Pre-operative education in total hip or knee arthroplasty
Date First Published:
November 1, 2006
Last Updated:
June 28, 2007
Report by:
Laura Hay and Stephanie Purcell, Senior II Physio & Senior I Occupational Therapist (MRI)
Three-Part Question:
In [adults undergoing primary total hip or knee arthroplasty] does [pre-operative patient education] reduce [inpatient length of stay]?
Clinical Scenario:
The orthopaedic department has listed several patients for total hip or knee arthroplasty which is putting demand on bed turnover. It is hypothesised that a pre-operative education session would reduce length of stay post-operatively as an in-patient.
Search Strategy:
AMED 1985 to March 2007, CINAHL 1982 to March 2007, Embase 1996 to March 2007, Medline 1996 to March 2007, Cochrane to March 2007 and Pedro to March 2007
Search Details:
[Hip Prosthesis/ or Arthroplasty/ or Arthroplasty, Replacement, Knee/ or Arthroplasty, Replacement, Hip/ or Joint Prosthesis/] AND [Education/ or Patient Education/]
Pre-op therapy education. mp, Pre-admission education.mp,
Limited to English Language.
Pre-op therapy education. mp, Pre-admission education.mp,
Limited to English Language.
Outcome:
2 papers were found relevant to the 3 part question. One was a Cochrane review. There was 1 systematic review with meta-analysis.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Pre-operative education for hip or knee replacement (Review) McDonald S, Hetrick S, Green S, 2004 Australia | Patients undergoing hip or knee replacements 9 studies (n=782) 4 Studies looked at LOS (n=365) | Cochrane review looking at pre-operative education on post-operative outcomes including anxiety, pain, mobility, length of stay (LOS) and incidence of DVTs | Length of Stay (LOS) | NSS for all four studies | The results were inconclusive as this review included a number of post-operative outcomes which made it difficult to ascertain whether LOS was reduced with pre-operative education |
| Preoperative education for orthopaedic patients: systematic review Johansson K, Nuutila L, Virtanen H, Katajisto J, Salantera S. 2005 Finland | Hip and knee arthroplasty 11 studies (n=1044) 5 LOS studies (n = 512) |
Systematic review and meta-analysis. | Length of Stay | 3 studies NSS and 2 studies SS. No other information available & no meta-analysis done. | Small number of studies Included studies other than RCTs Limited to English Language studies Meta-analysis of length of stay outcome not performed. |
Author Commentary:
Overall, pre-operative education for total knee and hip replacements does not reduce length of stay to a level of statistical significance.
Patient education may still be of benefit to patients in different ways other than length of stay such as anxiety levels.
Further research will help to determine more conclusive results in this area to help justify the cost implications of pre-operative education.
Patient education may still be of benefit to patients in different ways other than length of stay such as anxiety levels.
Further research will help to determine more conclusive results in this area to help justify the cost implications of pre-operative education.
Bottom Line:
Pre-operative patient education for these patients does not reduce length of stay.
References:
- McDonald S, Hetrick S, Green S,. Pre-operative education for hip or knee replacement (Review)
- Johansson K, Nuutila L, Virtanen H, Katajisto J, Salantera S.. Preoperative education for orthopaedic patients: systematic review