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.
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;
Presence of lower limb movement impairments;
Accompanied by severe complications;
Infectious diseases or severe immune system disorders;
Other acute and critical illnesses;
A total of 117 patients who underwent TKA for knee osteoarthritis from July 2025 to July 2026 were selected as the study subjects.
Other
Prospective
Implement nursing interventions based on the ABC-X model
Other interventionEstablish a Nursing Team Based on the ABC-X Model Implement the Nursing Intervention Plan: 1. A - Stressor Assessment, including physiological assessment, assessment of life challenges, and evaluation of the social support network. 2. B - Coping Resources, involving organizing medical system resources, individual internal resources, and family and social resources. 3. 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. 4. 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.
Postoperative recovery effectiveness
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
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
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
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.
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