McDonald S, Hetrick S, Green S
Australasian Cochrane Centre, Monash University, Monash Medical Centre, Locked Bag 29, Clayton, Victoria, Australia.
Cochrane Database Syst Rev. 2004(1):CD003526. doi: 10.1002/14651858.CD003526.pub2.
Hip or knee replacement is a major surgical procedure which can be physically and psychologically stressful for patients. It is hypothesised that education before surgery reduces anxiety and enhances postoperative outcomes.
To determine whether preoperative education improves postoperative outcomes (anxiety, pain, mobility, length of stay and the incidence of deep vein thrombosis) in patients undergoing hip or knee replacement surgery.
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2003), MEDLINE (1966 to April 2003), EMBASE (1980 to June 2002), CINAHL, PsycINFO and PEDro until May 2003. We handsearched the Australian Journal of Physiotherapy (1954 to 2001) and reviewed the reference lists.
Randomised trials of preoperative education (verbal, written or audiovisual) delivered by a health professional within six weeks of surgery to patients undergoing hip or knee replacement.
Two reviewers independently assessed study quality and extracted data. Continuous outcomes were combined using weighted mean difference (WMD) and 95% confidence intervals (CI).
Nine studies involving 782 participants met the inclusion criteria. Four studies involving 365 participants assessed length of hospital stay (days) but detected no significant difference between preoperative education and usual care (WMD -0.97; 95% CI -2.67 to 0.73). However, one study of 133 participants with more complex needs, indicated that individually tailored programmes of education and support were beneficial in reducing length of stay. The four studies reporting length of stay did not find any significant effect of preoperative education on days to standing and days to climb stairs. Three trials found preoperative education was beneficial in reducing preoperative anxiety (WMD -5.64; -7.45 to -3.82) on a scale of 0 to 100. No significant effect on postoperative anxiety was detected either on the day following surgery, or at discharge. None of the five studies reporting postoperative pain detected any difference between the groups.
REVIEWER'S CONCLUSIONS: There is little evidence to support the use of pre-operative education over and above standard care to improve postoperative outcomes in patients undergoing hip or knee replacement surgery, especially with respect to pain, functioning and length of hospital stay. There is evidence that preoperative education has a modest beneficial effect on preoperative anxiety. There may also be beneficial effects when preoperative education is tailored according to anxiety, or targeted at those most in need of support (e.g. those who are particularly disabled, or have limited social support structures).
髋关节或膝关节置换是一项重大外科手术，对患者而言会造成身体和心理压力。据推测，术前教育可减轻焦虑并改善术后结果。
确定术前教育能否改善接受髋关节或膝关节置换手术患者的术后结果（焦虑、疼痛、活动能力、住院时间及深静脉血栓形成发生率）。
我们检索了Cochrane对照试验中心注册库（2003年第2期《Cochrane图书馆》）、MEDLINE（1966年至2003年4月）、EMBASE（1980年至2002年6月）、CINAHL、PsycINFO及PEDro直至2003年5月。我们手工检索了《澳大利亚理疗杂志》（1954年至2001年）并查阅了参考文献列表。
由健康专业人员在手术六周内为接受髋关节或膝关节置换的患者提供的术前教育（口头、书面或视听形式）的随机试验。
两名评价员独立评估研究质量并提取数据。连续结果采用加权均数差（WMD）及95%置信区间（CI）进行合并。
9项研究纳入782名参与者，符合纳入标准。4项研究纳入365名参与者，评估住院时间（天数），但未发现术前教育与常规护理之间存在显著差异（WMD -0.97；95% CI -2.67至0.73）。然而，一项针对133名有更复杂需求参与者的研究表明，个体化定制的教育与支持方案有助于缩短住院时间。4项报告住院时间的研究未发现术前教育对站立天数及爬楼梯天数有任何显著影响。3项试验发现术前教育有助于减轻术前焦虑（WMD -5.64；-7.45至-3.82），焦虑评分范围为0至100。术后当天或出院时均未检测到对术后焦虑有显著影响。5项报告术后疼痛的研究均未发现两组之间存在差异。
几乎没有证据支持在标准护理之外使用术前教育来改善接受髋关节或膝关节置换手术患者的术后结果，尤其是在疼痛、功能及住院时间方面。有证据表明术前教育对术前焦虑有适度的有益影响。当根据焦虑情况定制术前教育或针对最需要支持的人群（如残疾特别严重或社会支持结构有限的人群）时，可能也会有有益效果。
