Application of sensory and motor training in AIDET communication mode in patients after knee arthroplasty

Abstract

BACKGROUND

Patients with knee arthroplasty often have problems such as slow recovery of knee function, which may cause negative emotions and affect their postoperative rehabilitation. The application of sensory and motor training in the Acknowledge, Introduce, Duration, Evaluation, Thank You (AIDET) communication mode in patients after knee arthroplasty can provide reference for the selection of postoperative rehabilitation training measures.

AIM

To explore the sensory and motor training effects in AIDET communication mode on knee function recovery and resilience of patients after knee arthroplasty.

METHODS

One hundred patients who underwent knee arthroplasty at our hospital between January 2022 and January 2024 were randomly divided into two groups. The control group (n = 50) received routine rehabilitation training. In the observation group (n = 50), the AIDET communication mode was used to perform sensory and motor training, in addition to routine rehabilitation training. The rehabilitation training was administered for 8 weeks. After surgery, knee function, balance ability, walking ability, proprioception, and resilience were compared between the two groups.

RESULTS

The New York Hospital for Special Surgery knee scores of the observation group at the time of discharge and 8 weeks after intervention were (65.23 ± 6.84, 84.53 ± 5.27), which was higher than those of the control group (61.03 ± 7.15, 74.92 ± 6.52) (P < 0.05). The balance ability of the observation group at the time of discharge and 8 weeks after the intervention was higher than that of the control group, the time of time up to go test was shorter than that of the control group, and proprioceptive function was higher than that of the control group (P < 0.05). The resilience level in the observation group after the intervention was higher than that in the control group (P < 0.05).

CONCLUSION

Sensory and motor training in AIDET communication mode promotes knee function recovery of patients after knee arthroplasty, improves their limb walking ability and balance function, and increases their resilience level.

Key Words: AIDET communication mode; Sensory and motor training; Knee arthroplasty; Knee function; Resilience

Core Tip: The application of sensory and motor training in AIDET communication mode to patients after knee arthroplasty can significantly promote their postoperative knee function recovery, improve their walking ability and balance, and increase their psychological resilience. This study observed knee function recovery after knee arthroplasty and confirmed the efficacy of sensory and motor training in AIDET communication mode at promoting knee function recovery after knee arthroplasty.

INTRODUCTION

Knee arthroplasty is a major treatment for end-stage knee disease and can significantly relieve postoperative joint pain and improve joint motion. In recent years, with an aging society, the number of knee arthroplasty procedures has increased annually. It is estimated that by 2030, 3.48 million cases of total knee arthroplasty will be performed annually[1]. Although knee arthroplasty has gradually become a common and routine operation in the clinic, we still need to pay attention to the detailed rehabilitation process in patients after surgery to promote better recovery. Some studies[2] have pointed out that joint pain and proprioception defects commonly exist in patients after knee arthroplasty, which leads to reduced neuromuscular control ability, joint stability, balance function, and poor rehabilitation effect of joint function in patients. Therefore, promoting the postoperative rehabilitation of patients' limb function has become the focus of clinical research. Currently, sensory and motor training is a new type of rehabilitation training measure for patients after knee arthroplasty that can repair the damaged receptors of joints after surgery and promote feedback control of the neuromuscular system, thus improving the rehabilitation level of patients' limbs after surgery[3]. However, diversified sensory and motor training measures, postoperative pain, and improper understanding of diseases increase doctor-patient disputes and affect the smooth progress of postoperative rehabilitation. To fully understand the role of limb rehabilitation, it is particularly important to increase patients’ understanding of the disease and provide rehabilitation training. The acknowledging (A), introducing (I), duration (D), explanation (E), and thanks (T) (AIDET) communication mode is common in the medical field, which can provide patients with flexible and effective transmission of medical information, thereby establishing a good nurse-patient relationship and providing patients with high-quality and efficient medical intervention[4,5]. Therefore, to promote postoperative rehabilitation, in this study, a knee arthroplasty patient was taken as an example and sensory and motor training was carried out in AIDET communication mode to analyze the effects on the knee function and resilience, aiming to provide a reference for the rehabilitation training scheme after knee arthroplasty. The results are as follows.

