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Luke S Austin - One of the best experts on this subject based on the ideXlab platform.
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the effect of Preoperative Education on opioid consumption in patients undergoing arthroscopic rotator cuff repair a prospective randomized clinical trial 2 year follow up
Journal of Shoulder and Elbow Surgery, 2020Co-Authors: Quincy T Cheesman, Danielle Weekes, Joseph A Abboud, Michael Defrance, James F Stenson, Jenna Feldman, Luke S AustinAbstract:Background With the recent opioid epidemic in the United States, measures by both government and medical providers are being taken to decrease the opioid dependence rate. Different methods have been proposed, including patient Education and multimodal pain therapies. The purpose of this study was to determine whether Preoperative opioid Education reduces the risk of opioid dependence at 2 years following arthroscopic rotator cuff repair (ARCR). Methods This study was a 2-year follow-up of the 2018 Neer Award study that demonstrated the use of Preoperative opioid Education as a means to reduce postoperative opioid consumption after ARCR at 3-month follow-up. This was a prospective, single-center, single-blinded, parallel-group, 2-arm, randomized clinical trial with a 1:1 allocation ratio. To study the effect of Preoperative opioid Education on opioid dependence at 2 years, we randomized patients into 2 cohorts, a study cohort and a control cohort. Data were obtained with a review of prescription data–monitoring software and a patient telephone interview. Results Opioid Education (P = .03; odds ratio, 0.37; 95% confidence interval, 0.14-0.90) was found to be an independent factor that is protective against opioid dependence. Study patients had a lower rate of opioid dependence (11.4%, 8 of 50) than control patients (25.7%, 18 of 50) (P = .05). Significantly fewer prescriptions were filled by study patients (mean, 2.9) than by control patients (mean, 6.3) (P = .03). Additionally, fewer pills were consumed by study patients (median, 60; interquartile range [IQR], 30, 132) than by control patients (median, 120; IQR, 30, 340) (P = .10). Finally, fewer morphine milligram equivalents were consumed by study patients (median, 375; IQR, 199, 1496) than by control patients (median, 725; IQR, 150, 2190) (P = .27). Conclusion Our study found that patients who were Preoperatively educated on opioid use were less likely to become opioid dependent at 2-year follow-up. Therefore, we demonstrated that opioid Education does impart significant long-term benefits to patients undergoing ARCR.
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neer award 2018 the effect of Preoperative Education on opioid consumption in patients undergoing arthroscopic rotator cuff repair a prospective randomized clinical trial
Journal of Shoulder and Elbow Surgery, 2018Co-Authors: Usman Ali M Syed, Alexander W Aleem, Charles Wowkanech, Danielle Weekes, Mitchell K Freedman, Fotios P Tjoumakaris, Joseph A Abboud, Luke S AustinAbstract:Background Opioids are commonly administered for the treatment of acute and chronic pain symptoms. The current health care system is struggling to deal with increasing medication abuse and rising mortality rates from overdose. Preoperative patient-targeted Education on opioid use is an avenue yet to be explored. The purpose of the study was to determine whether Preoperative narcotics Education reduces consumption after arthroscopic rotator cuff repair (ARCR). Methods Patients undergoing primary ARCR at our institution were randomized to receiving opioid-related Preoperative Education or not. Patients filled out Preoperative questionnaires detailing complete medical history and visual analog scale (VAS) for pain. Patients completed questionnaires regarding their opioid consumption and pain at their 2-week, 6-week, and 3-month follow-up. Results The study enrolled 140 patients. Patients in the study group consumed significantly less narcotics than the control group at the 3-month follow-up. Patients in the Education group were 2.2 times more likely to discontinue narcotic use by the end of follow-up (odds ratio, 2.19; P = .03). In addition, patients with a history of Preoperative narcotic use that were in the Education group were 6.8 times more likely to discontinue narcotics by the end of follow-up (odds ratio, 6.8; P = .008). Discussion/Conclusions The findings of this study determined that Preoperative Education intervention significantly decreased the number of narcotic pills consumed at 3 months after ARCR. In addition, Education resulted in earlier cessation of opioids; therefore, directed patient Education can help alleviate the current opioid epidemic.
Emilio J Puentedura - One of the best experts on this subject based on the ideXlab platform.
