Preoperative Education Session Research Articles

Does Participation in Virtual or In-Person Preoperative Education Relate to Reduced Length of Stay After Total Joint Arthroplasty?

Advancements in surgical procedures for total joint arthroplasty (TJA) have resulted in more effective procedures with more rapid recovery. To prepare patients for surgery, many organizations offer a preoperative "joint class," which has been associated with reduced length of stay (LOS). Virtual modes of education are increasingly favored for those having TJA. To determine whether participation in an individually administered preoperative educational session ("Prehab") relates to reduced LOS or increased likelihood of same-day discharge (SDD) for those undergoing TJA. Additionally, to establish whether and the virtual mode of education provision is superior or inferior to the in-person mode with regards to LOS benefits. The author conducted a case-control study of 2532 patients who had a primary or revision TJA between January 2022 and August 2022 at a single institution. Data were obtained from the electronic medical record. A total of 1118 patients attended Prehab; 1414 patients did not. Patients were included if they were over the age of 18 and had a total hip arthroplasty (THA) or total knee arthroplasty (TKA) during the study period. T-tests, chi-square χ2 tests, and binomial logistic regression were used to evaluate the LOS and SDD outcomes for those who participated in Prehab compared with those who did not. Those receiving Prehab in any form had shorter LOS than those who had not. Those receiving virtual Prehab had the shortest LOS. There was no difference in the rate of SDD for outpatient-class patients. Preoperative education is associated with LOS benefits to patients undergoing TJA. The virtual mode of education provision is at minimum non-inferior, and may be superior, to the in-person mode. The lack of statistically significant between-group differences for SDD outcomes may be explained by a lack of SDD-specific educational content provided during Prehab.

The Efficacy of a Preoperative Occupational Therapy Educational Session for Saudi Patients Undergoing a Lower Extremity Joint Replacement.

Prior to a lower extremity joint replacement, many surgical candidates participate in a preoperative occupational therapy educational program that is meant to increase patient awareness, promote positive health behaviors, and improve health outcomes after surgery. With the limited number of occupational therapists in Saudi Arabia, patients may only receive one preoperative educational session. The objective of the study was to explore the efficacy of one preoperative occupational therapy educational session for patients undergoing a lower extremity joint replacement. A total of 19 participants were included in the study, 7 participants to the intervention and 12 participants to the control groups. Participants underwent either a total knee or total hip replacement. The intervention group received one preoperative educational session prior to the surgery and the control group received usual care. After the surgery, both groups were assessed on pain (SF-MPQ), Satisfaction (SPSQ), Quality of life (QOLS), functional performance (FIM). Mann-Whitney U-tests were used to compare between groups. The findings showed significant improvements in both pain (12.14 ± 7.22 vs 21.25 ± 8.60; p=0.02) and satisfaction (106.28 ± 25.17 vs 78.08 ± 31.49; p=0.03) when compared to usual care. Although both FIM and QOLS scores indicated improvements when compared to usual care, these results were not statistically significant. Effect sizes showed moderate and large effects for score differences on both the SF-MPQ and SPSQ (r= 0.47, r=0.52) respectively. Whereas effect sizes for score differences on both the FIM and QOLS were small. An occupational therapy preoperative education session shows promise for patients undergoing lower extremity joint replacement; however, further research is needed to confirm these findings.

The Use of a Personalized 3D Printed Model for Pre-Operative Education in Patients with Severe Periarticular Foot and Ankle Fractures

