Randomized blinded trial of standardized written patient information before total knee arthroplasty
July
Randomized blinded trial of standardized written patient information before total knee arthroplasty
Benedicte Eschalier 0 1
Stephane Descamps 0
Bruno Pereira 0
He lène Vaillant- Roussel 0 1
Guillaume Girard 0
Stephane Boisgard 0
Emmanuel Coudeyre 0
0 Editor: Ara Nazarian, Harvard Medical School/ BIDMC , UNITED STATES
1 D eÂpartement de Me decine Ge neÂrale, Faculte de M eÂdecine, Universite Clermont Auvergne Clermont- Ferrand, France, 2 Service de Chirurgie Orthop eÂdique et Traumatologie, CHU Clermont-Ferrand, C- BIOSENSS, Universit e Clermont Auvergne , Clermont-Ferrand , France , 3 Direction de la Recherche Clinique et de l'Innovation , CHU Clermont-Ferrand, Clermont-Ferrand , France , 4 Service de M eÂdecine Physique et de R eÂadaptation , CHU Clermont-Ferrand , France , INRA, Universite Clermont Auvergne , Clermont-Ferrand , France
Results
Of 44 eligible patients, 42 were randomized, 22 to the intervention and 20 to the control
group, all of whom were included in the analysis. The groups were comparable at baseline.
The intervention was associated with significantly better patient knowledge scores.
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OPEN ACCESS
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: The funders had no role in study design,
data collection and analysis, decision to publish, or
preparation of the manuscript.
Competing interests: There are no patents,
products in development or marketed products to
declare. This study received funding from SANOFI
France. This does not alter our adherence to PLOS
ONE policies on sharing data and materials.
Background
osteoarthritis.
Purposes
among patients awaiting TKA.
Patients and methods
Conclusions
An educational booklet improves knowledge among patients awaiting TKA. A study assessing the impact of the booklet combined with a exercise program would be helpful.
Level of evidence
Level I, randomized controlled double-blind trial; see S1 CONSORT Checklist.
Trial registration
clinicaltrials.gov #NCT01747759
Introduction
Knee osteoarthritis results in loss of function due to muscle weakness, mobility and balance
impairments, and cardiorespiratory deconditioning [
1
]. Knee osteoarthritis is the main reason
for total knee arthroplasty (TKA), and the number of TKA procedures for knee osteoarthritis
is expected to increase by 70% between 2005 and 2030 in the US [
2
]. TKA improves both
function and pain. Pain and functional status before TKA predict the quality of the postoperative
recovery [
3
].
Although recently published data support the delivery of patient education before TKA [4±
8], the interventions studied vary widely and the results are somewhat conflicting. A 2011
meta-analysis of randomized controlled trials provided low-to-moderate evidence that a
variety of preoperative interventions, including patient education, improved outcomes after TKA
[
5
]. In a randomized trial, a booklet describing a combined exercise and educational
intervention during the 4 weeks before TKA showed no significant differences versus standard care in
terms of quality of life, pain, function, motion range, or muscle strength [
6
]. Nonsignificant
decreases in hospital stay length and use of postoperative rehabilitation were noted in the
intervention group. Another randomized controlled trial compared standard care to combined
therapeutic education and functional rehabilitation involving two 30-minute one-on-one
information sessions and two 90-minute group sessions on theoretical knowledge and
execution of the exercises, without the delivery of written information [
7
]. The intervention was
associated with improved function, decreased pain, increased analgesic consumption during
the first 9 months, fewer primary-care physician visits, and diminished healthcare costs during
the first 6 months. Finally, randomization to a single 40-minute preoperative educational
session on rehabilitation combined with a booklet on the hospital stay and postoperative course
was followed by decreases in surgical-ward stay length and costs compared to standard care
but had no effect on function or pain [
8
]. In none of these trials were the theoretical and
practical sessions supported by a validated and standardized printed document containing
information on overall perioperative management in order to ensure uniformity of the information
provided across healthcare providers, as suggested in current recommendations [
9
]. To our
knowledge, no consensus has been developed regarding an information document similar to
that described previously for low back pain but specifically designed for patients awaiting TKA
[
10
]. In an open study, we used the method described by McClune et al. [
11
] to develop and
validate an information booklet for patients awaiting TKA [
12
].
The primary purpose of our study was to evaluate the impact of our infor (...truncated)