J Korean Acad Nurs.  2020 Aug;50(4):554-570. 10.4040/jkan.19216.

A Structural Equation Model of Health-Related Quality of Life among Older Women Following Bilateral Total Knee Replacement

• Lee HO
• Yoo JS

• KMID: 2505817
• DOI: http://doi.org/10.4040/jkan.19216

Abstract

Purpose
This study aimed to develop and test a structural equation model of health-related quality of life among older women following bilateral total knee replacement based on a literature review and Wilson and Cleary’s model of health-related quality of life.
Methods
One hundred ninety three women who were diagnosed with osteoarthritis, were older than 65 years, and were between 13 weeks and 12 months of having a bilateral total knee replacement were recruited from an outpatient clinic. Data were collected from July 2017 to April 2018 using a structured questionnaire and medical records. Data were analyzed using SPSS/WIN 22.0, AMOS 22.0, and Smart PLS 3.2.4.
Results
The fitness of the hypothetical model was good, with coefficients of determination (R² ) ranging between .28 and .75 and predictive relevance (Q² ) between .26 and .73. The standardized root mean square residual of the model fit indices for the hypothetical model was .04; which explained 64.2% of physical and 62.5% of mental health-related quality of life. Self-efficacy, symptom status, functional status, and general health perceptions had a significant direct effect on physical health-related quality of life, while social support, symptom status, and general health perceptions had a significant direct effect on participants’ mental-health-related quality of life.
Conclusion
To improve the physical and mental quality of life of older women who receive bilateral knee replacement, nursing-based intervention strategies that reduce symptoms, improve functional status, and increase health perceptions, self-efficacy, and social support are needed. The most important factor is the symptom status.

Keyword

Total Knee Replacement; Quality of Life; Osteoarthritis; Women