. Written informed consent will be obtained from the participants. Findings of this work will be disseminated at international conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER: Not applicable.

Decision regret regarding treatments among women with early-stage breast cancer: a systematic review protocol.

INTRODUCTION: Women with early-stage breast cancer (EBC) are commonly required to make treatment decisions. Decision regret regarding treatments is an adverse outcome that negatively affects women's psychological well-being and quality of life. A systematic review will be conducted to synthesise evidence about decision regret among women regarding treatments for EBC. The study will focus on levels of decision regret, what is regretted, and the factors associated with decision regret. METHODS AND ANALYSIS: A systematic review will be conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Electronic databases, including CINAHL Complete, Embase, PubMed, Medline and Web of Science, will be searched for relevant articles published from 2000 to 2021. The reference lists of eligible studies will also be manually searched. All types of quantitative, qualitative and mixed-methods studies that report on decision regret regarding treatments among women with EBC will be included. The primary outcome of this review will be women's levels of decision regret regarding breast cancer treatments. The secondary outcomes will include the content of their regrets, and the factors contributing to decision regret. The methodological quality of the studies will be assessed using the Joanna Briggs Institute appraisal tools. Meta-analysis and thematic synthesis approaches will be used to synthesise quantitative and qualitative data, respectively. A convergent parallel approach will be used to integrate quantitative and qualitative findings. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review. The findings of this work will be disseminated at international conferences and peer-reviewed journals. The findings of this systematic review will inform the development of decision interventions to improve the decision outcomes of breast cancer treatments. PROSPERO REGISTRATION NUMBER: CRD42021260041.

Patients' needs regarding rehabilitation services delivered via mobile applications after arthroplasty: A qualitative study.

AIMS AND OBJECTIVES: To obtain an in-depth understanding of the specific needs of patients for rehabilitation services delivered via mobile applications after total hip or knee arthroplasty. BACKGROUND: Due to increased demand for arthroplasty, the provision of face-to-face rehabilitation services for patients is becoming challenging. New approaches using digital technologies are being developed, such as mobile applications to deliver rehabilitation services. However, the perspectives of patients on the delivery of these services via mobile applications after total hip or knee arthroplasty have not been explored extensively. DESIGN: A qualitative descriptive study. METHODS: Twenty patients who had been discharged from the hospital after a total hip or knee arthroplasty were interviewed via telephone about their needs regarding the future use of mobile applications to conduct arthroplasty rehabilitation. Interview records were transcribed verbatim and analysed using inductive content analysis. Reporting of the findings complies with the COREQ checklist for qualitative studies. RESULTS: Four categories emerged from the data collected from the participants: (1) assisting rehabilitation self-management, (2) facilitating peer support, (3) facilitating contact with healthcare professionals and (4) supporting emotional well-being. CONCLUSIONS: The study provided an in-depth understanding of the specific needs of patients for rehabilitation services delivered via mobile applications after total hip or knee arthroplasty. The findings of the study could be used in the development or revision of mobile application rehabilitation programmes to better support the rehabilitation of patients. Future studies are needed to evaluate the effectiveness of such programmes, especially including the self-efficacy of patients as an outcome measure. RELEVANCE TO CLINICAL PRACTICE: From the perspective of patients who have undergone arthroplasty, a mobile application rehabilitation programme should encourage patients in rehabilitation self-management, assist them to contact healthcare professionals and other patients and support their postoperative emotional well-being. The study findings will assist nurses with the preparation and delivery of telerehabilitation programmes after arthroplasty.

Decision-Making Experience Related to Mastectomy Among Women With Breast Cancer: An Integrative Review.

BACKGROUND: Deciding to have a mastectomy can be challenging for women. An understanding of the decision-making experience related to mastectomy would contribute to improving the support of women making this decision. OBJECTIVE: The aim of this study was to understand women's decision-making experience related to mastectomy. METHODS: Studies published from 2000 to 2020 were identified by searching databases (CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Web of Science, and China National Knowledge Infrastructure) and reference lists of previous reviews. Methodological quality of these studies was assessed using the Mixed Methods Appraisal Tool version 2018. Data were analyzed using content comparison analysis. RESULTS: Twenty-three quantitative and 6 qualitative studies were included in this review. Four themes emerged from the included studies: participation in decision-making, seeking information about treatment choices, postoperative perceptions of mastectomy decision-making, and factors related to mastectomy choice. Several negative experiences related to decision-making were identified. A number of clinical, sociodemographic, and psychosocial factors that influenced women to choose a mastectomy were identified. CONCLUSIONS: This review provides in-depth information about decision-making experiences and factors that influence the choice of mastectomy. Research is required about women who have had a mastectomy using standardized instruments to investigate their decision-making experiences. Studies are also necessary in non-Western countries. IMPLICATIONS FOR PRACTICE: The factors and experiences identified in this review may help nurses to assist in the treatment decision-making process. Further research is required regarding breast care and other nurses' involvement in the decision-making process related to mastectomy.

Self-Management of Dementia by Family Carers: A Scoping Review.

