Effects of perioperative nurse-led coaching on pain, anxiety, and self-care outcomes up to 90 days following total knee replacement: a randomized controlled trial

Abstract Background Total knee replacement (TKR) is commonly performed to relieve pain and improve functional mobility in patients with degenerative knee diseases. However, postoperative pain, anxiety, and limitations in self-care may negatively affect recovery and rehabilitation outcomes. Perioperative nurse-led coaching has emerged as a patient-centered approach that may be associated with self-management, emotional support, and participation in postoperative care. This study aimed to evaluate the effects of nurse-led coaching integrated into perioperative nursing care on pain, anxiety, self-care agency, activities of daily living, satisfaction with nursing care, analgesic use, and hospital readmission in patients undergoing total knee replacement. Design A parallel-group randomized controlled trial was conducted in patients undergoing TKR. Methods Seventy-two participants were randomized (36 per group). As there was no single predefined primary endpoint, the findings were evaluated based on multiple outcome measures. The primary intention-to-treat analysis was conducted using baseline-adjusted linear mixed-effects models that included all 72 randomized participants in their originally assigned groups. Each participant provided at least one post-baseline measurement for each of the VAS, STAI-I, SCAS, and MBI scores, and the models utilized all available follow-up observations without imputing missing values. The intervention consisted of a total of nine scheduled, in-person, nurse-led coaching sessions that began during the preoperative outpatient phase, continued throughout the hospital stay, and were conducted on the 15th, 45th, and 90th days after discharge. The longitudinal outcomes were evaluated at five time points using the Visual Analog Scale, State-Trait Anxiety Inventory, Self-Care Agency Scale, and Modified Barthel Index; nursing care satisfaction was assessed using the Newcastle Satisfaction with Nursing Scale. Results In baseline-adjusted linear mixed-effects models, intervention-group scores were lower across follow-up for pain (overall group effect: likelihood-ratio χ²=51.16, p < 0.001) and anxiety (χ²=60.71, p < 0.001), and higher for self-care agency (χ²=56.73, p < 0.001). At day 90, adjusted between-group differences were − 1.97 points for VAS (95% CI − 2.71 to − 1.22; d = − 1.48), − 14.36 for STAI-I (95% CI − 18.58 to − 10.13; d = − 2.01), and 26.81 for SCAS (95% CI 19.87 to 33.74; d = 2.39). Adjusted MBI differences were significant at discharge and day 15 but not at days 45 or 90. NSNS scores were significantly higher in the intervention group (mean difference = 18.25; 95% CI 11.98–24.52; Hedges’ g = 1.40; p < 0.001). In the complete-case sensitivity population, analgesic use decreased in 87.9% (29/33) versus 70.6% (24/34), with Cramér’s V = 0.31, while readmission did not differ significantly (RR = 0.26, 95% CI 0.06–1.12; p = 0.083). Conclusions Perioperative nurse-led coaching was associated with lower pain and anxiety and higher self-care agency, nursing care satisfaction, and early functional independence following TKR. The findings suggest that structured perioperative nurse-led coaching may be associated with more favorable patient-centered, self-management, and rehabilitation-related outcomes. However, the single-center design, unblinded outcome assessment, and baseline score imbalances require cautious interpretation of results. Because the multiple-comparison correction was applied only to the four post-baseline comparisons within each longitudinal outcome and did not account for multiplicity across the different outcome variables, the findings should be interpreted as supportive rather than confirmatory. Trial registration ClinicalTrials.gov, NCT04683588. Registered on December 24, 2020.