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a controlled clinical trial of Preoperative pain neuroscience Education for patients about to undergo total knee arthroplasty
Clinical Rehabilitation, 2019Co-Authors: Adriaan Louw, Emilio J Puentedura, Jordan Reed, Korey Zimney, Derek Grimm, Merrill R LandersAbstract:Objective:The aim of this study was to determine if a Preoperative pain neuroscience Education program would result in superior outcomes compared to usual Preoperative Education for total knee arth...
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immediate Preoperative outcomes of pain neuroscience Education for patients undergoing total knee arthroplasty a case series
Physiotherapy Theory and Practice, 2019Co-Authors: Adriaan Louw, Merrill R Landers, Jordan Reed, Korey Zimney, Emilio J PuenteduraAbstract:Background: Standard Preoperative Education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such Education programs fail to educate...
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Preoperative pain neuroscience Education for lumbar radiculopathy a multicenter randomized controlled trial with 1 year follow up
Spine, 2014Co-Authors: Adriaan Louw, Ina Diener, Merrill R Landers, Emilio J PuenteduraAbstract:Study Design. Multicenter, randomized, controlled trial on Preoperative pain neuroscience Education (NE) for lumbar radiculopathy. Objective. To determine if the addition of NE to usual Preoperative Education would result in superior outcomes with regard to pain, function, surgical experience, and health care utilization postsurgery. Summary of Background Data. One in 4 patients after lumbar surgery (LS) for radiculopathy experience persistent pain and disability, which is nonresponsive to perioperative treatments. NE focusing on the neurophysiology of pain has been shown to decrease pain and disability in populations with chronic low back pain. Methods. Eligible patients scheduled for LS for radiculopathy were randomized to receive either Preoperative usual care (UC) or a combination of UC plus 1 session of NE delivered by a physical therapist (verbal one-on-one format) and a NE booklet. Sixty-seven patients completed the following outcomes prior to LS (baseline), and 1, 3, 6, and 12 months after LS: low back pain (numeric rating scale), leg pain (numeric rating scale), function (Oswestry Disability Index), various beliefs and experiences related to LS (10-item survey with Likert scale responses), and postoperative utilization of health care (utilization of health care questionnaire). Results. At 1-year follow-up, there were no statistical differences between the experimental and control groups with regard to primary outcome measure of low back pain ( P = 0.183), leg pain ( P = 0.075), and function ( P = 0.365). In a majority of the categories regarding
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Preoperative Education addressing postoperative pain in total joint arthroplasty review of content and Educational delivery methods
Physiotherapy Theory and Practice, 2013Co-Authors: Adriaan Louw, Ina Diener, David S Butler, Emilio J PuenteduraAbstract:Objective: Evaluate content and Educational delivery methods of Preoperative Education in total joint arthroplasties of the hip and knee (THA and TKA) addressing postoperative pain. Data sources: Systematic searches conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect, and Web of Science. Secondary searching (pearling) was undertaken. Data extraction: Data were extracted utilizing the participants, interventions, comparisons, and outcomes approach. Study selection: All randomized controlled trials (RCTs) evaluating the effect of Preoperative Education on postoperative pain in THA and TKA surgery were considered for inclusion. Limitations: Studies published in English; published within the last 20 years and patients over the age of 18. No limitations were set on specific outcome measures of pain. Data synthesis: This review included 13 RCTs involving a total of 1,017 subjects who underwent THA or TKA. Educational delivery methods comprised verbal one-onone or group Education sessions, delivered within 4 weeks of surgery lasting an average of 30 minutes, and accompanied by other written materials. The Educational content centered on descriptions of Preoperative preparation, hospital stay, surgical procedure, immediate/intermediate experiences, expectations following surgery, rehabilitation, encouragement/reassurance, and answering common question associated with the surgical experience. Conclusions: Preoperative Education centered on a biomedical model of anatomy and pathoanatomy as well as procedural information has limited effect in reducing postoperative pain after THA and TKA surgeries. Preoperative Educational sessions that aim to increase patient knowledge of pain science may be more effective in managing postoperative pain.