Category: Trauma; Other Introduction/Purpose: Complex periarticular foot and ankle fractures have shown to have significant psychosocial effects on patients such as developing catastrophizing behaviours and poor pain coping strategies. These factors have shown to influence patient satisfaction. Interestingly, a positive association exists between patient satisfaction and preoperative expectations being met. For patient expectations to be met, clear comprehensive preoperative education is required. 3D printing has gained popularity due to its benefits in preoperative planning as well as patient education. Our aims were to 1) investigate the impact of a personalized 3D printed model for patient education on pre- and post-operative expectations and overall satisfaction and 2) investigate the impact of this teaching modality on PROMS and their correlation to patient expectation and satisfaction. Methods: Twenty-eight patients presenting complex periarticular foot and ankle fractures (pilon, talus and calcaneus) were randomized to either control or intervention (3D). All patients underwent a preoperative standardized education session with or without a personalized 3D printed model. Patient expectation and satisfaction were quantified pre- and postoperatively using the MODEMS questionnaires while the following PROMs (VAS and SF-12) were assessed at 2 weeks, 3 months, 6 months and 12 months post-operatively. Results: No significant differences were found between groups for MODEMS pre- (p=0.329) and postoperative expectation (p=0.654), and satisfaction (p=0.411). While not statistically significant, there was a trend towards expectations being better met in the intervention group when compared to the control group (31.2% vs 43.5% respectively). Also, there were no significant differences between groups for VAS and SF-12 at different time points, expect for SF-12 at 3 months for physical component only. A strong positive correlation (0.905, p=0.013) was found between MODEMS preoperative expectation and VAS scores at 12 months in the intervention group. Conclusion: Although there were no significant differences found between groups for pre- and postoperative patient expectation and overall satisfaction at 12 months, there is a trend towards expectations being better met in the intervention group. This could indicate that lower and more realistic expectations are set preoperatively when educating patients using a 3D model. Expectations preoperatively are strongly correlated with pain scores at 12 months in the intervention group demonstrating an association with realistic expectations and improved pain scores when a 3D model was used. Thus, personalized 3D printed education is a non- invasive tool that may impact pain coping strategies post-operatively.

Physiotherapy and Anterior Resection Syndrome (Paris) Trial A Feasibility Study to Assessing if a Preoperative Education and Physiotherapy Session Before an Anterior Resection, and a 3 Month Pelvic Floor Muscle Rehabilitation Programme Prior to Ileostomy Reversal are Feasible

Physiotherapy and Anterior Resection Syndrome (Paris) Trial A Feasibility Study to Assessing if a Preoperative Education and Physiotherapy Session Before an Anterior Resection, and a 3 Month Pelvic Floor Muscle Rehabilitation Programme Prior to Ileostomy Reversal are Feasible

The Effect of Preoperative Education Prior to Hip or Knee Arthroplasty on Immediate Postoperative Outcomes.

There is ample research demonstrating improved patient outcomes when using an enhanced recovery program. However, the literature reporting the impact of preoperative education alone prior to hip and knee arthroplasty is conflicting. With the number of these surgical procedures expected to increase in the next few years, the identification of strategies that positively impact outcomes is important. The aim of this study was to evaluate immediate postoperative physical therapy (PT) performance following a total hip or knee arthroplasty in patients who attended a preoperative education class compared with those who did not. This study was a retrospective chart review of 707 hip and knee arthroplasty patients, comparing outcomes based on preoperative educational session attendance. Demographics, comorbidities, length of stay (LOS), discharge disposition, and PT performance were collected from the chart review. Patients who attended the preoperative education class had significantly greater ambulation distances (p < .001), greater degrees of knee flexion (p < .001), and greater degrees of hip flexion (p = .012) on postoperative Day 1. Both hip (p < .001) and knee (p < .001) patients who attended the class had a significantly shorter LOS. The cost benefit analysis indicated a savings of $921.57 in direct costs per knee arthroplasty in those who attended a class. Patients who received preoperative education had greater mobility in the immediate postoperative period and reduced LOS for both hip and knee arthroplasties. Based on this study's results, preoperative education is effective in improving outcomes and reducing the cost of hip and knee arthroplasties.

Implementing a telehealth prehabilitation education session for patients preparing for major cancer surgery

BackgroundPrehabilitation services assist patients in preparing for surgery, yet access to these services are often limited by geographical factors. Enabling rural and regional patients to access specialist surgical prehabilitation support with the use of telehealth technology has the potential to overcome health inequities and improve post-operative outcomes.AimTo evaluate the current and likely future impact of a telehealth preoperative education package for patients preparing for major abdominal cancer surgery.MethodsA telehealth alternative to a hospital based pre-operative education session was developed and implemented at a dedicated cancer hospital. Adult patients (≥18 years) scheduled for elective major cancer surgery were offered this telehealth alternative. Impact evaluation was conducted using the RE-AIM framework.ResultsTo date, 35 participants have consented to participate in the study. Thirty-one participants attended the intervention; 24 (69%) residing in rural or regional areas. Twenty-four (77%) reported that if given a choice they would prefer the online session as opposed to attending the hospital in person. The majority (97%) reported they would recommend the intervention to others preparing for surgery. Session information was recalled by all 26 participants and 77% of participants reported acting on recommendations 2 weeks after the session. Lessons learnt and recommendations for providers implementing similar programs are reported.ConclusionTelehealth alternatives to hospital based pre-operative education are well received by patients preparing for major cancer surgery. We make seven recommendations to improve implementation. Further evaluation of implementation strategies alongside clinical effectiveness in future studies is essential.Trial registrationACTRN12620000096954, 04/02/2020.

