Randomized blinded trial of standardized written patient information before total knee arthroplasty

PLOS ONE, Jul 2017

Background The effect of patient education before total knee arthroplasty (TKA) is controversial. No consensus exists about the optimal content of educational interventions. In a previous study, we developed and validated an educational booklet on the peri-TKA management of knee osteoarthritis. Purposes Our primary purpose was to evaluate the impact of the educational booklet on knowledge among patients awaiting TKA. Patients and methods This randomized controlled single-blind trial evaluated standard information by the surgeon with or without delivery of the educational booklet 4–6 weeks before primary noncomplex TKA in patients aged 55–75 years with incapacitating knee osteoarthritis. Patients were enrolled at a French surgical center between June 2011 and January 2012. A patient knowledge score was determined at baseline, on the day before TKA, and 3–6 weeks after TKA, using a self-administered questionnaire developed for our previous study. The assessor was blinded to group assignment. 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. 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

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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. a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 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)


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Benedicte Eschalier, Stephane Descamps, Bruno Pereira, Hélène Vaillant-Roussel, Guillaume Girard, Stephane Boisgard, Emmanuel Coudeyre. Randomized blinded trial of standardized written patient information before total knee arthroplasty, PLOS ONE, 2017, Volume 12, Issue 7, DOI: 10.1371/journal.pone.0178358