Effects of an experimental program on post-hospital adjustment of early discharged patients

The role of digital health interventions to improve health literacy in surgical patients: a narrative review in arthroplasty

BACKGROUND

Arthroplasty is a high-volume but costly treatment option for advanced osteoarthritis. Health literacy and patient education are modifiable factors that can improve patient outcomes in arthroplasty. Digital technologies show potential as an instrument for providing patients with reliable information. This narrative review aimed to identify the current evidence for how effective digital health interventions (DHIs) are in targeting health literacy and related constructs (including knowledge, decision-making and self-efficacy) in arthroplasty.

METHODS

Six databases were searched for published studies comprising health literacy and related constructs, arthroplasty, and DHIs. The main outcome measure was health literacy. Two reviewer-authors independently screened studies according to predefined inclusion criteria and performed data extraction. Data was analysed and summarized in tabular and narrative form.

RESULTS

Two thousand seven-hundred and sixty-four titles and abstracts were screened. One hundred and sixty-seven papers underwent full-text analysis. No studies used health literacy as an outcome measure; therefore, the outcome measure was broadened to include its constructs, and the full-text analysis was repeated. Thirteen studies were included. No study following a structured design for their DHI. Eleven studies demonstrated participant improvement in constructs of health literacy, including knowledge, decision-making and self-management.

CONCLUSION

Current evidence suggests digital technology may provide new means of educating patients and improving aspects of their health literacy. More research digital technology with a structured approach, framework and standardized measures is required. Well-designed digital technology may become a useful adjunct to future patient care.

Video-based patient decision aids: A scoping review

OBJECTIVE

This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends.

METHOD

The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted.

RESULTS

488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase.

CONCLUSION

Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations.

PRACTICE IMPLICATIONS

Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.

Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty

BACKGROUND

Total hip arthroplasty (THA) is one of the most common orthopaedic operations performed worldwide. Painful osteoarthritis of the hip is the primary indication for THA. Following THA, people have conventionally been provided with equipment, such as raised toilet seats and chairs, and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees, or adduction or rotation past the midline. These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation. However, the appropriateness of these recommendations has been questioned.

OBJECTIVES

To assess the effects of provision of assistive devices, education on hip precautions, environmental modifications and training in activities of daily living (ADL) and extended ADL (EADL) for people undergoing THA.

SEARCH METHODS

We searched MEDLINE (1946 to April 2016), EMBASE (1947 to April 2016), the Cochrane Library including CENTRAL (Issue 4 of 12, 2016), Database of Reviews of Effects (DARE), Health Technology Assessment (HTA), Economic Evaluations Database (EED), CINAHL, PEDro and CIRRIE from inception to April 2016. In addition we checked Controlled Clinical Trials, Clinicaltrials.gov, the National Institutes of Health Trial Registry, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and the OpenGrey database from inception to April 2016.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs that evaluated the effectiveness of the provision of assistive devices, education on hip precautions, environmental modifications, or training in ADL and EADL for people undergoing THA. The main outcomes of interest were pain, function, health-related quality of life (HRQOL), global assessment of treatment success, reoperation rate, hip dislocation and adverse events.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures recognised by Cochrane. We conducted a systematic literature search using several databases and contacted corresponding authors, appraised the evidence using the Cochrane risk of bias tool, analysed the data using a narrative analysis approach (as it was not possible to conduct a meta-analysis due to heterogeneity in interventions), and interpreted all outcomes using the GRADE approach.

MAIN RESULTS

We included three trials with a total of 492 participants who had received 530 THA. The evidence presented with a high risk of performance, detection and reporting bias.One study (81 participants) compared outcomes for participants randomised to the provision of hip precautions, equipment and functional restrictions versus no provision of hip precautions, equipment or functional restrictions. Due to the quality of evidence being very low, we are uncertain if the provision of hip precautions, equipment and functional restrictions improved function measured using the Harris Hip Score at 12 month follow-up, or health-related quality of life (HRQOL) measured by the Short Form-12 at four week follow-up, compared to not providing this. There were no incidences of hip dislocation or adverse events in either group during the initial 12 postoperative months. The study did not measure pain score, global assessment of treatment success or total adverse events.One study (265 participants; 303 THAs) evaluated the provision of hip precautions with versus without the prescription of postoperative equipment and restrictions to functional activities. Due to the quality of evidence being very low, we are uncertain if perceived satisfaction in the rate of recovery differed in people who were not prescribed postoperative equipment and restrictions (135/151 satisfied) compared to those prescribed equipment and restrictions (113/152) (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.75 to 0.93; 265 participants, one trial; number needed to treat for an additional beneficial outcome (NNTB) = 7). Due to the low quality evidence, we are uncertain if the incidence of hip dislocation differed between participants provided with hip precautions with (1/152) compared to without providing equipment or restrictions post-THA (0/151) (RR 2.98, 95% CI 0.12 to 72.59). The study did not measure pain, function, HRQOL, re-operation rates or total adverse events.One study (146 participants) investigated the provision of an enhanced postoperative education and rehabilitation service on hospital discharge to promote functional ADL versus a conventional rehabilitation intervention in the community. This study was of very low quality evidence. We were uncertain if the provision of enhanced postoperative education and rehabilitation improved function at six months follow-up, when assessed using the Objective and Subjective Functional Capability Index (146 participants, one trial; P > 0.05; no numerical results provided) compared to conventional rehabilitation. The study did not measure pain score, HRQOL, global assessment of treatment success, hip dislocation, re-operation rate or total adverse events.

