Research on Evidence-based Nursing Practice Based on the LEARNS Model in Early Postoperative Rehabilitation of Patients With Lower Limb Fractures.

PURPOSE: To evaluate the efficacy of a digitally integrated, phase-stratified nursing education intervention based on the LEARNS-Ortho Continuity Model in improving recovery outcomes among patients undergoing lower-limb fracture surgery.

DESIGN

A prospective cohort validation study conducted between 2023 and 2025.

METHODS

A total of 500 orthopedic trauma patients aged 40-75 years were recruited from a tertiary hospital in Guangdong, China. Participants were stratified by age, fracture type, and digital literacy. Primary outcomes included American Orthopaedic Foot and Ankle Society (AOFAS) scores, complication rates, length of stay, and patient satisfaction. Secondary outcomes included task compliance, diary adherence, and intervention fidelity.

FINDINGS: AOFAS scores improved significantly from discharge (62.5 ± 7.8) to 90 days (83.0 ± 6.4), with greater gains observed in younger patients and those with ankle fractures. The overall complication rate was 16.6%, highest among ASA III and comorbid patients. Median length of stay was 6.0 days. Patient satisfaction increased from 34.6 ± 5.8 to 44.5 ± 3.6, and self-care confidence reached 9.8 ± 1.9 at 90 days. Task compliance and diary adherence exceeded 85% in high-literacy groups. Nurse educator fidelity averaged 94.5%. Sensitivity analyses confirmed robustness of results.

CONCLUSIONS

Digitally enabled, phase-stratified nursing education significantly improves postoperative recovery outcomes and patient-centered measures following orthopedic trauma surgery.