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Preoperative Education for lumbar radiculopathy a survey of us spine surgeons
The International Journal of Spine Surgery, 2012Co-Authors: Adriaan Louw, Ina Diener, David S Butler, Emilio J PuenteduraAbstract:Background: We sought to determine current utilization, importance, content, and delivery methods of Preoperative Education by spine surgeons in the United States for patients with lumbar radiculopathy. Methods: An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of Preoperative Education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of Preoperative Education by spine surgeons in the United States for patients with lumbar radiculopathy. Results: Of 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide Preoperative Education informally during the course of clinical consultation versus a formal Preoperative Education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated Educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the Preoperative Education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the Education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model. Conclusions: Spine surgeons believe that Preoperative Education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings.
Merrill R Landers - One of the best experts on this subject based on the ideXlab platform.
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a controlled clinical trial of Preoperative pain neuroscience Education for patients about to undergo total knee arthroplasty
Clinical Rehabilitation, 2019Co-Authors: Adriaan Louw, Emilio J Puentedura, Jordan Reed, Korey Zimney, Derek Grimm, Merrill R LandersAbstract:Objective:The aim of this study was to determine if a Preoperative pain neuroscience Education program would result in superior outcomes compared to usual Preoperative Education for total knee arth...
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immediate Preoperative outcomes of pain neuroscience Education for patients undergoing total knee arthroplasty a case series
Physiotherapy Theory and Practice, 2019Co-Authors: Adriaan Louw, Merrill R Landers, Jordan Reed, Korey Zimney, Emilio J PuenteduraAbstract:Background: Standard Preoperative Education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such Education programs fail to educate...
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Preoperative pain neuroscience Education for lumbar radiculopathy a multicenter randomized controlled trial with 1 year follow up
Spine, 2014Co-Authors: Adriaan Louw, Ina Diener, Merrill R Landers, Emilio J PuenteduraAbstract:Study Design. Multicenter, randomized, controlled trial on Preoperative pain neuroscience Education (NE) for lumbar radiculopathy. Objective. To determine if the addition of NE to usual Preoperative Education would result in superior outcomes with regard to pain, function, surgical experience, and health care utilization postsurgery. Summary of Background Data. One in 4 patients after lumbar surgery (LS) for radiculopathy experience persistent pain and disability, which is nonresponsive to perioperative treatments. NE focusing on the neurophysiology of pain has been shown to decrease pain and disability in populations with chronic low back pain. Methods. Eligible patients scheduled for LS for radiculopathy were randomized to receive either Preoperative usual care (UC) or a combination of UC plus 1 session of NE delivered by a physical therapist (verbal one-on-one format) and a NE booklet. Sixty-seven patients completed the following outcomes prior to LS (baseline), and 1, 3, 6, and 12 months after LS: low back pain (numeric rating scale), leg pain (numeric rating scale), function (Oswestry Disability Index), various beliefs and experiences related to LS (10-item survey with Likert scale responses), and postoperative utilization of health care (utilization of health care questionnaire). Results. At 1-year follow-up, there were no statistical differences between the experimental and control groups with regard to primary outcome measure of low back pain ( P = 0.183), leg pain ( P = 0.075), and function ( P = 0.365). In a majority of the categories regarding
Adriaan Louw - One of the best experts on this subject based on the ideXlab platform.
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a controlled clinical trial of Preoperative pain neuroscience Education for patients about to undergo total knee arthroplasty
Clinical Rehabilitation, 2019Co-Authors: Adriaan Louw, Emilio J Puentedura, Jordan Reed, Korey Zimney, Derek Grimm, Merrill R LandersAbstract:Objective:The aim of this study was to determine if a Preoperative pain neuroscience Education program would result in superior outcomes compared to usual Preoperative Education for total knee arth...
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immediate Preoperative outcomes of pain neuroscience Education for patients undergoing total knee arthroplasty a case series
Physiotherapy Theory and Practice, 2019Co-Authors: Adriaan Louw, Merrill R Landers, Jordan Reed, Korey Zimney, Emilio J PuenteduraAbstract:Background: Standard Preoperative Education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such Education programs fail to educate...
