Self-efficacy expectations and functional ability in everyday activities in clients undergoing total knee arthroplasty

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Wallace, Linda S.
McElhinney, James H.
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Thesis (D. Ed.)
Department of Educational Leadership
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This longitudinal, descriptive study based on Bandura's self-efficacy theory (1977), examined the effects of educational activities on self-efficacy and of self-efficacy on functional ability in everyday activities in clients undergoing elective, primary, unilateral, total knee arthroplasty (TKA). Educational activities included: attending a joint replacement class and a physical therapy session, performing exercises, and reading educational materials. Other sources of client information were also discussed. Self efficacy was assessed regarding confidence in ability to perform activities required for discharge home. Cronbach's alpha for the self-efficacy scale was .94 (pre-education) and .81 (post-education). Functional ability in everyday activities was operationalized as length of hospital stay, discharge placement, and perceived health status. Perceived health status was assessed using the three-scale Western Ontario McMasters University Osteoarthritis Index (WOMAC). Cronbach's alpha was: pain .85, joint stiffness .76, and physical function .94 (preoperatively); and pain .86, joint stiffness .80, and physical function .94 (postoperatively).Evidence was collected from a convenience sample of 31 participants: (a) when the process of scheduling surgery began; (b) before surgery, after the client had opportunities to participate in educational activities, and (c) approximately six weeks after surgery. The orthopedic surgeon and professional staff reviewed instruments for validity. Five clients reviewed the questionnaires for understandability and readability. Data were analyzed using Pearson r correlation coefficients, independent samples t-tests, analyses of variance and chi-square tests. An alpha level of .05 was designated as significant.Higher self-efficacy scores were associated with more expected benefits, previous TKA, and greater pain relief. Lower self-efficacy scores correlated with greater improvement in self-efficacy. Shorter lengths of hospital stay were associated with greater joint stiffness reduction, younger age and previous TKA. Discharge home was associated with younger age and living with someone else. Participants that were "very sure" of the need for TKA exhibited higher self-efficacy scores than participants that were "unsure". Improved outcomes were not associated with any one type of educational activity.This study highlighted the need for further refinement of context sensitive self-efficacy instruments, more sophisticated means of assessing the impact of an increasing array of information sources and more longitudinal studies with larger sample sizes.