Participation in a Preoperative Patient Education Session Is a Significant Predictor of Better WOMAC Total Index Score and Higher EQ-5D-5L Health Status Index 1 Year After Total Knee and Hip Arthroplasties: A Retrospective Observational Study.

The aim of the study was to investigate whether patient-specific factors, preoperative patient-reported outcome measures, and participation in a preoperative patient education session significantly predict 1-yr Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) health status index of patients who underwent total hip or knee arthroplasties within an enhanced rehabilitation program. This is a retrospective observational cohort study. The inclusion criteria were met by 676 (373 total hip arthroplasties and 303 total knee arthroplasties) patients. Two multiple regression models were carried out to estimate the contributions of nine potential predictors. Younger age (P = 0.006), higher preoperative EQ-5D-5L index (P = 0.004), lower patient clinical complexity level (P = 0.001), lower preoperative WOMAC total score (P < 0.001), preoperative patient education session (P = 0.004), and submitting for total hip arthroplasty (P < 0.001) were significant predictors of better 1-yr WOMAC total score. Higher preoperative EQ-5D-5L index (P < 0.001), lower patient clinical complexity level classification (P < 0.001), lower preoperative WOMAC total score (P = 0.009), preoperative patient education session (P = 0.04), and submitting for total hip arthroplasty (P = 0.01) were significant predictors of higher 1-yr EQ-5D-5L health status index. Better baseline patient-reported outcome measure scores, less comorbidities, younger age, submitting for total hip arthroplasty, and attending a preoperative patient education session were significant predictors of better WOMAC total scores and higher EQ-5D-5L health status index 1 yr after total hip or total knee arthroplasties.

The Relationship between Preoperative Educational Session and Anxiety Level among Women Undergoing Cesarean Section: A Scoping Review

Context: Anxiety is felt in women undergoing elective cesarean section. In obstetric patients, literature has reported a higher level of preoperative anxiety than the general surgical population. One of the commonest surgical procedures in obstetrics is Caesarean section (CS). Preoperative anxiety has been described as being associated with several adverse physiological and psychological effects.&#x0D; Aim: This review aimed to determine the relationship between preoperative educational sessions and anxiety levels among women undergoing cesarean section.&#x0D; Methods: The search strategy of this study relies on some of the electronic bibliographic databases under the Medicine, Nursing, and Health Sciences departments. Various databases have been used to include different perspectives in the findings, CINAHL, Ovid MEDLINE, Pub Med, and Embase databases used to collect primary articles for this study.&#x0D; Results: The current review of the literature included seven quantitative studies that fulfill the inclusion criteria. The included studies revealed the intervention used as mental health training (one study), video is used in three studies, and health instruction in five studies. Two studies used both video and health instruction. In terms of the effect of preoperative sessions on anxiety level, four out of seven studies reported a decrease in the anxiety level. In comparison, the remaining three studies reported a non-significant educational intervention effect in decreasing the women’s anxiety.&#x0D; Conclusion: Most of the reviewed studies indicated that preoperative education intervention could positively impact anxiety levels among women undergoing CS. This makes the reviewed theme open for further randomized control intervention studying.

Does performing outpatient total hip arthroplasty contribute to early complications and readmissions? Retrospective case-control study of 50 patients

