Mediating effect of rehabilitation self-efficacy on perceived social support and rehabilitation exercise adherence in hospitalized patients after hip/knee arthroplasty

doi:10.3969/j.issn.1674-8115.2024.08.004

Abstract

Abstract:

Objective ·To explore the correlation among perceived social support, rehabilitation self-efficacy and rehabilitation exercise adherence of in-patients after hip/knee arthroplasty, and examine the mediating role of rehabilitation self-efficacy in the correlation between perceived social support and rehabilitation exercise adherence. Methods ·A convenience sampling method was used, and 141 post-total hip/knee arthroplasty inpatients in the bone and joint ward of the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital) from October 2021 to February 2023 were selected as the study subjects. The general demographic data, such as age and gender, and the information of disease and operation were assessed by using General Data Questionnaire. The adherence to rehabilitation exercise in patients after hip/knee arthroplasty was assessed by using the Rehabilitation Exercise Adherence Scale (REAS); the self-efficacy of rehabilitation exercise was assessed by using the Self-Efficacy for Rehabilitation Outcome Scale (SER); the social support level of individual subjective feelings of the patients was assessed by using the Perceived Social Support Scale (PSSS). Pearson's correlation analysis was used to test the correlation between the variables, and Bootstrap method was used to investigate the mediating role of rehabilitation self-efficacy in the correlation between perceived social support and rehabilitation exercise adherence. Results ·A total of 167 questionnaires were distributed and 141 valid questionnaires were recovered, with a valid recovery rate of 84.4%. The age range of the 141 patients after hip/knee arthroplasty was 26?84 years old, and the average age was (64.75±10.74) years old. The total score of SER of the patients after hip/knee arthroplasty was (100.45±21.71), the total score of PSSS was (68.29±10.89), and the total score of REAS was (11.93±2.29). Pearson's correlation analysis results showed that there was a significant correlation between SER score and PSSS score, SER score and REAS score, and PSSS score and REAS score in patients after hip/knee arthroplasty. The mediation effect analysis showed that the indirect effect of perceived social support on rehabilitation exercise adherence was significant (effect value 0.033, 95%CI 0.017?0.058, P<0.05), and the direct effect of perceived social support on rehabilitation exercise adherence was not significant (effect value 0.027, 95%CI -0.008?0.065, P>0.05). Conclusion ·Perceived social support positively predicts rehabilitation exercise adherence, and rehabilitation self-efficacy fully mediates the correlation. Direct intervention in rehabilitation self-efficacy is superior to moderating the level of perceived social support.

Key words: joint replacement, self-efficacy, perceived social support, compliance, mediating effect

CLC Number:

R473.6

XU Jiale, FU Liqin, WU Hong, ZAN Jiaojiao, WU Jing. Mediating effect of rehabilitation self-efficacy on perceived social support and rehabilitation exercise adherence in hospitalized patients after hip/knee arthroplasty[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(8): 959-967.