Family carers increasingly take on the responsibility of self-management of dementia as the condition progresses. However, research on this topic is scarce. This scoping review aimed to identify the key characteristics related to self-management of dementia by carers including its components, theoretical/conceptual frameworks that underpinned these components and measurements. A scoping review was conducted in 8 databases and 16 publications met the inclusion criteria. Twenty-two components were identified and grouped into two categories: activities and carer characteristics and skills. The identified theoretical/conceptual frameworks were numerous and varied as were the measures. There was a little consistency of the key characteristics of self-management of dementia by carers. The findings assist carers and healthcare providers to understand the components involved in self-managing dementia which will guide the development and delivery of self-management support interventions for carers. Further research is required to validate these findings and to develop specialized conceptual frameworks and measures.

The Uptake and Factors Associated with Mastectomy among Chinese Women with Breast Cancer: A Retrospective Observational Study.

OBJECTIVE: There are limited data concerning the use of mastectomy and associated factors in China in recent years. This study aimed to investigate the uptake of mastectomy and determine the associations between patients' characteristics and mastectomy among Chinese women with breast cancer. METHODS: A retrospective analysis of female breast cancer cases from 1st January 2015 to 31st December 2019 from a tertiary hospital was conducted. Socio-demographic data, clinical data, and surgery types were collected by reviewing the medical record system. Chi-squared test, Fisher's exact test and multivariate logistic regression analysis were used to determine any correlations of patients' characteristics with mastectomy. RESULTS: A total of 1,171 women with breast cancer were identified, and 76.60% of them underwent a mastectomy. The mastectomy rates showed an increase from 70.62% in 2015 to 86.87% in 2017 and then dropped to 71.91% in 2019. Women undergoing mastectomy were older and were more likely to be married and have at least one child. They had an advanced cancer stage, larger tumour size, and more lymph node invasion and were positive for HER-2 overexpression. Older age, larger tumour size (2-5 cm), higher cancer stages (stage 2- stage 3) and being positive for HER-2 were the four independent variables that significantly predicted the uptake of mastectomy. CONCLUSIONS: Our results showed a wide application of mastectomy in China and uncovered the factors associated with mastectomy uptake from a single-centre experience. Findings suggested the potential overuse of mastectomy among women with early-stage breast cancer, and highlighted the significance of promoting cancer screening in China. Findings could be also used to develop relevant provisions and interventions to facilitate breast cancer treatment decision-making and screening planning.
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The effectiveness of internet-based telerehabilitation among patients after total joint arthroplasty: An integrative review.

BACKGROUND: Total joint arthroplasty is one of the most commonly performed orthopaedic procedures globally. Telerehabilitation has recently been used as a supplement or an alternative to face-to-face rehabilitation services among patients after total joint arthroplasty. OBJECTIVES: To synthesise the evidence on the effectiveness of internet-based telerehabilitation regarding pain relief, range of motion, physical function, health-related quality of life, self-efficacy, psychological well-being/problems, and satisfaction among patients after total joint arthroplasty. METHODS: An integrative review was conducted using defined search periods, databases, and search terms. This review adopted a five-stage approach: problem identification, literature search, data evaluation, data analysis and presentation. Studies published in English and Chinese were included. The Mixed Methods Appraisal Tool was used to assess the quality of included studies. RESULTS: Twenty-two eligible studies with 1,179 participants were included in this review. Nineteen of them were conducted in North America, Europe and Australia, and three in China. There were 20 quantitative and two qualitative studies. Synchronous mode using videoconferencing (n = 11) was predominant in the studies between 2003 and 2017, while asynchronous mode using mobile apps (n = 7) has become the main mode since 2017. Internet-based telerehabilitation was delivered by physiotherapists in 17 studies and by nurses in three. Most of the included studies reported that, compared to face-to-face rehabilitation, internet-based telerehabilitation showed a comparable improvement in pain relief, range of motion, physical function, and health-related quality of life. Patients had a high satisfaction level. Very few studies addressed the patients' psychological well-being/problems and self-efficacy as the outcome measures. CONCLUSIONS: Internet-based telerehabilitation appears to be effective for and accepted by patients after total joint arthroplasty. Telerehabilitation could be delivered by nurses in collaboration with physiotherapists and surgeons as a team. The mobile app is an accessible and flexible delivery medium for telerehabilitation. Robust randomised controlled trials are warranted to enhance the quality of evidence on the effectiveness of mobile app-based telerehabilitation and nurse-delivered program. Qualitative components are suggested to be included in future research. Psychological outcomes should also be measured.

Moving on from adversity: an understanding of resilience in rural Thai older people.

