A Randomized Controlled Trial of an Individualized Preoperative Education Intervention for Symptom Management Following Total Knee Arthroplasty

Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Painrelated interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004).;This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three.;There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4+/-14.4 in the intervention group and 22.4+/-15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed.;Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.;Keywords: Total knee arthroplasty, pain, nausea, preoperative education.