Total hip arthroplasty (THA) improve the patients' quality of life, and one of the most important problems after surgery is to optimize postoperative pain management. It has been shown that pain is intimately linked to the fear of movement, the so-called kinesiophobia, which can affect the entire perioperative period and quality of life in people undergoing THA. In this study, we aimed to present a new integrative approach called IARA model specifically focused on educational interventions such as knowledge and awareness of illness, guided imagery, and drawings to help the patient achieve full autonomy and confidence about the perioperative period and surgery. The Hip Injury and Osteoarthritis Outcome Score (HOOS), Tampa Scale Kinesiophobia (TSK) questionnaire, and Numeric Rating Scale 0-10 have been used to test the efficacy of IARA. The main finding in the present study was the effectiveness of IARA model in improving indexes of pain (p < 0.01) and QoL (p < 0.01) and to keep kinesiophobia levels low in patients undergoing THA.

Patients affected by gastroesophageal reflux disease (GERD) have a poor quality of life caused by several manifestations such as cough, asthma, laryngitis and dental erosion. The clinical conditions are highly disabling for patients and symptoms are difficult to manage. These conditions lead to many discomforts which contribute to an increase of the disease perception. For these reasons, it is important to improve the interventions on psychological aspects that ameliorate the patients' quality of life. The application of IARA model has proven useful to decrease GERD symptoms, distress and medication intake and to increase adherence to care, improving the patient's quality of life.

Chronic obstructive pulmonary disease (COPD) is one of the most deadly and costly chronic diseases in the world characterized by many breathing problems. The management of COPD and the prevention of exacerbations are a priority goals to improve the quality of life in patients affected by this illness. In addition, it is also crucial to improve the patients' adherence to care which, in turn, depends on their knowledge and understanding of some factors such as the prescribed medical treatment, changes in dailylife, and the process of breathing. In turn, the adherence to care leads to greater autonomy for the patient who is thus able to better manage his illness. Here we presented the application of the Model IARA in patients affected by COPD in order to achieve their autonomy in illness management which, in turn, leads to a better quality of life. IARA is an intervention program which improve the awareness and knowledge of patients with respect to both the disease and symptoms through health education. Moreover, through IARA the patients are encouraged to become more actively involved in COPD care process, also regarding drug therapy adherence. Using St. George's Respiratory Questionnaire combined with qualitative analysis, we demonstrated that IARA could be considered a useful approach in COPD management.

Introduction: Postoperative complications in TKA are well-known, especially regarding kinesiophobia which affects both perception of pain and good post-operation recovery, preventing the normal course and sometimes leading to a new intervention even in the presence of a technically successful operation. Methods: The study had a quasi-experimental, controlled, before-and-after design and was conducted on 84 patients; 44 were assigned to IARA and 40 to control group. According to IARA model three meetings were performed (two pre-and one postoperative). The control group received normal preand postoperative interaction. With the purpose of evaluating pain, kinesiophobia and health-related Quality of Life (QoL), we used respectively the NRS 0-10, TSK, and KOOS questionnaires. Results: Applying two-way mixed design ANOVA we found significant Time × Group interaction in all KOOS subscales: Pain (F1,82=10.808, p<0.001); Symptom (F1,82=15.497, p<0.001); ADL (F1,82=20.342, p<0.001); Sport/Rec (F1,82=20.451, p<0.001); QOL (F1,82=4.275, p<0.001) and also in TSK questionnaire (F1,82=4.275, p=0.042). Conclusion: IARA turned out to be a short and effective approach to reducing kinesiophobia and pain at 40 th day after surgery, significantly improving QoL indexes in patient undergoing TKA. Level of evidence: III.

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