A successful combination: preadmission testing and preoperative education

A Modern Pain Neuroscience Approach in Patients Undergoing Surgery for Lumbar Radiculopathy: A Clinical Perspective

Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it.

A Comparative Study of the Effectiveness of a Preoperative Education Programme for Total Hip Replacement Patients

This study examined some effects of providing preoperative education to patients prior to their hospital admission for a total hip replacement. The preoperative education programmes are organised and presented by an occupational therapist with the assistance of a physiotherapist, an anaesthetist, an orthopaedic nurse and a dietician. The content includes information on preparation for surgery, what to expect of admission, surgery and rehabilitation, and how to prepare for discharge.

A quasi-experimental design was used to compare a group of patients who had attended an education programme with, as control, a group of patients who had not. The variables Investigated were length of hospitalisation, morphine usage, mobility independence and discharge preparation.

The results showed that the patients in the experimental group had a mean of 4 days' less hospitalisation than the control group, required less postoperative morphine and achieved mobility independence sooner. The control patients' lack of knowledge of what to expect from their surgery was evident from the lack of preparation for their discharge home. Large financial savings were then calculated as a direct consequence.

Preparing Patients for Total Hip Replacement

Previous research indicates that giving appropriate information to patients before surgery yields many benefits. This randomized controlled trial evaluated a pre admission and postadmission intervention comprising a video, booklet and plastic models for patients undergoing total hip replacement. Seventy-eight patients participated in the study and were randomized into control and intervention groups. The intervention was implemented one month before surgery. Over the operative period, patients completed questionnaires including the Hospital Anxiety and Depression Scale, Nottingham Health Profile and Stress Arousal Checklist. Results showed no significant differences between control and intervention groups for the Hospital Anxiety and Depression Scale, Nottingham Health Profile and Stress Arousal Checklist. However, patients from the intervention group were more likely to know as much as they wanted to know before admission ( p <.001) and felt less confronted by information on arrival for the hospital stay. In an era when patient satisfaction is of paramount importance, this preoperative intervention has applications in many settings.

A multidisciplinary enhanced recovery programme allows discharge within two days of total hip replacement; three- to five-year results of 100 patients

We present three- to five- year results of 100 sequential patients undergoing total hip replacement (THR) through a multidisciplinary rapid recovery programme, with mean length of stay (LOS) 1.99 nights. Patients attend pre-admission 'bone school', with talks and assessments by the senior sister, physiotherapist and occupational therapist. All receive an uncemented Corail-Pinnacle THR via piriformis-sparing mini-posterior approach. 'Low dose' spinal plus light general anaesthesia provides sensory block whilst retaining motor function; painfree mobilisation is predictably achieved within four hours. Following radiograph and haemoglobin check next morning, patients are discharged on meeting specific nursing/physiotherapy criteria. Those within 20 miles receive outreach follow-up. Follow-up assessment is undertaken using SF36, Visual Analogue, Merle d'Aubigné-Postel and Oxford Hip Scores. Mean age was 65 years (25-91), mean BMI 28.7 (19-43). ASA ranged 1-3 (mode 2), Charlson comorbidity index from 0-9 (mode 3). Major complications were: one dislocation with deep infection; one myocardial infarction; one trochanteric bursitis requiring exploration; one ceramic fracture; and three metal debris reactions. Several more minor complications occurred. LOS was longer in older patients (p = 0.03) and those with higher Charlson index (p = 0.02).Eighty-two patients remain under follow-up, (mean 37.8 months, range 36-61). Six have died; five underwent revision; seven have moved away or been lost. Ninety-seven percent remain quite or very satisfied. Our LOS is amongst the shortest in the United Kingdom, with encouraging outcomes. The SSP succeeds by involving all team-members, and managing patient expectation. At a time of limited healthcare resources we propose that our SSP could readily be reproduced elsewhere with similar benefits.

At your convenience: preoperative assessment by telephone

This article describes how practitioners in one trust have worked in partnership with colleagues at NHS Direct to develop a telephone preoperative assessment service for elective day case surgery patients. The service has improved theatre utilisation by reducing the numbers of 'did not attends' (DNAs) and ensures the safe preparation of appropriately selected patients for day case surgery. It has reduced the number of trips to hospital patients need to make and, more recently, the length of time spent there.

The impact of preoperative education on postoperative pain. Part 1

This article, the first of two parts, explores the general concept of preoperative education through a literature review. The relatively complex relationships between the ways people perceive a threatening situation, their levels of anxiety, coping styles and postoperative pain is explored. In dealing with these complex relationships, teaching strategies and forms of presentation of preoperative education are also discussed. The second part will examine the impact of preoperative education on postoperative anxiety, pain and recovery. This will be achieved by analysing the evidence available to provide a rigorous appraisal of the literature.

Managing chronic obstructive pulmonary disease in the community. A randomized controlled trial of home-based pulmonary rehabilitation for elderly housebound patients

PURPOSE

Pulmonary rehabilitation is essential for managing chronic obstructive pulmonary disease (COPD). Housebound COPD patients are frequently excluded from this treatment because they are unable to access outpatient pulmonary rehabilitation programs because of the severity of their disease. This randomized controlled trial assesses the effects of a 12-week home-based pulmonary rehabilitation program for 60 housebound COPD patients older than 60 years.