Figures/Tables 3

TrendMD

References 37

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Item	Total/n(%)	PSSS score/score	REAS score/score	SER score/score
Gender
Male	51 (36.2)	66.76±11.14	11.98±2.42	100.86±22.25
Female	90 (63.8)	69.15±10.71	11.90±2.22	100.22±21.52
t value		1.576	0.040	0.028
P value		0.211	0.842	0.867
Age
≤60 years old	39 (27.7)	66.67±11.52	11.92±2.33	97.87±23.29
>60 years old	102 (72.3)	68.91±10.63	11.93±2.28	101.44±21.11
t value		1.201	0.000	0.761
P value		0.275	0.985	0.384
Job
Retirement	78 (55.3)	69.31±10.97	12.02±2.30	102.13±21.95
Worker	13 (9.2)	63.46±13.23	11.92±2.14	90.46±34.36
Farmer	29 (20.6)	67.59±10.58	11.59±2.47	101.72±15.06
Other	21 (14.9)	68.48±9.20	12.05±2.20	98.67±18.33
F value		1.124	0.278	1.157
P value		0.341	0.841	0.329
Education
Elementary school and below	44 (31.2)	69.18±11.59	11.84±2.21	103.23±24.69
Junior high school	43 (30.5)	66.05±10.43	11.70±2.50	97.09±21.21
High school/secondary school	35 (24.8)	68.94±10.57	12.34±2.11	100.63±21.72
Junior college and above	19 (13.5)	70.10±10.86	11.89±2.35	101.32±14.88
F value		0.923	0.546	0.588
P value		0.431	0.652	0.624
Family monthly income
≤3 000 yuan	40 (28.4)	66.95±11.37	11.05±2.36	99.75±20.00
3 001‒5 000 yuan	49 (34.8)	67.80±11.30	11.94±2.29	101.16±19.08
5 001‒10 000 yuan	38 (27.0)	67.84±10.03	12.68±1.93	101.08±24.19
>10 000 yuan	14 (9.9)	75.07±8.65	12.36±2.34	98.29±29.28
F value		2.116	3.714	0.087
P value		0.101	0.013	0.967
Place of residence
Town/city	111 (78.7)	68.44±10.91	11.96±2.32	101.23±20.25
Country	30 (21.3)	67.73±10.96	11.83±2.20	97.60±26.62
t value		0.099	0.066	0.657
P value		0.753	0.797	0.419
Living condition
Living alone	21 (14.9)	70.48±10.78	12.00±2.10	95.19±16.71
Not living alone	120 (85.1)	67.91±10.91	11.92±2.33	101.38±22.40
t value		0.994	0.024	1.455
P value		0.321	0.878	0.230
Previous hospitalisation history
Yes	109 (77.3)	68.72±11.28	11.92±2.23	98.89±19.92
No	32 (22.7)	66.84±9.44	11.97±2.51	105.78±26.62
t value		0.730	0.012	2.520
P value		0.395	0.912	0.115
Previous surgical history
Yes	87 (61.7)	69.97±10.71	12.02±2.25	98.77±20.37
No	54 (38.3)	65.59±10.73	11.78±2.37	103.17±23.65
t value		5.548	0.381	1.370
P value		0.020	0.538	0.244
Joint replacement history
Yes	26 (18.4)	67.31±12.18	11.87±2.29	98.35±22.53
No	115 (81.6)	68.51±10.62	12.19±2.32	100.93±21.59
t value		0.258	0.420	0.299
P value		0.612	0.518	0.585
Chronic medical history
Yes	82 (58.2)	68.54±10.43	12.01±2.29	101.17±17.25
No	59 (41.8)	67.95±11.58	11.81±2.31	99.46±26.84
t value		0.099	0.257	0.212
P value		0.753	0.613	0.646
Joint replacement site
Knee	71 (50.4)	69.31±10.99	11.68±2.10	102.45±22.48
Hip	70 (49.6)	67.26±10.77	12.19±2.46	98.43±20.87
t value		1.255	1.757	1.212
P value		0.265	0.187	0.273

