Impact of ABC-X Model Nursing on Psychological Resilience and Family Function in TKA Patients

The ABC-X model is a systematic intervention approach based on stress source analysis and adaptation theory. It emphasizes the dynamic interaction between stressors (A), coping resources (B), cognitive appraisal (C), and crisis outcomes (X). By systematically assessing patients' psychosocial stress, integrating family and social support resources, and optimizing disease cognition, it helps patients and their families alleviate psychological pressure and cope with disease challenges. This study aims to explore the impact of nursing interventions based on the ABC-X model on coping styles and family functioning in patients after total knee arthroplasty.

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Key information

Conditions

Total Knee Arthroplasty

Age range

30 year–65 year

Sex eligibility

All sexes

Study type

Observational

About this study

Total Knee Arthroplasty (TKA) is primarily indicated for patients with knee joint diseases that are unresponsive to conservative treatment and significantly impair daily life and work, such as osteoarthritis, rheumatoid arthritis, traumatic arthritis, osteonecrosis, or other inflammatory joint conditions. It is one of the widely used and well-established surgical procedures in the field of orthopedics. This surgery can effectively alleviate pain, correct joint deformities, and restore joint function. However, TKA may still be associated with various postoperative complications. Coupled with the prolonged off-hospital rehabilitation period, patients often exhibit insufficient compliance and limited coping strategies, which can adversely affect their postoperative recovery outcomes. Current routine nursing care primarily focuses on consolidating surgical outcomes, preventing complications, and promoting functional recovery. While it helps improve patients' daily activity levels and facilitates postoperative rehabilitation, it lacks systematic intervention in addressing patients' psychological stress, family support, and the integration of social resources. Moreover, patients often experience varying degrees of impaired self-care ability in the short term after surgery, necessitating reliance on family members for daily assistance. Therefore, when patients transition from hospital to family and social life, providing them with a professional and multifaceted nursing model is crucial, as it directly influences the speed and quality of their recovery.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Meet the diagnostic criteria for knee osteoarthritis as outlined in the Guidelines for Diagnosis and Treatment of Osteoarthritis (2018 Edition)[6], with confirmation by imaging examination;
Age 30-65 years;
Meet the surgical indications of our hospital and be a first-time candidate for unilateral TKA;
Normal neurological and cognitive function, with stable vital signs;
Family members have signed the informed consent form.

Exclusion criteria

Presence of lower limb movement impairments;
Accompanied by severe complications;
Infectious diseases or severe immune system disorders;
Other acute and critical illnesses;
History or presence of mental dysfunction;
Language or communication disorders.

Treatment and study plan

Implement nursing interventions based on the ABC-X model

Other

Establish a Nursing Team Based on the ABC-X Model

Implement the Nursing Intervention Plan:

A - Stressor Assessment, including physiological assessment, assessment of life challenges, and evaluation of the social support network.
B - Coping Resources, involving organizing medical system resources, individual internal resources, and family and social resources.
C - Cognitive Appraisal: Use open-ended questioning to help patients understand the normality of stress responses, reduce fear of negative emotions, and minimize self-blame.
X - Crisis Outcome, assessing the patient's emotional state, behavioral responses, physiological reactions, and family functioning.

The intervention will be conducted over a period of 6 months.

Primary outcomes

Postoperative recovery effectiveness

Time frame: The intervention will be conducted over a period of 6 months.

Postoperative recovery effectiveness: Six months after surgery, the modified Macnab criteria are used for therapeutic evaluation: Excellent indicates complete symptom relief with return to normal daily life and work; Good indicates mild symptoms with slight limitations on daily activities, without adverse effects on daily life and work; Fair indicates significant symptom relief but with limitations on daily activities and adverse effects on daily life and work; Poor indicates no improvement or worsening of symptoms before and after treatment.
Psychological resilience

Time frame: Intervention will take place within 6 months.

Psychological resilience：Evaluated using the Resilience Scale (CD-RISC), which has a Cronbach's α coefficient of 0.875, including three dimensions: strength (10 items, 40 points), optimism (8 items, 32 points), and 韧性 (7 items, 28 points). Each item is scored from 0 to 4 points, with a total score of 100 points, with higher scores indicating better psychological resilience.
Self-care ability

Time frame: Intervention will take place within 6 months

The Self-Care Ability Scale (ESCA) was used for evaluation, with a Cronbach's α coefficient of 0.86~0.92. It consists of 4 dimensions and 43 items, with each item scored on a scale of 0 to 4 points. The total score ranges from 0 to 172, with higher scores indicating stronger self-care ability.
Rehabilitation exercise adherence

Time frame: Intervention will take place within 6 months

The Functional Exercise Adherence Scale for Orthopedic Patients was used for assessment. This scale consists of 3 dimensions and 15 items, covering exercise adherence related to physical aspects, psychological aspects, and active learning. A 1-5 point Likert 5-point rating scale is used, with a total score of 75 points. Scores <20 points, 20-55 points, and ≥55 points respectively indicate low adherence, partial adherence, and high adherence.
Family functions

Time frame: Intervention will take place within 6 months

The Family Function Assessment Scale (APGAR) was used for evaluation, with a Cronbach's α coefficient of 0.856. It consists of 5 items: cooperativeness, adaptability, emotional quality, maturity, and intimacy. Each item is scored out of 10, with higher scores indicating better family function.

Study contacts

Contact information is provided by the study sponsor or research team.

bingbing wu

CONTACT

[email protected]

13757151757

wenying wu

CONTACT

[email protected]

18857176306

Sponsors and collaborators

Lead sponsor

The Fourth Affiliated Hospital of Zhejiang University School of Medicine

Other

Registry information

Official study title

Study on the Impact of Nursing Interventions Based on the ABC-X Model on Psychological Resilience and Family Functioning in Patients After Total Knee Arthroplasty

Important dates

Study start: 2025
Primary completion: 2028
Study completion: 2028
First posted: Jan 13, 2026
Registry last updated: Jan 13, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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