MATERIALS AND METHODS

General data

One hundred patients who underwent knee arthroplasty at our hospital between January 2022 and January 2024 were selected and divided into two groups according to a random number table, (n = 50 each). A statistical comparison of the relevant data showed no intergroup differences (P > 0.05; Table 1).

Table 1 Patients' general data, n (%)/mean ± SD.

General data	Control group (n = 50)		Observation group (n = 50)	χ2/t	P value
Sex	Male	26 (52.00)	23 (46.00)	χ2 = 0.360	0.549
	Female	24 (48.00)	27 (54.00)
Age (years)	63.86 ± 6.15		64.18 ± 6.25	t = 0.258	0.797
Affected limb	Left	24 (48.00)	27 (54.00)	χ2 = 0.360	0.549
	Right	26 (52.00)	23 (46.00)
BMI (kg/m2)	22.96 ± 2.84		23.04 ± 3.01	t = 0.137	0.892
Basic diseases	Hypertension	18 (36.00)	20 (40.00)	χ2 = 0.428	0.807
	Hyperlipidemia	15 (30.00)	16 (32.00)
	No	17 (34.00)	14 (28.00)
History of smoking	Yes	12 (24.00)	15 (30.00)	χ2 = 0.457	0.499
	No	38 (76.00)	35 (70.00)

BMI: Body mass index.

Inclusion and exclusion criteria

The inclusion criteria were as follows: (1) All the patients underwent knee arthroplasty for the first time; (2) Unilateral illness; (3) Good cognitive function; and (4) Detailed rules of the study and signed consent forms.

The exclusion criteria were as follows: (1) Simultaneous hip arthroplasty; (2) A long history of bed rest and physical dysfunction before replacement; (3) Joint infection, severe knee deformity, joint tuberculosis, and other joint diseases; (4) Heart, brain, liver, kidney, and other important organ lesions; and (5) Malignant tumors.

Methods

Patients in both groups received disease education, physical signs were observed, and complications were prevented during their hospital stay. Patients in the control group received routine rehabilitation training; on the day after surgery, the rehabilitation personnel assisted the patients in appropriately raising the affected limb, and an ice bag was applied to the affected limb for 10–15 minutes each time, once a day. Patients were guided to turn over and exercise the ankle pump. A continuous passive motion machine was used for joint passive rehabilitation training. The patient was guided to conduct isometric contraction of the quadriceps and popliteal extensor and straight leg elevation training, 20 times for each group, three groups for each time, and three times for each day. The patients were evaluated by a physician before getting out of bed and were allowed to move down the stairs. They gradually transitioned to walking alone or up and down stairs using a walker.

Observation group: The routine rehabilitation training method was the same as that used in the control group. Additionally, sensory and motor training was conducted in the AIDET communication mode.

Acknowledge

After the inclusion of the patient in the group, the medical staff greeted the patient with a smile, and a gentle tone and mild attitude were used in communication, such as "Hello" and "How are you doing today”? The medical staff introduced himself, observed the changes in the patient’s facial expression and tone, understood the patient’s cognition degree of knee arthroplasty and the postoperative rehabilitation content, and formulated the sensory and motor training plan according to the specific cognitive degree of the patient.

Introduce

The nursing staff actively introduced the identities and skills of surgeons and rehabilitation physicians to the patients and explained the identities and experiences of participants through the introduction manual or video of the medical staff, emphasizing the work advantages of participants. The staff focused on the purpose and importance of sensory and motor training and need for functional training. During the introduction, simple and understandable explanations were used to increase the patients’ cognitive level and rehabilitation confidence.