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Preoperative pain neuroscience Education for lumbar radiculopathy a multicenter randomized controlled trial with 1 year follow up
Spine, 2014Co-Authors: Adriaan Louw, Ina Diener, Merrill R Landers, Emilio J PuenteduraAbstract:Study Design. Multicenter, randomized, controlled trial on Preoperative pain neuroscience Education (NE) for lumbar radiculopathy. Objective. To determine if the addition of NE to usual Preoperative Education would result in superior outcomes with regard to pain, function, surgical experience, and health care utilization postsurgery. Summary of Background Data. One in 4 patients after lumbar surgery (LS) for radiculopathy experience persistent pain and disability, which is nonresponsive to perioperative treatments. NE focusing on the neurophysiology of pain has been shown to decrease pain and disability in populations with chronic low back pain. Methods. Eligible patients scheduled for LS for radiculopathy were randomized to receive either Preoperative usual care (UC) or a combination of UC plus 1 session of NE delivered by a physical therapist (verbal one-on-one format) and a NE booklet. Sixty-seven patients completed the following outcomes prior to LS (baseline), and 1, 3, 6, and 12 months after LS: low back pain (numeric rating scale), leg pain (numeric rating scale), function (Oswestry Disability Index), various beliefs and experiences related to LS (10-item survey with Likert scale responses), and postoperative utilization of health care (utilization of health care questionnaire). Results. At 1-year follow-up, there were no statistical differences between the experimental and control groups with regard to primary outcome measure of low back pain ( P = 0.183), leg pain ( P = 0.075), and function ( P = 0.365). In a majority of the categories regarding
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Preoperative Education addressing postoperative pain in total joint arthroplasty review of content and Educational delivery methods
Physiotherapy Theory and Practice, 2013Co-Authors: Adriaan Louw, Ina Diener, David S Butler, Emilio J PuenteduraAbstract:Objective: Evaluate content and Educational delivery methods of Preoperative Education in total joint arthroplasties of the hip and knee (THA and TKA) addressing postoperative pain. Data sources: Systematic searches conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect, and Web of Science. Secondary searching (pearling) was undertaken. Data extraction: Data were extracted utilizing the participants, interventions, comparisons, and outcomes approach. Study selection: All randomized controlled trials (RCTs) evaluating the effect of Preoperative Education on postoperative pain in THA and TKA surgery were considered for inclusion. Limitations: Studies published in English; published within the last 20 years and patients over the age of 18. No limitations were set on specific outcome measures of pain. Data synthesis: This review included 13 RCTs involving a total of 1,017 subjects who underwent THA or TKA. Educational delivery methods comprised verbal one-onone or group Education sessions, delivered within 4 weeks of surgery lasting an average of 30 minutes, and accompanied by other written materials. The Educational content centered on descriptions of Preoperative preparation, hospital stay, surgical procedure, immediate/intermediate experiences, expectations following surgery, rehabilitation, encouragement/reassurance, and answering common question associated with the surgical experience. Conclusions: Preoperative Education centered on a biomedical model of anatomy and pathoanatomy as well as procedural information has limited effect in reducing postoperative pain after THA and TKA surgeries. Preoperative Educational sessions that aim to increase patient knowledge of pain science may be more effective in managing postoperative pain.
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Preoperative Education for lumbar radiculopathy a survey of us spine surgeons
The International Journal of Spine Surgery, 2012Co-Authors: Adriaan Louw, Ina Diener, David S Butler, Emilio J PuenteduraAbstract:Background: We sought to determine current utilization, importance, content, and delivery methods of Preoperative Education by spine surgeons in the United States for patients with lumbar radiculopathy. Methods: An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of Preoperative Education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of Preoperative Education by spine surgeons in the United States for patients with lumbar radiculopathy. Results: Of 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide Preoperative Education informally during the course of clinical consultation versus a formal Preoperative Education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated Educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the Preoperative Education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the Education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model. Conclusions: Spine surgeons believe that Preoperative Education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings.
Ping Guo - One of the best experts on this subject based on the ideXlab platform.
