Assessing Patient Expectations and Concerns in a Physical Medicine and Rehabilitation Unit: A Real-Time Snapshot

Assessing preoperative hope and expectations related to functional neurosurgery: a new questionnaire

BACKGROUND

Despite successful functional neurosurgery, patients suffering from epilepsy or Parkinson's disease may experience postoperative psychological distress and social maladjustments. Difficulties in coping with postoperative changes, even positive ones, have shown to be related to patients' presurgery cognitive representations (i.e., expectations, hope). The aim of this study was to develop an instrument assessing various key features of surgery outcomes' representations, namely the Preoperative Hope and Expectations Questionnaire (PHEQ).

METHODS

Participants were patients (n = 50) diagnosed with Parkinson's disease (n = 25) or epilepsy (n = 25), candidates for functional neurosurgery (i.e., Deep brain stimulation, anterior temporal lobectomy). Two to three weeks before the planned surgery, they were administrated items assessing their actual state, preoperative expectations, and hope regarding surgery outcomes. They also completed measures assessing optimism, quality of life and mood.

RESULTS

Exploratory analysis resulted in a 14-item version of the PHEQ composed of two factors (abstract representations, including psychological well-being and concrete representations, such as direct surgery outcomes). The PHEQ demonstrated high internal consistency and good convergent validity. Patients were more prone to express postoperative improvements in terms of hope rather than expectations. They generally focused on concrete rather than abstract features, although patients with Parkinson's disease had higher abstract future-oriented representations.

CONCLUSIONS

The PHEQ presents satisfactory psychometric properties and may be considered as a reliable instrument for research and clinical practice.

Decreasing Opioid Utilization in Rehabilitation Patients Using a Clinical Nurse Specialist Pain Consultant Program

OBJECTIVE

To investigate whether access to a clinical nurse specialist (CNS) with expertise in pain management will result in more rapid decline in opioid use across the rehabilitation hospitalization.

DESIGN

Retrospective chart review of patients discharged during 6 months prior to and 6 months after introduction of the CNS role.

SETTING

Not-for-profit 98-bed community inpatient rehabilitation hospital.

PARTICIPANTS

Two population-based samples of adult, inpatient rehabilitation patients (N=72) with daily opioid use ≥30mg morphine equivalent dose (MED) per day on admission and length of stay ≥24 days.

INTERVENTIONS

Implementation of a CNS pain consult program.

MAIN OUTCOME MEASURES

Change in average daily opioid use (milligrams of MED per day), measured at admission, week 1, week 2, and week 3.

RESULTS

Linear mixed modeling was used to estimate individual and group average opioid trajectories, including individual patient intercepts (opioid use at admission) and slopes (change in opioid use over time). There was a significant interaction between group and time (b=5.75, t=2.52, P<.01), indicating faster change in opioid use for the CNS group (quadratic slope, -5.91) compared with the no CNS group (quadratic slope, -.16). Quadratic change in the CNS group reflected an initial increase in opioid use from admission to week 1, followed by a steady decline. Conversely, there was virtually no change in the no CNS group. Random effects revealed considerable variability in opioid trajectories across patients.

CONCLUSIONS

Addition of a CNS pain consultant program to an inpatient rehabilitation hospital supported a distinct pattern of opioid tapering that promoted more rapid titration of daily opioid use across the rehabilitation hospitalization.