Duration

The nursing staff actively introduced the time and steps of sensory and motor training to the patients, created a flowchart of sensory and motor training, and provided a brief explanation of the basic steps under each action. Sensory and motor training procedures were recorded and distributed to patients via the WeChat platform for viewing. (1) Knee angle regression: To assist the patient in lying down position, the operator firstly passively flexed the knee joint of the patient, straightened the joint of the lower limb after staying for 5 s, and then stopped moving when the patient felt that the joint could reach the initial staying position. Each flexion angle was repeated three times per group, 5–10 groups per day; (2) Balance pad training: After the patient could get out of bed, the patient was guided to stand on the balance pad, and the knee joint was maintained in the micro-flexion position (160°–170°) to maintain body balance and control body shaking to the maximum extent. If the joint was crossed out of the balance pad, it was immediately returned to the balance pad for micro-flexion of the joint for 40 s, eight times a day; (3) Upper and lower balance pad training: The patient stood opposite to the balance pad at a distance of approximately 50 cm, and the affected limb was guided to lunge forward and step on the balance pad for 5 s to recover the lower limb, five times/group, four groups per day; (4) Walking flexibility training: The training was performed using auxiliary walkers: (a) The patients were guided to walk sideways, alternately left and right, 5–10 m walking per group, one group per day; (b) Walking in series: The patients were guided to walk alternately after aligning one side of the heel with the other side of the toe, 5–10 m for each group, one group per day; (c) Cross walking: The patients were trained to walk on one limb over the opposite limb, with each group walking for 5–10 m, one group per day; (d) Sliding walking: The patient was instructed to stand with the knee joint flexed 70°, firstly supporting the body weight with the healthy limb, and instructing the affected side to slide forwards and backwards on the sole, and then standing back to the original position, 20 times/group, one group per day; (e) Functional walking exercise: Patient was instructed to stand up, walk for 3 m, turn around, return to the original position, and sit down, which was repeated three times/group, one group per day; (f) Functional "Horse stance": The patient was instructed to bend the knee joint by 40°, and the ball was thrown to distract him/her, 10 min/time, once a day; and (5) Swiss ball training: The patient was instructed to take the sitting position after surgery, with his/her feet on both sides of the Swiss ball, and he/she was required to rub the Swiss ball forward and backward, once a day, and 10 min/time. The Swiss ball was placed against the wall and the patient stood in front of the Swiss ball in the semi-squat position so that the ball was dented for 10 min/time, once a day.

Explanation

When patients underwent sensory and motor training, the operating personnel accompanied and closely monitored the entire process and explained to the patients the steps and implementation necessity of sensory and motor training before functional training. Simultaneously, questions about patients' discomfort during training and possible limb soreness could be answered, the reasons and countermeasures were explained, and patients' anxiety and fear could be avoided. Moreover, any measures taken during the rehabilitation of the patient were confirmed, thereby increasing the patient’s confidence in the rehabilitation.

Thanks

After each training, the patients were thanked, such as "Thank you for your cooperation and understanding”, "You have done a very good job", and "You have made a good recovery”. The efforts of the patients were acknowledged, which helped them complete the rehabilitation training in a relaxed and comfortable environment.

Patients in both groups received continuous training for 8 weeks. After discharge, patients were followed up through the WeChat platform, telephone, and outpatient service to guide them to continue training; they were reminded to receive functional rehabilitation training at a fixed time every week and to answer questions about training after discharge.

Outcome indicators

Knee function: The New York Hospital for Special Surgery knee scores were used for evaluation at the time of admission, discharge, and 8 weeks after the intervention[6], covering joint pain, activity function, activity range, and joint deformity. The scoring standard ranges from 0 to 100 points, and score increases with improvements in joint function.

Balance function: The assessment was conducted at the time of admission, discharge, and 8 weeks after the intervention using the Berg Balance Scale[7], including activities such as standing from left to right, standing alone, standing with eyes closed, and turning around. The total number of functional items was 14, with a functional score of 0–4 and a total score of 56. The score increased with the improvement in the balance function.

Functional walking ability: Evaluation was conducted at admission, discharge, and 8 weeks after the intervention. The experimental method was the time up-to-go test, in which the patient walked for 3 m and then returned to the original position to sit down. The time required for the entire process was recorded. The time was shortened with an improvement in the patient’s walking ability.

