Background: Patient education in connection with hip replacement is intended to prepare

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania, Sweden)

The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

In the recovery process of arthroplasty patients, their family members play an important role due to short hospital stay and increased age of patients. Family members need to have knowledge to be able to support the patient. The aim of this study was to explore expected and received knowledge in family members of arthroplasty patients and describe the relationships between the differences in received and expected knowledge and background factors, country, information and control preferences and access to knowledge. The study was conducted in six European countries (Cyprus, Greece, Finland, Iceland, Spain and Sweden). The study design was cross-cultural, prospective and comparative with two measurement points: pre-operative and at discharge from hospital. Knowledge Expectations of significant other-scale and Krantz Health Opinion Survey were used before surgery and Received Knowledge of significant other-scale and Access to Knowledge at discharge. Patients undergoing elective hip or knee arthroplasty in seventeen hospitals were asked to identify one family member. The sample size was decided by power calculation. A total of 615 participants answered the questionnaires at both measurements. Family members perceived to receive less knowledge than they expected to have, most unfulfilled knowledge expectations were in the financial, social and experiential dimensions of knowledge. Seventy-four per cent of participants had unfulfilled knowledge expectations. Increased access to information from healthcare providers decreased the difference between received and expected knowledge. Compared to family members in southern Europe, those in the Nordic countries had more unfulfilled knowledge expectations and less access to information from healthcare providers. The evidence from this study highlights the need to involve the family members in the educational approach.

The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state.

AcknowledgmentsThe study has required contribution by many people in the participating countries. We wish to thank all those who took part in this study. This study was financially supported by the following: Finland-University of Turku; A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPTEmpowering knowledge and its connection to health-related quality of life: a cross-cultural study A concise and informative title: Empowering knowledge and its connection to health-related quality of life AcknowledgmentsThe study has required contribution by many people in the participating countries. We wish to thank all those who took part in this study. Abbreviations EK hpExpected knowledge (hospital patients) EQ-5DEuroQoL 5-dimensional classification component scores (www.euroqol.org) HRQoLHealth-related quality of life OA Osteoarthritis RK hpReceived knowledge (hospital patients) THA Total hip arthroplasty TKA Total knee arthroplasty A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT AbstractAims: Assess the association between patient education (i.e. empowering knowledge) and preoperative health-related quality of life, 6 months postoperative health-related quality of life, and the increase in health-related quality of life in osteoarthritis patients who underwent total hip or total knee arthroplasty.Method: This is a cross-cultural comparative follow-up study using structured instruments to measure the difference between expected and received patient education and self-reported healthrelated quality of life (EQ-5D) in Finland, Greece, Iceland, Spain and Sweden.Results: The health-related quality of life was significantly increased 6 months postoperatively in all countries due to the arthroplasties. In the total sample, higher levels of empowering knowledge were associated with a higher health-related quality of life, both pre-and postoperatively, but not with a higher increase in health-related quality of life. On the national level, postoperative healthrelated quality of life was associated with higher levels of empowering knowledge in Finland, Iceland and Sweden. The increase in health-related quality of life was associated with levels of empowering knowledge for Greece.Conclusions: Overall, it can be concluded that the level of empowering knowledge was associated with high postoperative health-related quality of life in the total sample, even though there is some variation in the results per country.

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Background Older community-dwelling people with multimorbidity are often not only vulnerable, but also suffer from several conditions that could produce a multiplicity of symptoms. This results in a high symptom burden and a reduced health-related quality of life. Even though these individuals often have frequent contact with healthcare providers they are expected to manage both appropriate disease control and symptoms by themselves or with the support of caregivers. The aim of this study was therefore to describe the symptom management strategies used by older community-dwelling people with multimorbidity and a high symptom burden. Method A qualitative descriptive design using face-to-face interviews with 20 community-dwelling older people with multimorbidity, a high healthcare consumption and a high symptom burden. People ≥75 years, who had been hospitalized ≥3 times during the previous year, ≥ 3 diagnoses in their medical records and lived at home were included. The participants were between 79 and 89 years old. Data were analysed using content analyses. Result Two main strategy categories were found: active symptom management and passive symptom management. The active strategies include the subcategories; to plan, to distract, to get assistance and to use facilitating techniques. An active strategy meant that participants took matters in their own hands, they could often describe the source of the symptoms and they felt that they had the power to do something to ease their symptoms. A passive symptom management strategy includes the subcategories to give in and to endure. These subcategories often reflected an inability to describe the source of the symptoms as well as the experience of having no alternative other than passively waiting it out. Conclusions These findings show that older people with multimorbidity and a high symptom burden employ various symptom management strategies on daily basis. They had adopted appropriate strategies based on their own experience and knowledge. Healthcare professionals might facilitate daily life for older people with multimorbidity by providing guidance on active management strategies with focus on patient’s own experience and preferences.