IntroductionAdvances in anesthesia and surgical practices have allowed total hip arthroplasty to be performed as an outpatient procedure. The aim of this study was to demonstrate its feasibility in a selected population compared to a group of inpatients by analyzing the cumulative length of hospital stay, complications and readmissions. Patients and methodsThis was a retrospective, single-surgeon study of continuous adult patients between October 2016 and May 2018 who underwent primary total hip arthroplasty (THA) and were eligible to undergo this procedure either as an inpatient or outpatient based on their health and comprehension level. Two groups of patients were set up. The outpatient group was given a preoperative treatment education session. The same anesthesia protocol and surgical technique was used in both groups. ResultsFifty outpatients were compared to 77 inpatients. In the outpatient group, the patients were significantly younger, had a greater walking distance and were predominantly male. The two groups were comparable in terms of functional and medical criteria. The mean cumulative hospital stay was 1.2days in the outpatient group with one discharge failure because of nausea and vomiting, versus 5.1days in the inpatient group (p<0.0001). There were three complications in each group (p=1.00). There were three readmissions in the outpatient group and four in the inpatient group (p=1.00) that were of similar length (p=0.86). There was no difference in the mean number of additional office visits over this period between the two groups. ConclusionOutpatient THA procedures can be done reliably and safely in France in a carefully selected population without increasing the complication rate or readmission rate. Expanding this practice requires implementing specific anesthesia and surgery protocols, along with close perioperative monitoring to help manage risk. Level of evidenceIV (retrospective cohort study).

For which patients is attending a pre-operative education session most important in a total hip and knee replacement eras pathway?

Objectives: Optimising the psychological status of patients’ pre-surgery through education is recommended by the Enhanced Recovery after Surgery (ERAS) Society. However, despite this; the majority of the current evidence base does not confirm that preoperative education reduces length of stay in total hip or knee replacement pathways. The aim of this study is to compare length of stay between patients who attended an education class prior to elective total hip or knee replacement surgery, compared to those who did not

The inclusion of preoperative education in Eras spinal surgery pathways: A systematic review

Objectives: Enhanced Recovery after Surgery (ERAS) principles are starting to be adopted in major spinal procedures, and the high volume of surgeries, and wide variations in length of stay and complications rates suggest that improvements are both desirable and possible. Psychosocial factors related to different degrees of clinical impairment and quality of life in the preoperative period may influence outcomes, and patients have expressed a need for individualised information given in sufficient quantities and at the appropriate time to help attenuate preoperative anxiety. Preoperative education is a core component of ERAS that aims to empower patients to undertake positive health actions and support autonomous decision making. This review aims to summarise the current evidence for inclusion of a preoperative education session into ERAS spinal surgery pathways.

The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review.

Psychosocial factors related to different degrees of clinical impairment and quality of life in the preoperative period may influence outcomes from elective spine surgery. Patients have expressed a need for individualized information given in sufficient quantities and at the appropriate time. Therefore, this review article aims to determine whether a preoperative education session improves clinical, psychological and economic outcomes in elective spinal surgery. PubMed, Cochrane Library, CINAHL Complete, Medline Complete and PsychINFO were searched in July 2018 for randomized clinical trials to evaluate the effects of a preoperative education intervention on psychological, clinical and economic outcomes in spinal surgery. The search yielded 78 results, of which eleven papers (seven studies) were relevant for inclusion. From these results, there is limited, fair-quality evidence that supports the inclusion of a preoperative education session for improving clinical (pain, function and disability), economic (quality-adjusted life years, healthcare expenditure, direct and indirect costs) and psychological outcomes (anxiety, depression and fear-avoidance beliefs) from spinal surgery. Other benefits are reported to be improved patient knowledge, feelings of better preparation, reduced negative thinking and increased levels of physical activity after the intervention. No differences in quality of life, return to work, physical indicators or postoperative complications were reported. From the limited evidence, it is not possible to conclusively recommend that preoperative education should be delivered as a standalone intervention before elective spine surgery; however, given the low risk profile and promising benefits, future research in this area is warranted.

AB135. 176. Feasibility study of the Impact of one preoperative physiotherapy education session and patient information leaflet on patient compliance with physiotherapy after oesophago-gastric cancer resections

AB135. 176. Feasibility study of the Impact of one preoperative physiotherapy education session and patient information leaflet on patient compliance with physiotherapy after oesophago-gastric cancer resections

A preoperative education class reduces length of stay for total knee replacement patients identified at risk of an extended length of stay.

