LAUSR

I read the article entitled “Effects of a continuous nursing care model on elderly patients with total hip arthroplasty: a randomized controlled trial” with great interest. In this study, the authors focused on the effectiveness of two different nursing models in patients with total hip arthroplasty. Physical results such as function, activities of daily living, independence of individuals and psychological consequences such as depression and anxiety are discussed [1]. Since the importance of physical performance in total hip arthroplasty is well known, it is essential to investigate the effectiveness of different treatment modalities. The study was carried out in accordance with its purpose; I congratulate the authors in this respect. However, some methodological details should be emphasized. Firstly, the authors did not identify the randomization method. Since several guidelines (e.g., CONSORT, STROBE) dictated the necessity of emphasizing the randomization preference, the authors should further describe their method [2, 3]. Additionally, the recruitment procedure should also be given in detail to declare the ethical and methodological scope of the study. Guo et al. calculated the sample size with PS software (power and sample size collection version 3.0.12). However, they did not mention the details of the calculation method. To improve the evidence of the study, the formula of the calculation should be detailed. Effect size, prevalence or other relevant reference data should be presented, then significance and power level should be given to show the potency of the sample size calculation. Secondly, a single evaluator would be better for the data collection. The authors of the study stated multiple blind evaluators. However, some of the assessments are clinical-based tools. For instance, Barthel index and Harris Hip Score are scored by the clinician. Therefore, different evaluators could cause a potential evaluation bias, which could affect the study results. On the other hand, the validity and reliability of the Barthel Index, which is used to evaluate the disability levels of patients, has not been demonstrated in total hip arthroplasty. It is essential to reveal the psychometric properties of standardized questionnaires before they are used in specific clinical groups. In this respect, it would be more appropriate to use WOMAC, which is more preferred in the relevant case group and has been shown to be valid and reliable [4]. Considering the citations of the questionnaires used in the evaluation of depression and anxiety, it is not clear that these tools are not based on validity and reliability studies and are not modern tools. Last but not least, it is indispensable to follow-up the patients with post-operative total hip arthroplasty progressively with some standardized protocols, explicitly modifying the activities of daily living suitable for some surgical procedures. Therefore, similar care should not be applied to patients who have been treated with different surgical procedures. In this respect, adding a surgical procedure to the exclusion criteria would have been more effective. In other words, it should be detailed which exercise practices are performed differently in the conventional care and CNC model of the patients, which treatment protocols are adhered to, which phases of the treatment [5]. Whether there is a difference between the two groups in these respects, and detailed exercise prescription, which is thought to be advantageous for patients in the CNC model, would contribute to other studies for further research. On the other hand, it was stated that patients had pain measurements (“1st the degree of pain and swelling of the patient's joints were evaluated to give appropriate care for pain reduction”), but no pain-specific evaluation was presented. * Fatih Özden [email protected]