关于现实期望的术前教育可提高全膝关节置换术后中枢敏化患者的满意度：一项随机对照试验。
Preoperative education on realistic expectations improves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized-controlled trial.
作者信息
Nam Hee Seung, Yoo Hyun Jin, Ho Jade Pei Yuik, Kim Yong Beom, Lee Yong Seuk
机构信息
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
Department of Orthopedic Surgery, Konyang University College of Medicine, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, South Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4705-4715. doi: 10.1007/s00167-023-07487-9. Epub 2023 Jun 25.
PURPOSE
The aim of this study was to investigate whether an additional module on realistic expectations following total knee arthroplasty (TKA) would lead to a higher proportion of satisfied patients compared to existing preoperative education.
METHODS
This was a single-center, randomized-controlled trial. A total of 172 patients who were scheduled for TKA between September 2020 and October 2021 were enrolled. Patients were randomized to receive either only standard preoperative education, or an additional module on realistic expectations following TKA. The primary outcome was patient satisfaction. Secondary outcomes were Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, crepitus score, and range of motion. Subgroup analysis was performed based on central sensitization inventory (CSI) score stratification. Assessment was performed at the 3-month, 6-month, and > 1-year follow-up.
RESULTS
At more than 1 year, 65/78 (83.3%) patients in the intervention group and 52/80 (65.0%) patients in the control group were satisfied (P = 0.03). The mean satisfaction score was measured as 4.2 ± 0.9 in the intervention and 3.9 ± 0.9 in the control at > 1 year (P = 0.01). There were significant differences in Short Form-36 physical and mental component summary scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores at 6 months (P = 0.02, P = 0.02, P = 0.04, P = 0.04). The frequency of satisfaction and mean satisfaction score in the top 25 percentile CSI group were 15/16 (93.8%) and 4.6 ± 0.6 in those who received intervention and 12/19 (63.2%) and 3.8 ± 0.8 in those who did not (P = 0.01, P = 0.01).
CONCLUSIONS
Thorough preoperative education on realistic expectations following TKA showed effects on WOMAC pain and satisfaction at > 1 year after surgery. It was more prominent in the group with a higher CSI score at > 1-year follow-up.
LEVEL OF EVIDENCE
Level I.
目的
本研究旨在调查与现有的术前教育相比，全膝关节置换术（TKA）后增加关于现实期望的额外模块是否会使患者满意度更高。
方法
这是一项单中心随机对照试验。共纳入2020年9月至2021年10月期间计划接受TKA的172例患者。患者被随机分为仅接受标准术前教育组，或接受TKA后关于现实期望的额外模块组。主要结局是患者满意度。次要结局包括简明健康状况调查量表（Short Form-36）、西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index）、摩擦音评分和关节活动范围。基于中枢敏化量表（central sensitization inventory，CSI）评分分层进行亚组分析。在3个月、6个月和超过1年的随访时进行评估。
结果
超过1年时，干预组65/78例（83.3%）患者和对照组52/80例（65.0%）患者感到满意（P = 0.03）。超过1年时，干预组的平均满意度评分为4.2±0.9，对照组为3.9±0.9（P = 0.01）。在6个月时，简明健康状况调查量表的生理和心理成分总结评分以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）的疼痛和僵硬评分存在显著差异（P = 0.02、P = 0.02、P = 0.04、P = 0.04）。在CSI评分处于前25%的亚组中，接受干预者的满意度频率和平均满意度评分分别为15/16（93.8%）和4.6±0.6，未接受干预者分别为12/19（63.2%）和3.8±0.8（P = 0.01、P = 0.01）。
结论
TKA后关于现实期望的全面术前教育在术后超过1年时对WOMAC疼痛和满意度有影响。在超过1年随访时，在CSI评分较高的组中这种影响更显著。
证据水平
I级。
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