To establish whether attendance at an education class prior to total hip or knee replacement surgery as part of an enhanced recovery after surgery pathway could decrease length of hospital stay. A single-site, retrospective cohort study comparing length of stay in hospital for patients who attended and did not attend an education class prior to hip or knee replacement surgery. Patients were stratified into 3 groups according to the predicted likelihood of an extended inpatient hospital stay using the Risk Assessment Predictor Tool. Mean length of stay reduced by 0.37 days for patients who received hip replacement (n = 590) (95% confidence interval (95% CI) -0.74, -0.01, p = 0.05) and by 0.77 days for patients who underwent knee replacement (n = 643) (95% CI -1.23, -0.31, p = 0.001) following attendance at a preoperative education class. Patients undergoing knee replacement who were considered at high risk of an extended hospital stay stayed, on average, 2.59 days less in hospital after attending the class (mean length of stay: 4.52 (standard deviation (SD) 1.26) vs 7.11 (SD 4.18) days (95% CI -4.62, -0.54, p < 0.02). This study supports the inclusion of a preoperative education session in this context for both hip and knee replacement procedures, and indicates that this may be most beneficial for patients undergoing knee replacement who are at risk of an extended length of stay.

Improving postoperative patient reported benefits and satisfaction following spinal fusion with a single preoperative education session

BACKGROUND CONTEXTPatient expectations have been demonstrated to influence recovery following spine surgery. Addressing patient expectations specifically in regards to pain and postsurgical healing is an important factor in improving recovery patterns. Presurgical education can potentially help manage patient expectations. PurposeThe primary objective was to determine if participation in a single preoperative multidisciplinary educational session would result in reduced patient dissatisfaction with surgical expectations. A secondary objective was to determine if participation resulted in improvements in postsurgical pain, disability, and reductions in emergency room visits following surgery. Study DesignA retrospective cohort study utilizing data from the Canadian Spine Outcomes and Research Network (CSORN) registry and hospital electronic medical records. Patient SampleParticipants were patients receiving elective spinal fusion for 2–5 levels (N=206). Cohort 1 included patients who participated in preoperative multidisciplinary education (n=103). Cohort 2 included patients who opted out of the educational session (n=103). Outcome MeasuresOutcomes measured included the Oswestry Disability Index (ODI), NRS scales for back and leg pain (NRS-B/NRS-L), CSORN questions pertaining to patient satisfaction with surgery and whether or not the surgery met expectations. Electronic chart review quantified emergency room visits following surgery. MethodsSpinal fusion patients are encouraged to attend a one time, two-hour education session 3–6 weeks prior to their surgery. The education session includes interactive discussions with nursing, physiotherapy, and occupational therapy staff concentrating on what patients should expect, how to best prepare for surgery and proper care postsurgery. A one-way ANOVA was conducted for continuous variables of interest (age, number of levels operated on, ASA score, and number of visits to the emergency room following surgery). Chi-squared analysis was conducted for categorical variables of interest (pathology, gender, patient satisfaction, and patient expectations). A two (Cohort; education: no education) × 2 (Time; baseline: follow-up) repeated measure ANOVA was conducted for NRS-B, NRS-L, and ODI. Significance was set at p<.05. ResultsPatients (n=103) who took part in the presurgical education sessions were significantly more satisfied with their surgery compared to the control cohort (p=.014). Patients (n=103) who did not participate in the education session failed to have their expectations met in terms of improvement in daily activities (p=.03), improvement in walking capacity (p=.03) and their expectation of back pain reduction (p=.001). There was a statistically significant effect of participation in the educational session reducing postoperative back pain (p=0.03), although this improvement did not reach a minimally clinically important difference. Number of visits to the emergency room in the 12 weeks following spine surgery was significantly lower (p=.04) for patients in the education cohort. ConclusionsReduced emergency room utilization, improved patient satisfaction, achievement of expected improvements and alleviation of back pain were documented with greater success following participation in a single 2-hour educational session prior to surgery. A single education session is a viable tool for improving patient outcomes due to its low administrative burden.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM Interventional Pain Management: 33. Improving spinal fusion patient-reported outcomes with a single preoperative education session