Item	Total/n(%)	PSSS score/score	REAS score/score	SER score/score
Gender
Male	51 (36.2)	66.76±11.14	11.98±2.42	100.86±22.25
Female	90 (63.8)	69.15±10.71	11.90±2.22	100.22±21.52
t value		1.576	0.040	0.028
P value		0.211	0.842	0.867
Age
≤60 years old	39 (27.7)	66.67±11.52	11.92±2.33	97.87±23.29
>60 years old	102 (72.3)	68.91±10.63	11.93±2.28	101.44±21.11
t value		1.201	0.000	0.761
P value		0.275	0.985	0.384
Job
Retirement	78 (55.3)	69.31±10.97	12.02±2.30	102.13±21.95
Worker	13 (9.2)	63.46±13.23	11.92±2.14	90.46±34.36
Farmer	29 (20.6)	67.59±10.58	11.59±2.47	101.72±15.06
Other	21 (14.9)	68.48±9.20	12.05±2.20	98.67±18.33
F value		1.124	0.278	1.157
P value		0.341	0.841	0.329
Education
Elementary school and below	44 (31.2)	69.18±11.59	11.84±2.21	103.23±24.69
Junior high school	43 (30.5)	66.05±10.43	11.70±2.50	97.09±21.21
High school/secondary school	35 (24.8)	68.94±10.57	12.34±2.11	100.63±21.72
Junior college and above	19 (13.5)	70.10±10.86	11.89±2.35	101.32±14.88
F value		0.923	0.546	0.588
P value		0.431	0.652	0.624
Family monthly income
≤3 000 yuan	40 (28.4)	66.95±11.37	11.05±2.36	99.75±20.00
3 001‒5 000 yuan	49 (34.8)	67.80±11.30	11.94±2.29	101.16±19.08
5 001‒10 000 yuan	38 (27.0)	67.84±10.03	12.68±1.93	101.08±24.19
>10 000 yuan	14 (9.9)	75.07±8.65	12.36±2.34	98.29±29.28
F value		2.116	3.714	0.087
P value		0.101	0.013	0.967
Place of residence
Town/city	111 (78.7)	68.44±10.91	11.96±2.32	101.23±20.25
Country	30 (21.3)	67.73±10.96	11.83±2.20	97.60±26.62
t value		0.099	0.066	0.657
P value		0.753	0.797	0.419
Living condition
Living alone	21 (14.9)	70.48±10.78	12.00±2.10	95.19±16.71
Not living alone	120 (85.1)	67.91±10.91	11.92±2.33	101.38±22.40
t value		0.994	0.024	1.455
P value		0.321	0.878	0.230
Previous hospitalisation history
Yes	109 (77.3)	68.72±11.28	11.92±2.23	98.89±19.92
No	32 (22.7)	66.84±9.44	11.97±2.51	105.78±26.62
t value		0.730	0.012	2.520
P value		0.395	0.912	0.115
Previous surgical history
Yes	87 (61.7)	69.97±10.71	12.02±2.25	98.77±20.37
No	54 (38.3)	65.59±10.73	11.78±2.37	103.17±23.65
t value		5.548	0.381	1.370
P value		0.020	0.538	0.244
Joint replacement history
Yes	26 (18.4)	67.31±12.18	11.87±2.29	98.35±22.53
No	115 (81.6)	68.51±10.62	12.19±2.32	100.93±21.59
t value		0.258	0.420	0.299
P value		0.612	0.518	0.585
Chronic medical history
Yes	82 (58.2)	68.54±10.43	12.01±2.29	101.17±17.25
No	59 (41.8)	67.95±11.58	11.81±2.31	99.46±26.84
t value		0.099	0.257	0.212
P value		0.753	0.613	0.646
Joint replacement site
Knee	71 (50.4)	69.31±10.99	11.68±2.10	102.45±22.48
Hip	70 (49.6)	67.26±10.77	12.19±2.46	98.43±20.87
t value		1.255	1.757	1.212
P value		0.265	0.187	0.273

Effect	Effect value	95%CI	P value
Perceived social support →Rehabilitation self-efficacy→ Rehabilitation exercise adherence (indirect effect)	0.033	0.017‒0.058	0.000
Perceived social support →Rehabilitation exercise adherence (direct effect)	0.027	-0.008‒0.065	0.130
Perceived social support →Rehabilitation exercise adherence (total effect)	0.060	0.025‒0.107	0.002

Effect	Effect value	95%CI	P value
Perceived social support →Rehabilitation self-efficacy→ Rehabilitation exercise adherence (indirect effect)	0.033	0.017‒0.058	0.000
Perceived social support →Rehabilitation exercise adherence (direct effect)	0.027	-0.008‒0.065	0.130
Perceived social support →Rehabilitation exercise adherence (total effect)	0.060	0.025‒0.107	0.002

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