AUTHORS' CONCLUSIONS

Very low quality evidence is available from single trials, thus we are uncertain if hip precautions with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA. There is also insufficient evidence to support or refute the adoption of a postoperative community rehabilitation programme consisting of functional reintegration and education compared to conventional rehabilitation strategies based on functional outcomes.Further high-quality trials are warranted to assess the outcomes of different occupational therapy interventions both in the short and longer-term for those who undergo THA. An assessment of the impact of such interventions on pain and restriction on personal ADL, EADL and instrumental ADL is needed, and also of functional integration-type interventions rather than just hip precautions, equipment and restrictions.

Preparing Patients for Total Hip Replacement

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.

Short hospital stay augmented with education and home-based rehabilitation improves function and quality of life after hip replacement: randomized study of 50 patients with 6 months of follow-up

BACKGROUND

Because of current cost restrictions, we studied the effect of a shorter hospital stay on function, pain and quality of life (QOL) after total hip replacement (THR).

PATIENTS AND METHODS

50 patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team, and a control group (CG) of 23 patients receiving "conventional" rehabilitation often augmented by a stay at a rehabilitation center.

RESULTS

Mean hospital stay was shorter for the SG than for the CG (6.4 days and 10 days, respectively; p < 0.001). During the 6-month study period, there were 9 non-fatal complications in the SG and 12 in the CG (p = 0.3). The difference in Oxford Hip Score between the groups was not statistically significant before the operation, but was better for the SG at 2 months (p = 0.03) and this difference remained more or less constant throughout the study. The overall score from the Nottingham Health Profile indicated a better QOL in the SG.

INTERPRETATION

Our preoperative education program, followed by postoperative home-based rehabilitation, appears to be safer and more effective in improving function and QOL after THR than conventional treatment.

Criteria for determining optimal time of discharge after total hip replacement

Total hip replacement is a common and expensive procedure and any attempt to shorten the length of hospital stay safely is desirable. This paper proposes a scoring system specifically designed for this patient population, to determine the optimal timing of safe discharge and post-acute care placement. The authors discuss the implications for the quality of patient care.

Preoperative education for total hip and knee replacement patients

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Preadmission psychosocial screening of older orthopedic surgery patients: evaluation of a Social Work Service

A preadmission social work intervention was evaluated for impact on length of hospital stay (LOS) and patient satisfaction. Psychosocial issues related to function and post-discharge needs were assessed at an exploratory level. A modified post-test only control group design was used. Study group patients were screened before hospitalization and offered services on admission. Control group patients received standard care. Study group patients were significantly more satisfied with services but impact on length of stay was not demonstrated with one possible exception. Post-operative complications were significantly related to longer LOS; however, unlike control group patients, study group patients with complications did not have significantly longer LOS. Women and those limited in preadmission physical function were most likely to report insufficient help after discharge. A more intensive preadmission intervention is recommended to improve impact on LOS and informal support system involvement, while future outcome studies would clarify the nature of service gaps and high risk groups.

Innovations in the Management of Heart Failure in the Home Health Care Environment

As home health care providers are confronted with a capitated care environment, the challenge for survival is to provide patients chronically ill with heart failure, the least costliest care in a time constrained and cost contained environment without compromise to quality while ensuring decreased use of emergency department visits and rehospitalizations. Specific to home care, innovation to meet this challenge can be operationalized by network communication incorporating an integrated pathway of service delivery; an interactive patient education manual that can be computer generated; utilization of cardiac mentors in the delivery of care as service office resources; incorporation of a telemanagement and telemonitoring system to enhance patient compliance; and a systematic approach to outcome measurement. Since incorporation of these new frontiers, Advocate Home Health Services has realized a hospital readmission rate of only 4.8% in 30 days or less from last rehospitalization when compared to the national average of 23%.