BACKGROUND CONTEXT Patient expectations have been demonstrated to influence recovery following spine surgery. Addressing patient expectations specifically in regards to pain and postsurgical healing is an important factor in improving patient's recovery patterns. Presurgical education can potentially help manage patient expectations. PURPOSE The primary objective was to determine if participation in a single preoperative multidisciplinary educational session would result in reduced patient dissatisfaction with surgical expectations. A secondary objective investigated if participation resulted in improvements in postsurgical pain and disability. STUDY DESIGN/SETTING A retrospective cohort study using Canadian Spine Outcomes and Research Network (CSORN) data. PATIENT SAMPLE Participants were patients receiving elective spinal fusion for 2-5 levels (N=206). Cohort 1: patients who participated in preoperative multidisciplinary education (n=103). Cohort 2: patients who opted-out of the educational session (n=103). OUTCOME MEASURES Outcome measures included the Oswestry Disability Index (ODI), NRS Scales for back and leg pain (NRS-B/L), CSORN questions pertaining to the patient's satisfaction with surgery and whether the surgery met a variety of their expectations. METHODS Spinal fusion patients are encouraged to attend a one-time, two-hour education session 3-6 weeks prior to surgery. The education session includes interactive discussions with nursing, physiotherapy and occupational therapy staff concentrating on what patients should expect, how to best prepare for surgery and proper care after surgery. Baseline analysis was conducted to ensure cohorts did not significantly differ in any way outside of attendance to the education session. Outcome measures of interest were collected at 12 weeks postoperatively. Continuous variables were compared with ANOVA, and categorical variables with chi-square analysis. Significance was set at α RESULTS Patients who took part in the presurgical education sessions were significantly more satisfied with their surgery compared to the control cohort (p=0.014). Patients who did not participate in the education session failed to have their expectations met in terms of improvement in daily activities (p=.03), improvement in walking capacity (p=.03), and their expectation of back pain reduction (p=001). There was a statistically significant effect of participation in the educational session reducing postoperative back pain (p=.03), though this improvement did not reach clinically significant levels. CONCLUSIONS Participation in a single 2-hour educational session prior to surgery positively impacted patient satisfaction, expectations and back pain. Use of a low administrative burden, single education session is a viable tool for improving patient outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Educational impact of joint replacement school for patients undergoing total hip and knee arthroplasty: a prospective cohort study.

Enhanced recovery programmes for hip and knee arthroplasty surgery have been shown to decrease length of stay and improve patient outcomes in the elective setting. There are limited studies looking at pre-operative patient education alone and its role, however, more recent studies have demonstrated that it can help reduce length of stay and health care costs. The elective orthopaedic unit at Tullamore Hospital was the first unit in the Irish public health system to have a joint school, pre-operative, educational session, and the aim of this study was to assess our patient understanding of this session to ensure a sustained, high level of patient care, quality assurance and educational standards. A sample size of n = 51 was calculated to adequately power the study. Final sample size was 57. Data was collected across four joint school sessions. Patients were asked to complete a questionnaire before and after the session. Twenty-seven male (47.3%) and 30 female (52.7%) patients completed the surveys. Mean age overall was 64.5years. All survey questions except those related to anaesthesia and physiotherapy showed a statistically significant improvement after the joint school session. A total knowledge score was calculated and revealed a statistically significant difference between pre- and post-joint school survey answering (P value < 0.001). Our joint school, pre-operative educational session remains a very effective way of delivering content to patients regarding their surgery. Continuous auditing is paramount to its success and there is potential scope for web-based learning as an adjunct to this validated session.

Preoperative Physical Therapy Education Reduces Time to Meet Functional Milestones After Total Joint Arthroplasty.

