RHD-HA-9: A scale for nurses to assess readiness for hospital discharge in older adults following hip arthroplasty—development and psychometric testing

Abstract

Background: Designing an instrument to assess discharge readiness post-hip surgery is essential due to trends showing poor patient outcomes, such as pain management issues, mobility challenges, and insufficient home support. A structured assessment tool would help ensure patients are better prepared for recovery, reducing the risk of complications and readmission. Objective: To develop and test the psychometric properties of the Readiness for Hospital Discharge Scale (RHD-HA-9) for hip arthroplasty. Methods: Items were generated from a comprehensive literature review and individual, face-to-face interviews with experts and patients. A cross-sectional study was conducted across four tertiary governmental hospitals to evaluate the psychometric properties of the scale. Data were collected from a total of 200 older adults who had undergone hip arthroplasty between June 2020 and February 2021. Exploratory Factor Analysis (EFA) was performed on data from 100 older adults to identify the underlying factor structure, followed by Confirmatory Factor Analysis (CFA) on a separate 100-patient dataset to validate the model. The questionnaire’s internal consistency, corrected item-total correlations, inter-rater reliability, construct, concurrent, and predictive validity were assessed. Results: The RHD-HA-9 included nine items, categorized into two factors: the physical performance of hip function and barriers to physical activity. EFA and CFA confirmed these factors, explaining 62% of the total variance. Model fit indices were acceptable (CFI = 0.97, TLI = 0.96, SRMR = 0.04), though RMSEA was 0.12. Chi-square was significant (X2 = 0.056, df = 24, p <0.001). The scale showed excellent internal consistency (Cronbach’s α = 0.89) and stability (ICC = 0.94). ROC analysis identified a cutoff of 9.5, with a sensitivity of 90.7%, specificity of 70.6%, and AUC of 0.89. Conclusion: The RHD-HA-9 demonstrated strong psychometric properties for assessing discharge readiness in older adults following hip arthroplasty. It identifies patients who need additional support during their transition home. Nurses can use this tool to accurately assess patient needs and implement effective post-discharge care, thereby enhancing patient outcomes.