Daltroy L H, Morlino C I, Eaton H M, Poss R, Liang M H
Multipurpose Arthritis and Musculoskeletal and Skin Diseases Center, Harvard Medical School, USA.
Arthritis Care Res. 1998 Dec;11(6):469-78. doi: 10.1002/art.1790110607.
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.
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.
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.
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.
心理教育准备已知可改善术后结果。我们在老年骨科患者中测试了两种常见的心理教育程序，研究如何根据心理类型将干预措施与患者进行最佳匹配。
222名接受全髋关节或膝关节置换术的老年患者被随机分配到以下两组：1）观看关于术后住院康复经历的幻灯片录像带；2）使用床边录音带进行本森放松反应训练，采用2×2析因设计。
放松反应并未影响术后结果。教育干预缩短了表现出最强否认情绪（即避免思考不愉快事件的倾向）的患者的住院时间并减少了其止痛药的使用，同时减少了基线焦虑程度最高的患者术后的焦虑情绪以及在简易精神状态检查表上的认知错误。对术后疼痛没有影响。
强化了在骨科手术前关注患者心理状态和准备程度的重要性。表现出最强否认情绪和最高焦虑程度的患者可能会从教育干预中受益，但与针对否认情绪和焦虑进行更正式的心理测试相比，患者直接表达对信息的需求可能不是决定哪些患者会受益的可靠依据。