OBJECTIVE: This study explored the concept of resilience in rural Thai older people. METHOD: The study was exploratory and descriptive in design. Ethnographic fieldwork was undertaken in four rural Thai communities. Non-participant observation (340 h) and 35 semi-structured interviews with older people enabled the collection of qualitative data. Nvivo 10 was used to collate and organise the qualitative data. Data analysis was conducted thematically. RESULTS: One major core theme and five qualitative sub-themes emerged from the data related to the theoretical construct of rural Thai elders' resilience. The subthemes of the core theme 'moving on' include: (1) keep doing a job and earning a living; (2) having Jai-Yai to fight for life; (3) accepting a situation (Plong and Taam-Jai); (4) expressing difficulty; and (5) connecting with people, beliefs and customs. CONCLUSION: The concept of 'moving on' provides a subcultural viewpoint of older rural Thai people in the face of adversity in their everyday lives. Previous conceptions of resilience and older people focus on it being bouncing back from adversity. Bouncing back implies a setback, whereas 'moving on' found in this study is the process of continuous movement forward and getting on with one's life despite difficulties.

The Association between Age, Comorbidities and Use of Radiotherapy in Women with Breast Cancer: Implications for Survival.

Background: Radiotherapy (RT) plays an important role in the management and survival of patients with breast cancer. The aim of this study was to examine the association between age, comorbidities and use of RT in this population. Methods: Patients diagnosed with breast cancer from 2004⁻2013 were identified from the American College of Surgeons National Cancer Database (NCDB). Follow-up time was measured from the date of diagnosis (baseline) to the date of death or censoring. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were used as the measure of association. Results: Independently of comorbidities and other important outcome-related factors, patients >65 years of age who received RT survived significantly longer than those who did not receive RT (aHR = 0.53, 95% CI = 0.52⁻0.54). However, as women aged, those with comorbidities were less likely to receive RT (adjusted p-trend by age < 0.0001). Conclusions: The development of decision-making tools to assist clinicians, and older women with breast cancer and comorbidities, are needed to facilitate personalized treatment plans regarding RT. This is particularly relevant as the population ages and the number of women with breast cancer is expected to increase in the near future.

Qualitative insights into the experience of pain in older Australian women with arthritis.

OBJECTIVE: To explore qualitative insights into the pain experience of older women with quantitatively derived pain profiles. METHODS: The sequential mixed methods design involved applying quantitative pain profiles, derived from an earlier latent class analysis, to qualitative comments by a sample of older Australian women with arthritis. Data from a substudy of the Australian Longitudinal Study on Women's Health, mid-aged cohort, born 1946-1951, were used. Inductive content analysis was conducted to explore qualitative insights into the experience of pain. RESULTS: The average age of women was 64.6 years (±1.4). Within each derived pain profile, themes generated from the qualitative comments of women were concordant with the profile descriptors: 'I manage my pain' for the uni-dimensional, mild pain profile (comments from 56 women); 'I live with pain every day' and 'I rely on medication regularly' for the moderate multidimensional pain profile (comments from 39 women); and 'multiple pains', 'I suffer with pain' and 'I am unable and adjust' for the severe multidimensional pain profile (comments from 31 women). CONCLUSION: Women with different pain profiles used different language and strategies in managing their pain experience, information which can guide clinicians to provide more tailored support for self-management and care of arthritis pain.

Experiences of older people following the introduction of consumer-directed care to home care packages: A qualitative descriptive study.

OBJECTIVE: To explore the experiences of older people receiving home care package (HCP) support following the introduction of consumer-directed care (CDC) by the Australian government on 1 July 2015. METHODS: Thirty-one older people with existing HCP support from two service providers in regional New South Wales, Australia, participated in a face-to-face interview and/or a qualitative survey. RESULTS: Analysis revealed the theme of Choices: Preferences, constraints, balancing and choosing. Participants described choosing to live at home with HCP support; however, they were constrained by poor communication and information about service changes and options, personal budgets and access to future care. HCP services remained largely unchanged during transition to CDC. CONCLUSION: Many aspects of the initial implementation of CDC were challenging for older people. Clear, relevant and timely communication and information about CDC and its consequences for consumers appear to be needed to enhance CDC.

Pain Assessment and Management for Older Patients with Dementia in Hospitals: An Integrative Literature Review.

Previous studies have suggested that pain in older people with dementia is often underestimated and undertreated in acute hospitals. Undermanaged pain negatively affects a person's recovery and prolongs hospital stays. However, the issues related to pain assessment and management by nurses for this group have not been fully understood. (1) To synthesize evidence about pain assessment and management for older people with dementia in hospital settings, and (2) to discuss implications for nurses and their practice. Integrative literature review. A systematic search of evidence-based research from six electronic databases (CINAHL, MEDLINE, ProQuest, Cochrane, JBI, and Scopus) was conducted for the period of 2006-2016. Following Cooper's integrative review framework and a systematic screening process, the articles included were analyzed and synthesized to identify the common issues and relationships. Fourteen empirical research articles were examined and synthesized. Two main categories were identified and include: the nursing practice of pain assessment in older patients with dementia is less than optimal, and the nursing practice of pain management for this group varies. The lack of initiation of pain assessment and use of pain assessment tools may contribute to the inadequate pain management by nurses. Whereas this review uncovered the extent and challenges related to pain assessment and management, previous studies were explorative and descriptive. The findings from the review provide nurses with an opportunity to establish empirical evidence that may improve nursing practice of pain assessment and management for older people with dementia in hospital settings.