The aim of this study was to evaluate the effects on length of stay, hospital and clinical indicators, safety and patient experience of adding an individual interdisciplinary preparation session focused on patient needs to a group information session in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery.
Patients undergoing standard primary THR or TKR in an ERAS-certified orthopaedic department with a Risk Assessment and Prediction Tool score > 6 were enrolled in a prospective randomised controlled trial.
Three groups were compared: the control group received a 1.5-hour group preoperative interdisciplinary information session. Intervention group 1 received an additional 1-hour preoperative education session with a physiotherapist and a nurse. Intervention group 2 received 3 telephone calls between the patient, a physiotherapist and a nurse in addition to intervention 1.
Data collected included sociodemographic data (age, weight, height, sex, BMI, comorbidities, prosthesis, surgeon, date of surgery, insurance status), length of hospital stay, discharge destination and complication rate. Clinical data were collected on pain (Pain Visual Analogue Scale VAS), anxiety and depression (Hospital Anxiety and Depression Scale), catastrophizing (Pain Catastrophizing Scale), expectations (HSS Knee/Hip Replacement Expectations Survey), satisfaction (Swiss national quality assurance scale), quality of life (EQ-5D) and function (HOOS/KOOS and WOMAC). Measurements were taken preoperatively, at D3, 2 weeks and 6 weeks.
Descriptive statistics were used to describe the characteristics of the sample. Student's t-test and chi-squared test were used to compare differences between groups for each variable. The significance level was set at p0.05.
One hundred and sixty-one patients were included (76 TKA/85 THA, 80♀/81♂, 66.9±11.4 years, 79.1±16.9 kg, 1.69±9.4 m). There were no differences in preoperative patient characteristics between the 3 groups for both THR and TKR patients. Length of stay, complication rate and discharge destination were identical between the 3 groups. At 3 days, 2 weeks and 6 weeks post-operatively, no differences were found between the groups in terms of hospital indicators, clinical indicators or patient experience. (p>0.05 for all analyses).
Furthermore, no differences were observed between the subgroups according to socio-demographic characteristics and no influential factors were identified, except for the type of prosthesis, with patients with THA having less pain at all follow-up stages (p0.05).
Compared with ERAS-certified THR or TKR management including group information, no additional effect on hospital outcomes, clinical outcomes and patient experience was found following the addition of a patient-centred intervention or the addition of home telephone calls as designed in the study.
This lack of effect was observed in both intervention groups regardless of patients' sociodemographic characteristics.
The addition of a patient-centred interdisciplinary session or telephone follow-up in the immediate postoperative period, as tailored in this study, cannot be recommended in clinical practice based on the lack of effect reported in this randomised controlled trial.
patient education
presurgical