As length of stay decreases for total joint arthroplasty, much of the patient preparation and teaching previously done in the hospital must be performed before surgery. However, the most effective form of preparation is unknown. This randomized trial evaluated the effect of a one-time, one-on-one preoperative physical therapy education session coupled with a web-based microsite (preopPTEd) on patients' readiness to discharge from physical therapy (PT), length of hospital stay, and patient-reported functional outcomes after total joint arthroplasty. Was this one-on-one preoperative PT education session coupled with a web- based microsite associated with (1) earlier achievement of readiness to discharge from PT; (2) a reduced hospital length of stay; and (3) improved WOMAC scores 4 to 6 weeks after surgery? Between February and June 2015, 126 typical arthroplasty patients underwent unilateral TKA or THA. As per our institution's current guidelines, all patients attended a preoperative group education class taught by a multidisciplinary team comprising a nurse educator, social worker, and physical therapist. Patients were then randomized into two groups. One group (control; n = 63) received no further education after the group education class, whereas the intervention group (experimental; n = 63) received preopPTEd. The preopPTEd consisted of a one-time, one-on-one session with a physical therapist to learn and practice postoperative precautions, exercises, bed mobility, and ambulation with and negotiation of stairs. After this session, all patients in the preopPTEd group were given access to a lateralized, joint-specific microsite that provided detailed information regarding exercises, transfers, ambulation, and activities of daily living through videos, pictures, and text. Outcome measures assessed included readiness to discharge from PT, which was calculated by adding the number of postoperative inpatient PT visits patients had to meet PT milestones. Hospital length of stay (LOS) was assessed for hospital discharge criteria and 6-week WOMAC scores were gathered by study personnel. At our institution, to meet PT milestones for hospital discharge criteria, patients have to be able to (1) independently transfer in and out of bed, a chair, and a toilet seat; (2) independently ambulate approximately 150 feet; (3) independently negotiate stairs; and (4) be independent with a home exercise program and activities of daily living. Complete followup was available on 100% of control group patients and 100% patients in the intervention group for all three outcome measures (control and intervention of 63, respectively). The preopPTEd group had fewer postoperative inpatient PT visits (mean, 3.3; 95% confidence interval [CI], 3.0-3.6 versus 4.4; 95% CI, 4.1-4.7; p < 0.001) and achieved readiness to discharge from PT faster (mean, 1.6 days; 95% CI, 1.2-1.9 days versus 2.7 days; 95% CI, 2.4-3.0; p < 0.001) than the control group. There was no difference in hospital LOS between the preopPTEd group and the control group (2.4 days; 95% CI, 2.1-2.6; p = 0.082 versus 2.6 days; 95% CI, 2.4-2.8; p = 0.082). There were no clinically relevant differences in 6-week WOMAC scores between the two groups. Although this protocol resulted in improved readiness to discharge from PT, there was no effect on LOS or WOMAC scores at 6 weeks. Preoperative PT was successful in improving one of the contributors to LOS and by itself is insufficient to make a difference in LOS. This study highlights the need for improvement in other aspects of care to improve LOS. Level II, therapeutic study.

The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial.

BackgroundPost-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised controlled trial has investigated the effect of pre-operative education and training on post-operative respiratory complications, hospital length of stay, and health-related quality of life following upper abdominal surgery.Methods/designThe Lung Infection Prevention Post Surgery - Major Abdominal- with Pre-Operative Physiotherapy (LIPPSMAck POP) trial is a pragmatic, investigator-initiated, bi-national, multi-centre, patient- and assessor-blinded, parallel group, randomised controlled trial, powered for superiority. Four hundred and forty-one patients scheduled for elective open upper abdominal surgery at two Australian and one New Zealand hospital will be randomised using concealed allocation to receive either i) an information booklet or ii) an information booklet, plus one additional pre-operative physiotherapy education and training session. The primary outcome is respiratory complication incidence using standardised diagnostic criteria. Secondary outcomes include hospital length of stay and costs, pneumonia diagnosis, intensive care unit readmission and length of stay, days/h to mobilise >1 min and >10 min, and, at 6 weeks post-surgery, patient reported complications, health-related quality of life, and physical capacity.DiscussionThe LIPPSMAck POP trial is a multi-centre randomised controlled trial powered and designed to investigate whether a single pre-operative physiotherapy session prevents post-operative respiratory complications. This trial standardises post-operative assisted ambulation and physiotherapy, measures many known confounders, and includes a post-discharge follow-up of complication rates, functional capacity, and health-related quality of life. This trial is currently recruiting.Trial registrationAustralian New Zealand Clinical Trials Registry number: ACTRN12613000664741, 19 June 2013.

SOULAGE-TAVIE

This article is the report of the development and validation of a tailored Web-based intervention for postoperative pain self-management in adults who underwent cardiac surgery. The development of SOULAGE-TAVIE included four main phases: (1) identification of a clinical problem, (2) outline design, (3) clinical operationalization, and (4) production. The validation of the intervention's feasibility and acceptability was made through pilot testing with 30 patients expecting cardiac surgery over 4 months in 2010. SOULAGE-TAVIE consists of a 30-minute computer-tailored preoperative educational session about postoperative pain management. Activities and information were tailored according to a predetermined profile. Two short reinforcements were provided in person postoperatively. Ninety-six percent of participants agreed that the strategies proposed responded to their needs. An iterative process among various sources of knowledge gave place to an innovative approach to preoperative education. Pilot testing provided preliminary support for the acceptability and feasibility of a tailored Web-based intervention. Patient empowerment is complementary yet crucial in the current context of care and may contribute to improved pain relief. The use of information technologies can increase personalization and accessibility to health education in a complex environment of care.