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Preoperative Education interventions to reduce anxiety and improve recovery among cardiac surgery patients a review of randomised controlled trials
Journal of Clinical Nursing, 2015Co-Authors: Ping GuoAbstract:Aims and objectives To update evidence of the effectiveness of Preoperative Education among cardiac surgery patients. Background Patients awaiting cardiac surgery may experience high levels of anxiety and depression, which can adversely affect their existing disease and surgery and result in prolonged recovery. There is evidence that Preoperative Education interventions can lead to improved patient experiences and positive postoperative outcomes among a mix of general surgical patients. However, a previous review suggested limited evidence to support the positive impact of Preoperative Education on patients' recovery from cardiac surgery. Design Comprehensive review of the literature. Methods The Cochrane Central Register of Controlled Trials from the Cochrane Library, MEDLINE, CINAHL, PsycINFO, EMBASE and Web of Science were searched for English-language articles published between 2000–2011. Original articles were included reporting randomised controlled trials of cardiac Preoperative Education interventions. Results Six trials were identified and have produced conflicting findings. Some trials have demonstrated the effects of Preoperative Education on improving physical and psychosocial recovery of cardiac patients, while others found no evidence that patients' anxiety is reduced or of any effect on pain or hospital stay. Conclusion Evidence of the effectiveness of Preoperative Education interventions among cardiac surgery patients remains inconclusive. Further research is needed to evaluate cardiac Preoperative Education interventions for sustained effect and in non-Western countries. Relevance to clinical practice A nurse-coordinated multidisciplinary Preoperative Education approach may offer a way forward to provide a more effective and efficient service. Staff training in developing and delivering such interventions is a priority.
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thinking outside the black box the importance of context in understanding the impact of a Preoperative Education nursing intervention among chinese cardiac patients
Patient Education and Counseling, 2014Co-Authors: Ping Guo, Linda East, Antony ArthurAbstract:Abstract Objective In a randomized controlled trial of a Preoperative Education intervention conducted for Chinese cardiac patients, we observed a greater effect on symptoms of anxiety and depression than that reported with regard to similar interventions in western care settings. The objective of this qualitative study was to help explain the findings of the trial by exploring Chinese patients’ experience of seeking and receiving information before cardiac surgery. Methods Semi-structured interviews were conducted with a purposive sample of 20 trial participants before discharge (ten from the Preoperative Education group; ten from the usual care control group). Data were analyzed using a thematic analysis approach. Results A total of five themes were generated: the role of reputation and hierarchy; gaining strength from knowledge; information as a low priority; being kept in the dark; and learning through peer support. Conclusion In health care systems where service users are given relatively little information, interventions designed to inform patients about their treatment are likely to have a much greater impact on their psychological health. Practice implications Providers of services for patients undergoing cardiac surgery in China should be encouraged to incorporate information giving into routine practice, tailored according to individual need.
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a Preoperative Education intervention to reduce anxiety and improve recovery among chinese cardiac patients a randomized controlled trial
International Journal of Nursing Studies, 2012Co-Authors: Ping Guo, Linda East, Antony ArthurAbstract:Abstract Background Patients awaiting cardiac surgery typically experience significant physical and psychological stress. However, although there is evidence that Preoperative Education interventions can lead to positive postoperative outcomes for surgical patients in general, less is known about the effectiveness among patients undergoing cardiac surgery, especially Chinese cardiac patients. Objectives To determine whether a Preoperative Education intervention designed for Chinese cardiac patients can reduce anxiety and improve recovery. Design Randomized controlled trial. Settings Cardiac surgical wards of two public hospitals in Luoyang, China. Methods 153 adult patients undergoing cardiac surgery were randomized into the trial, 77 to a usual care control group and 76 to Preoperative Education group comprising usual care plus an information leaflet and verbal advice. Measurement was conducted before randomization and at seven days following surgery. The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes were change in depression (HADS), change in pain as measured by subscales of the Brief Pain Inventory-short form (BPI-sf), length of Intensive Care Unit stay and postoperative hospital stay. Results Of 153 participants randomized, 135 (88.2%) completed the trial. Participants who received Preoperative Education experienced a greater decrease in anxiety score (mean difference −3.6 points, 95% confidence interval −4.62 to −2.57; P P P =0.02). There was some evidence to suggest a reduced number of hours spent in the Intensive Care Unit among Preoperative Education patients ( P =0.05) but no difference in length of postoperative hospital stay ( P =0.17). Conclusions This form of Preoperative Education is effective in reducing anxiety and depression among Chinese cardiac surgery patients. Based upon existing evidence and international practice, Preoperative Education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery.