Empowering Patient Education in Orthopaedic Care

The purpose of this research area is to assess the profitability of patient education in orthopedic care in relation to clinical, cognitive, functional, and emotional outcomes. Interventions of patient education and patient education practices have been compared internationally. Several instruments, including knowledge test, have been developed, tested, and culturally validated.


Empowering surgical orthopaedic patients through education

Principal investigator: Kirsi Valkeapää (ex Johansson), Adjunct Professor, PhD, RN

Research teams

The focus of the “Empowering Surgical Orthopaedic Patients through Education” project is on the education of osteoarthritis patients in the surgical context and it includes collaboration between researchers in health care and nursing science in seven European countries (Finland, Cyprus, Greece, Iceland, Lithuania, Spain and Sweden). This project aims to a) strengthen the theoretical basis of empowering patient education, b) identify and explain the differences between patient education in various countries, b) construct practice-oriented patient education models including those factors promoting best practices for orthopaedic patients in the surgical context and c) test and validate instruments used in evaluating patient education.

In this project, the theoretical basis lies in empowering patient education that emphasizes the power of patients and their self-management as a goal of patient education. In empowering patient education, it is essential to be aware of patients’ knowledge expectations and to measure the knowledge received. The basic assumption is that the closer patients’ expectations and received knowledge are, the more empowered they will be, and thus possibilities for self-management are created.

In the orthopaedic surgical context, knowledge of patients’ expectations and received care has been studied on the national level. “Empowering Surgical Orthopaedic Patients through Education” – the project is a step toward an international perspective on orthopaedic patient education. This project has already been started by a) making the research plan and establishing the international research team, b) preparing, testing and validating the instruments and c) planning the sample and data collection. Empirical data has been collected in seven participating countries. The data (N=1634) has been collected in all countries among surgical orthopaedic patients (n=172-279/country) and their significant others (n=1097) in connection with knee or hip replacement. Data collection points have been at admission, at discharge and 6-7 months after surgery. Nurses (n=317), caring for these patients, have also evaluated the quality of the education received by these patients. At this point, the data is under reporting.

The ultimate goal of these international analyses and comparisons is to construct the best educational practices internationally for supporting patient’s self-management in the orthopaedic surgical context.

This project has scientific, societal, clinical and educational outcomes.


Patient empowerment and recovery in orthopedic care

Principal investigator: Arja Pekonen, Doctoral candidate, MNSc, RN

Helena Leino-Kilpi, Professor and nurse director, PhD, RN, Department of Nursing Science, University of Turku, and Turku University Hospital
Petri Virolainen, hospital director, Turku University Hospital.

The purpose of this follow-up study is to evaluate patients’ recovery after short-stay orthopedic surgery and recognize factors which are connected to recovery, especially how patients’ knowledge and their own action are associated on recovery. Results of this study can be used to develop short-stay orthopedic patients’ care and improve the quality of care.


Pekonen, A., Eloranta, S., Stolt, M., Virolainen, P., & Leino-Kilpi, H. (2020). Measuring patient empowerment – A systematic review. Patient Education and Counseling, 103(4), 777–787. https://doi.org/10.1016/j.pec.2019.10.019

Empowering patient education in surgical care of patients with spinal stenosis

Principal investigator: Jukka Kesänen, PhD

The purpose of the present study was (A) to describe the use of knowledge tests in patient education, and (B) to assess the impact of a specific patient education intervention on the empowerment of patients undergoing surgery for lumbar spinal stenosis. The aim was to improve the quality of patient education in this patient group.


Kesänen, J. (2018). Empowering education in surgical care of patients with spinal stenosis (Doctoral dissertation).

Kesänen, J., Leino-Kilpi, H., Lund, T., Montin, L., Puukka, P., & Valkeapää, K. (2019). Spinal Stenosis Patients’ Visual and Verbal Description of the Comprehension of Their Surgery. Orthopedic Nursing, 38(4), 253–261. https://doi.org/10.1097/NOR.0000000000000572

Kesänen, J., Leino-Kilpi, H., Lund, T., Montin, L., Puukka, P., & Valkeapää, K. (2017). Increased preoperative knowledge reduces surgery-related anxiety: a randomised clinical trial in 100 spinal stenosis patients. European Spine Journal, 26(10), 2520–2528. https://doi.org/10.1007/s00586-017-4963-4

Kesänen, J., Leino-Kilpi, H., Lund, T., Montin, L., Puukka, P., & Valkeapää, K. (2016). The Knowledge Test Feedback Intervention (KTFI) increases knowledge level of spinal stenosis patients before operation-A randomized controlled follow-up trial. Patient Education and Counseling, 99(12), 1984–1991. https://doi.org/10.1016/j.pec.2016.07.025

Kesänen, J., Leino-Kilpi, H., Arifulla, D., Siekkinen, M., & Valkeapää, K. (2014). Knowledge tests in patient education: a systematic review. Nursing & Health Sciences, 16(2), 262–273. https://doi.org/10.1111/nhs.12097

Reported studies

Empowering patient education in ambulatory orthopeadic nursing internet-based intervention

Principal investigator: Katja Heikkinen, PhD

The aim of this study was to create and evaluate an Internet-based patient education programme aiming to cognitively empower ambulatory orthopaedic surgery patients. The research process was divided into two phases. In Phase I, the purpose was to create the content for cognitively empowering Internet-based patient education for ambulatory orthopaedic surgery patient care. In Phase II, the purposes were: to evaluate cognitively empowering Internet-based patient education (experiment group) user acceptance and the outcomes of this education, and to compare the outcomes of cognitively empowering Internet-based patient education to the outcomes of cognitively empowering face-to-face education (control group). The ultimate goal of this study was to create a new type of cognitively empowering patient education intervention which offers an individualized and engaging method that is free of time and place for patients having ambulatory orthopaedic surgery operations.


Heikkinen, K. (2011). Cognitively Empowering Internet-Based Patient Education for Ambulatory Orthopaedic Surgery Patients (Doctoral dissertation).