Proprioception: Assessment was conducted at the time of admission, discharge, and 8 weeks after the intervention, and the joint position matching test method was selected. The patient was instructed to slowly bend the knee joint at 90° and maintain it for 3 s; the joint was in the unbent position after recording the angle. The patient voluntarily and actively flexed the joint to the initially remembered angle and measured it three times in a row to calculate the differential angle, which decreased with improvement in the proprioceptive function of the knee joint.

Resilience: The Connor-Davidson Resilience Scale[8] was used before and after the intervention with 25 items to evaluate individual resilience, optimism, and sense of strength, with 13, 4, and 8 items, respectively. Each item was scored from 0 to 4 points, with a total score of 100 points. The scores increased with an increase in resilience.

Statistical analysis

Statistical analyses were performed using the SPSS 26.0 version of statistical software. The measurement data was presented as (mean ± SD), and when it conformed to the normal distribution, independent and paired samples t were used for the verification of data between and within groups. Data that did not conform to the normal distribution and were expressed as medians or interquartile ranges were examined within and between groups using the paired sample rank sum and rank sum of samples. Repeated-variance F was used to compare multiple data groups. Count data for rate (%), χ² test; P < 0.05 indicated that the difference was statistically significant.

RESULTS

Knee function

Compared with the functional scores of patients at the time of admission (P > 0.05), the knee joint functional scores of patients at the time of discharge and 8 weeks after intervention were significantly increased, and the scores of the observation group were significantly higher than those of the control group (P < 0.05) (Table 2).

Table 2 Comparison of the New York hospital for special surgery scores of knee function, mean ± SD.

Group	Admission	Discharge	Eight weeks after intervention	F	P value
Observation group (n = 50)	54.73 ± 6.83	65.23 ± 6.84a	84.53 ± 5.27a,b	282.734	< 0.001
Control group (n = 50)	56.04 ± 7.15	61.03 ± 7.15a	74.92 ± 6.52a,b	99.182	< 0.001
t value	0.937	3.001	8.106
P value	0.351	0.003	< 0.001

^aP < 0.05 vs the functional score at the time of admission.

^bP < 0.05 vs the functional score at discharge.

Balance function

The patients’ balance function was compared on admission (P > 0.05), and it increased at discharge and at 8 weeks after the intervention. The increase in the amplitude of the balance function in the observation group was higher than that in the control group (P < 0.05) (Table 3).

Table 3 Comparison of the Berg Balance Scale scores of balance function, mean ± SD.

Group	Admission	Discharge	Eight weeks after intervention	F	P value
Observation group (n = 50)	33.82 ± 5.48	40.58 ± 5.80a	48.52 ± 5.43a,b	87.175	< 0.001
Control group (n = 50)	34.40 ± 5.51	37.80 ± 5.67a	42.73 ± 5.51a,b	28.334	< 0.001
t value	0.528	2.424	5.292
P value	0.599	0.017	< 0.001

^aP < 0.05 vs the Berg Balance Scale score at the time of admission.

^bP < 0.05 vs the Berg Balance Scale score at discharge.

Functional walking ability

The comparison of the test time on admission (P > 0.05) and walk test times at discharge and 8 weeks after intervention were both shortened, especially in the observation group (P < 0.05) (Table 4).

Table 4 Comparison of time of functional walking ability tests, mean ± SD.

Group	Admission	Discharge	8 weeks after intervention	F	P value
Observation group (n = 50)	61.28 ± 6.23	28.84 ± 4.29a	16.82 ± 3.41a,b	1152.415	< 0.001
Control group (n = 50)	59.96 ± 6.82	36.84 ± 5.20a	25.10 ± 4.73a,b	491.940	< 0.001
t value	1.010	8.391	10.041
P value	0.315	< 0.001	< 0.001

^aP < 0.05 vs test time at admission.

^bP < 0.05 vs test time at discharge.

Proprioception

Patient proprioception on admission was also compared (P > 0.05). The proprioception test results at discharge and 8 weeks after the intervention improved, and the improvement in the observation group was more significant (P < 0.05) (Table 5).

Table 5 Comparison of proprioception test, mean ± SD.

Group	Admission	Discharge	8 weeks after intervention	F	P value
Observation group (n = 50)	18.10 ± 3.28	14.82 ± 2.75a	10.12 ± 1.54a,b	116.623	< 0.001
Control group (n = 50)	17.98 ± 3.35	16.37 ± 2.95a	13.68 ± 1.82a,b	30.466	< 0.001
t value	0.181	2.718	10.559
P value	0.857	0.008	< 0.001

^aP < 0.05 vs the proprioception test at the time of admission.

^bP < 0.05 vs the proprioception test at discharge.

Resilience

The resilience of patients before the intervention was compared (P > 0.05), while those after the intervention improved, and the improvement in the observation group was significant (P < 0.05) (Table 6).

Table 6 Comparison of resilience, mean ± SD.

Group	Tough and tensile		Optimistic		Sense of power
	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention	Pre-intervention	Post-intervention
Observation group (n = 50)	26.86 ± 5.18	43.28 ± 5.82a	8.92 ± 3.15	13.15 ± 2.20a	16.38 ± 4.82	25.83 ± 4.02a
Control group (n = 50)	27.25 ± 5.21	37.18 ± 5.52a	9.18 ± 3.24	11.63 ± 2.08a	17.04 ± 4.96	21.36 ± 4.18a
t value	0.375	5.377	0.407	3.550	0.675	5.450
P value	0.708	< 0.001	0.685	0.001	0.501	< 0.001

^aP < 0.05 vs pre-intervention.

DISCUSSION

Rehabilitation training after knee arthroplasty is the main measure for promoting postoperative rehabilitation of knee joint function. To date, clinical scholars have mostly recommended that patients undergo long-term and continuous lower limb muscle strength training to correct joint muscle strength deficiency, maintain the stability of patients’ joints after surgery, and reduce joint load, which is beneficial to the patient’s joint function recovery after surgery[9]. However, some studies[10] have revealed that patients still have problems such as decreased joint balance ability and poor walking function after surgery, which are mainly caused by decreased joint proprioception owing to the destruction of muscle tissues around joints and mechanical receptors of structures in joints after surgery. Proprioception includes the perception of joint statics and motion as well as the efferent ability of the joint muscle tension-regulating circuit. Therefore, in recent years, postoperative joint rehabilitation training for patients has not only been limited to limb muscle strength training, but sensory and motor training has also become an important postoperative rehabilitation measure that can promote the generation of a normal feedback loop of limb proprioceptors and improve the coordination ability of joint and muscle activities. However, postoperative rehabilitation training measures are diverse and complex, with high step requirements and long rehabilitation times. During the communication and guidance process, medical conflicts may be caused by incorrect language, leading to patients’ negative cognition of rehabilitation training and decreased rehabilitation compliance[11]. Therefore, to promote the smooth implementation of sensory and motor training, the nursing staff adopted the AIDET communication mode when communicating with patients to grasp the needs of patients in time and transmit the rehabilitation training information, which could promote better communication between doctors and patients and improve the clinical outcomes of patients.

The results showed that the knee function, balance ability, and functional walking ability in the observation group at discharge and 8 weeks after the intervention were higher than those in the control group (P < 0.05). The results showed that sensory and motor training in AIDET communication mode was conducive to the recovery of joint function in patients and improved their walking ability and limb balance function. Xiaojun et al[12] reported that proprioception training for patients after anterior cruciate ligament reconstruction could significantly correct kinematic abnormalities of the lower limbs and restore normal gait. Alaca et al[13] suggested that proprioception training for patients after stroke can improve limb motor function and prevent spasms. Combined with the above studies, we confirmed the necessity and effectiveness of sensory and motor training. In sensory and motor training, through joint angle regression, balance training, and force sense training, the activity of limb receptors can be stimulated, and the feedback ability of the proprioceptive neuromuscular system can be strengthened, thereby improving the body function of patients, maintaining the normal gait of limbs, improving the balance ability of patients’ limbs, and reducing the risk of falling. Simultaneously, during the sensory and motor training, the AIDET communication mode was adopted for guidance, in which greetings and introductions were given first to establish a good nurse-patient relationship, understand the patient’s rehabilitation needs and personality characteristics, and improve their confidence in the medical staff. In addition, sensory and motor training guidance was provided based on the clinical information of the patients, and the patients were accompanied throughout the rehabilitation training. Meanwhile, the discomfort during the rehabilitation training was explained to the patients to provide a targeted rehabilitation training plan for the patients, which would promote the implementation of sensory and motor training, improve the patients’ rehabilitation compliance, and facilitate joint function recovery[14].

Generally, after knee arthroplasty, patients have defects in joint position and movement awareness, while limbs have good proprioception, which can maintain the normal joint function of patients and avoid movement damage and human posture control disorders[15]. Studies have shown that proprioception at discharge and 8 weeks after the intervention was higher than that in the control group. These results indicate that sensory and motor training in the AIDET communication mode was beneficial for improving the patients’ proprioceptive function of the limbs. Joint angle regression, balance training, walking training, Swiss ball extrusion, and contact can promote the recovery of limb receptors and improve the regulation and feedback function of the neuromuscular response. Simultaneously, it can repair the damaged soft tissue tension of the patient’s limbs and enhance the response of joint mechanical receptors, which is conducive to the proprioceptive recovery of the patient’s limbs. Additionally, sensory and motor training can promote patients’ perception of efferent activities of joints, transmit body movement information to the central nervous system, and increase the sensitivity of limb proprioceptors to information transmission, thereby promoting the recovery of limb function[16].

Patients undergoing knee arthroplasty have low cognition of surgery and disease rehabilitation, significant trauma caused by surgery, and limited movement of limbs after surgery, all of which damage their psychological function and lead to adverse psychological states. However, resilience directly reflects the fact that individuals can dynamically adjust their psychological adaptation ability in the face of severe external traumatic events. The higher the level, the higher the psychological adaptation ability of the patient[17]. The study showed that the level of resilience in the observation group after the intervention was higher than that in the control group (P < 0.05). These results indicate that sensory and motor training in the AIDET communication mode is beneficial for the improvement of patients’ resilience. This is because reasonable communication with patients using a standardized language through the AIDET communication mode can relieve the stress response and psychological pressure of patients to a certain extent and improve their training experience. Before sensory and motor training, the purpose and importance of sensory and motor training, as well as why functional training is needed, are explained, which can improve the patient’s understanding of rehabilitation training and enhance their confidence in rehabilitation. Simultaneously, affirmation of patients’ rehabilitation behaviors and explanations of adverse conditions during rehabilitation training can alleviate psychological pressure on patients, eliminate their anxiety and fear, and improve their resilience.

In summary, the application of sensory and motor training in the AIDET communication mode is worthy of application because it can promote knee function recovery in patients after knee arthroplasty, improve their limb walking ability and balance function, and increase their resilience level.

In this study, sensory and motor training in the AIDET communication mode applied to patients after knee arthroplasty significantly promoted the recovery of postoperative knee function and improved their walking ability and balance function. The intervention improved the patients' psychological resilience. However, due to the study's limited sample size, its results may be biased. In the future, it will be necessary to expand the sample size to ensure more accurate research results.

CONCLUSION

Patients who have undergone knee arthroplasty generally experience joint function limitations and proprioception decline. Performing early and continuous muscle strength rehabilitation training for patients after knee arthroplasty and sensory and motor training in the AIDET communication mode can promote knee joint function recovery in patients after knee arthroplasty, improve their limb walking ability and balance function, increase limb sensation and perception ability, and improve their resilience level, obtaining a high application effect, which is worthy of further clinical exploration.