A randomized controlled trial of an individualized preoperative education intervention for symptom management following total knee arthroplasty

Abstract

Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Painrelated interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004).

This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three.

There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed.

Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.