METHODS

Intervention patients received an individually tailored supervised walking and arm exercise program as well as individual multidisciplinary education sessions on COPD and its management. Outcomes were assessed using the 6-minute walk test, St George's respiratory questionnaire, and Borg score of perceived breathlessness. Healthcare utilization was assessed using hospital admission rates with exacerbation of COPD and average length of stay at readmission.

RESULTS

Complete data for 23 patients in each group were available for analysis. There was no significant difference between groups on baseline measures. Compared with the control group, intervention patients demonstrated a significant improvement in 6-minute walk test (P = .023), Borg score of perceived breathlessness (P = .024), St George's respiratory questionnaire total score (P = .020), and impact subscore (P = .024). At 6 months, the intervention group had a significantly shorter average length of stay at readmission to hospital with exacerbation (P = .035).

CONCLUSION

A 12-week home-based pulmonary rehabilitation is effective in improving exercise tolerance, perception of breathlessness, and quality of life for housebound COPD patients. To manage COPD in the community more effectively, health services should focus on expanding home-based pulmonary rehabilitation.

Effects of multimedia with printed nursing guide in education on self-efficacy and functional activity and hospitalization in patients with hip replacement

This study aimed to examine the effects of multimedia with printed nursing guides in patient education on the improvement of self-efficacy, functional activity and length of hospitalization in patients with hip replacement. A quasi-experimental design was used. Control group received a routine care, whereas experimental group was given the multimedia with printed nursing guides. In the multimedia, CD is a collection of nursing instructions in the format of multimedia such as video and audio recorded into a CD. The result showed there are statistically different between experimental and control groups on self-efficacy (t = -7.93, P < 0.001), functional activities (t = 4.33, P < 0.001), and length of hospitalization (t = 2.54, P < 0.05). The findings indicated experimental group achieved higher self-efficacy with the help of multimedia with printed nursing guides. Control group needed more assistance in performing functional activities. Length of hospitalization was significantly shorter in experimental group than in control group. To better adapt to continual human resource reduction and to improve nursing service quality, wider applications of multimedia with printed nursing guides in patient education may be worthwhile.

Reducing anxiety by pre-operative education: make the future familiar

Pre-operative education is widely used by occupational therapists all over the world to help patients prepare for their impending surgery and post-operative needs. The purpose of this research was to gain understanding of how the pre-operative education process is beneficial in reducing anxiety for patients awaiting a total hip replacement provided in one National Health Service Trust in England. The participants in this study were a convenient sample of health care professionals who presented information on pre-operative education during a nine-month data collection period, and a sample of patients who attended the programme. Data were collected from observing five pre-operative education programmes, 26 written patient evaluations, 16 interviews with seven presenters of the education, observation of three team meetings, 20 interviews with 10 patients, and documentation pertaining to the programme. From the results it seems that patient education can reduce anxiety by making the unknown familiar. Such familiarity can be achieved in three ways by: providing an understanding of the experiences patients will encounter during and after surgery; giving an opportunity to meet the staff that will be caring for them; and familiarizing patients with the environments they will meet when in hospital. Major limitations of the study were not being able to control for researcher bias and not providing a standardized instrument to collect data. It is recommended that further research be carried out to understand the dynamics between patient education and the reduction of anxiety among patients undergoing hip replacements.

Pre-arthroplasty rehabilitation is effective in reducing hospital stay

BACKGROUND

The purpose of the trial was to evaluate the effect on length of stay of individually tailored rehabilitation for clients who were undergoing hip or knee arthroplasty.

METHOD

Clients (n = 133) with complex needs (comorbid conditions or limited social support) were randomly assigned to receive preoperative usual care (UC) or rehabilitation (R). Usual care clients received a single preoperative clinic visit. Rehabilitation clients were individually assessed and received multi disciplinary rehabilitation to optimize functional capacity, education about the in-hospital phase and early discharge planning. All rehabilitation subjects received interdisciplinary counseling/education focused on preparation for discharge home. The intervention for approximately half the rehabilitation clients was a single, cost-effective session, while others received physical conditioning.

RESULTS

Clients receiving rehabilitation achieved discharge criteria earlier (R = 5.4, UC = 8 days) and had a shorter actual length of stay (R = 6.5, UC = 10.5 days).

CLINICAL IMPLICATIONS

This preoperative, individually tailored, rehabilitation program reduced length of stay.

Effects of a surgical pre-operative assessment clinic on patient care

Surgery makes many demands of both hospitals and patients. For the hospital, there are many procedural aspects: admission, health assessment, and patient education; the actual operation; and the post-surgical recovery period, a time when patients are susceptible to complications and nosocomial infections. For the patient, surgery means physical pain and emotional anxiety. A pre-operative assessment clinic (POAC), however, can assist both hospital and patients by streamlining their admission, assessment, and education, by decreasing the time they spend in the hospital recovering from surgery, and by easing their anxiety. In this article, the authors describe a study of a POAC at a Canadian hospital.

General overview of rehabilitation in the rheumatoid patient

This article provides a general overview of rehabilitation in the rheumatoid patient. It discusses the physical therapy management of both the systemic musculoskeletal involvement of RA and of the specific postoperative rehabilitation associated with total joint arthroplasty. It is intended to highlight the major components of treatment and to guide the clinician in assessing these challenging, yet rewarding cases. Its emphasis is to support a multidisciplinary approach to patient care.