Pre-arthroplasty rehabilitation is effective in reducing hospital stay. Preoperative education for total hip and knee replacement patients. Videotape preparation of patients before hip replacement surgery reduces stress. Prehospital education: effectiveness with total hip replacement surgery patients. [No positive effect of preoperative exercise therapy and teaching in patients to be subjected to hip arthroplasty]. Effects of extended preoperative information on perioperative stress: an anaesthetic nurse intervention for patients with breast cancer and total hip replacement. Teaching of patients undergoing total hip replacement surgery. Preparing patients for total hip replacement: a randomized controlled trial of a preoperative educational intervention.
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.
                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.
                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).
                This preoperative, individually tailored, rehabilitation program reduced length of stay. Psychoeducational preparation is known to improve postoperative outcome. We tested two common psychoeducational procedures in elderly orthopedic patients, examining how best to match interventions to patients by psychological type.
                Two hundred twenty-two elderly patients undergoing total hip or knee replacement were randomly assigned to 1) a slide-tape with information on the postoperative, in-hospital rehabilitation experience, or 2) training in Benson's Relaxation Response with a bedside audiotape, in a 2 x 2 factorial design.
                The relaxation response did not influence postoperative outcomes. The educational intervention reduced length of stay and pain medication use for patients who exhibited most denial (tendency to avoid thinking about unpleasant events), and reduced postoperative anxiety and cognitive errors on the Mini-Mental State Exam for patients with most baseline anxiety. There was no effect on postoperative pain.
                The importance of attending to the patient's psychological state and level of preparation before orthopedic surgery is reinforced. Patients who exhibit most denial and highest anxiety may benefit from educational interventions, but patients' directly expressing desire for information may be a poor guide in deciding which patients would benefit, compared with more formal psychological testing for denial and anxiety. Elective surgery represents a considerable source of stress for the patient. Many attempts have been made to prepare patients before surgery with the aim of reducing stress and improving outcome. This study used a novel approach to fulfill this aim by showing a videotape of a patient undergoing total hip replacement surgery, covering the time period from hospital admission to discharge, that strictly keeps to the patient's perspective.
                Before elective total hip replacement surgery, 100 patients were randomly assigned to a control group or a preparation group; the latter group was shown the videotape on the evening before surgery. Anxiety and pain were evaluated daily for 5 days, beginning with the preoperative day, by means of the State-Trait Anxiety Inventory and a visual analog scale. Intraoperative heart rate and blood pressure, as well as postoperative intake of analgesics and sedatives, were recorded. Urinary levels of cortisol, epinephrine, and norepinephrine were determined in 12-hour samples collected at night for 5 nights, beginning with the preoperative night.
                Compared with the control group, the preparation group showed significantly less anxiety on the morning before surgery and the mornings of the first 2 postoperative days, and significantly fewer of them had an intraoperative systolic blood pressure increase of more than 15%. The pain ratings did not differ significantly between the two groups, but the prepared patients needed less analgesic medication after surgery. Prepared patients had significantly lower cortisol excretion during the preoperative night and the first 2 postoperative nights. Excretion of catecholamines did not differ significantly between groups.
                We conclude that use of the videotape decreased anxiety and stress, measured in terms of urinary cortisol excretion and intraoperative systolic blood pressure increase, in patients undergoing hip replacement surgery and prepared them to cope better with postoperative pain. In-hospital education can reduce anxiety, improve coping and shorten hospital stays of surgical patients. However, hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching. This study evaluated prehospital education for total hip replacement (THR) surgery. Half of the patients waiting for admission for THR surgery were randomly selected to receive a THR education booklet in the mail 4-6 weeks before their scheduled THR surgery. Compared to the No-Booklet patients, patients who had received the booklet were less anxious at the time of hospital admission and at discharge, were more likely to have practised physiotherapy exercises prior to hospitalization, and required significantly less occupational therapy and physiotherapy while in hospital. There were no group differences for length of hospital stay. To evaluate the benefits of preoperative physical therapy and instruction of patients with primary coxarthrosis to be subjected to a total hip arthroplasty.
                University Hospital Maastricht.
                Controlled trial.
                During 14 months the effects were measured of preoperative physical therapy and instruction of 64 patients divided into two populations; one group (n = 31) received preoperative instruction and physical therapy, the other did not (n = 33). Effects were measured with the Visual Analog Scale, the Harris Hip Score and the days patients could stand, walk, climb a stair and be discharged.
                The Harris Hip Score showed a significant difference (p < 0.05) favouring the instructed group on day 14 after the operation and at the moment the patients were discharged. The other parameters showed no significant differences between the groups. Differentiation by age, gender and type of arthroplasty showed the same results.
                Preoperative exercise and instruction is not useful for patients who in the near future will be treated with a total hip arthroplasty for primary coxarthrosis. An anaesthetic nurse intervention was performed in order to evaluate the effects of extended preoperative information, given by anaesthetic nurses, on perioperative stress in patients operated on for breast cancer or total hip replacement (THR). Forty-six consecutive patients scheduled for surgery for breast cancer, and 55 for THR, were randomized into two groups which were given different modes of preoperative information. Patients in the control group were informed about pre- and postoperative routines by a ward nurse. Patients in the intervention group were given extended formalized information by an anaesthetic nurse. Wilcoxon rank sum test was used to show relations between variables. There were no significant differences between the intervention group and control group for patients with breast cancer or for patients with THR. Breast cancer patients in the intervention group were significantly more anxious than THR patients in the intervention group (P < 0.01). Breast cancer patients in the intervention group showed the highest anxiety scores on the Hospital Anxiety and Depression Scale (HADS) scale on the day of surgery. This information may reflect an increased level of anxiety due to the extended information given preoperatively. The information may thus have had a negative effect on breast cancer patients, resulting in an increased state of anxiety. The result indicates a need for individualized modes of information to provide a proper balance between enough and too much information. We studied the effect of patient teaching in 60 patients who underwent primary total hip replacement surgery. All the patients received an illustrated patient guide. In addition to the general patient teaching given by doctors, nurses and physiotherapists, a randomly chosen group of 27 patients received a session of intensified patient teaching. At the follow-up, 2-3 months postoperatively, 61% of patients thought that they had received the main part of their information from the physiotherapists, 9% from their doctors and 4% from the nursing staff. The importance of a well-illustrated guide was pointed out. The knowledge of potential complications, such as infection, remained poor; 37% could not name one single relevant complication. At the follow-up, the younger or better educated patients did not score any better. The experimental group who had received intensified teaching differed only slightly from the controls, but they knew significantly better when to inform their doctor of potential complications. Also, the experimental group showed greater interest in obtaining more information about their replaced hip. Patients in the experimental group showed significantly better adherence to the instructions for the postoperative rehabilitation programme. 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.
There is little evidence to support the use of pre-operative education over and above standard care to improve postoperative outcomes in patients undergoing hip or knee replacement surgery, especially with respect to pain, functioning and length of hospital stay. There is evidence that preoperative education has a modest beneficial effect on preoperative anxiety. There may also be beneficial effects when preoperative education is tailored according to anxiety, or targeted at those most in need of support (e.g. those who are particularly disabled, or have limited social support structures).