A discharge scoring system for patients with total hip replacement

Total hip replacement is a common and expensive procedure. Any attempt to shorten the length of hospital stay safely is desirable. Proposes a scoring system specifically designed for this patient population, to determine the optimal timing of safe discharge and postacute care placement. Discusses its implications for the quality of patient care.

Effect of preparatory information prior to elective total hip replacement on post-operative physical coping outcomes

The aim of the study was to evaluate the effect of preparatory information on a patient's post-operative physical coping outcomes following a Total Hip Replacement (THR). The research design was quasi-experimental. Eighty-two healthy individuals, scheduled for an elective THR were used and selected using non-random techniques, and placed into one of two groups on an alternating basis. The subjects in the experimental group were given procedural, sensory and coping information relating to the whole surgical procedure of a THR. In addition, written information was provided for each experimental subject to support the verbal information. Subjects in the control group only received the advice and support that would routinely be given to THR patients by ward, medical and nursing staff. The study measured a number of physical outcomes using a "Physical Indicators of Coping Questionnaire" developed to measure physiological and physical outcomes post-operatively. In addition, a Linear Analogue Coping Scale was developed to assess a patient's personal perception of their overall coping ability with the THR. The study demonstrated that preparatory information, given pre-operatively, post-operatively and pre-discharge had positive effects on the physical recovery and coping outcomes measured. Subjects in the experimental group had significantly less post-operative intramuscular analgesia, mobilized sooner with a Zimmer frame and walking sticks and lastly, their length of stay was on average, 2 days less than the control group. The Linear Analogue Coping Scale demonstrated that patients in the experimental group did perceive they were coping more effectively post-operatively. Preparatory information of various types and in different forms appear to have positive effects on the ability of patients to cope with and recover physically from a THR in the immediate post-operative period.

Videotape Intervention: Producing Videotapes for Use in Nursing Practice and Education

The purpose of this article is to describe the process utilized to produce nursing-specific videotapes for application in clinical or educational settings. The three phases, pre-production, production and post-production, are exemplified with the description of the process used by the authors as they developed the Nurseline Video-Assisted Modeling Program (NuVAMP), a video intervention for caregivers of people with dementia that helps them to shape family members' behaviors in activities of daily living. The practical aspects of video production are emphasized, including script writing, budget development, and the video editing process.

The impact of posthospital home care on patients with cancer

Symptom distress, mental health status, enforced social dependency and health perceptions were measured in two groups of cancer patients, one receiving home care services (n = 49) and the other receiving no such services (n = 11). Data were obtained at hospital discharge and 3 months later. Patients receiving home care demonstrated statistically significant improvement on mental health and social dependency; patients not receiving home care did not improve on any variable. After controlling for baseline scores, the home care group had significantly higher mental health status at the second interview than the no home care group.

Learning needs of hospitalized and recently discharged patients

Patients' perceptions about the importance of health information they receive during hospitalization and their satisfaction with this information was investigated in a study of hospitalized and recently discharged patients. Results show that information about medications, treatment and complications, and enhancing quality of life are most valued by hospitalized patients followed by information concerning activities of living, community follow-up, skin care, and feelings about condition. For recently discharged patients, the importance of most health information increases, rather than diminishes. These recently discharged patients show high levels of satisfaction with the information they received during hospitalization. These results suggest that hospital-based nurses prioritize patient learning needs and diversify teaching strategies to address patient knowledge deficits both in the hospital and immediately post-discharge.

Determinants of subsequent home health care nursing service use by hospitalized patients with cancer

BACKGROUND

The authors examined the extent to which specific patient characteristics and length of hospital stay were capable of independently explaining the use of home health care nursing services by hospitalized patients with cancer after discharge.

METHODS

The current study represents a secondary analysis of a data set originally gathered to identify the home health care needs of patients with cancer. The sample involved 87 patients with cancer who received home health care after hospitalization and 43 patients who did not receive such services.

RESULTS

A logistic regression analysis indicated that home health care use was related to patient age, length of hospital stay, and level of symptom distress. Specifically, the likelihood of home health care use was found to increase among subjects older than 50 years of age, subjects with hospital stays of more than 7 days (apparently related to surgery), and those who experienced moderate to high levels of symptom distress.

CONCLUSIONS

The results indicate a need for home health care nurses to be skilled in the management of cancer symptoms and in the complex problems commonly experienced by the postsurgical patient with cancer.