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术前教育对骨科手术后疼痛和功能的影响:系统评价和荟萃分析。

The effect of preoperative education on postoperative pain and function after orthopedic surgery: A systematic review and meta-analysis.

机构信息

Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China.

Department of Physical Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 201619, China.

出版信息

Patient Educ Couns. 2024 Nov;128:108406. doi: 10.1016/j.pec.2024.108406. Epub 2024 Aug 16.

Abstract

OBJECTIVES

To systematically review the effect of preoperative education on reducing postoperative pain and disability in the short-term and long-term for patients undergoing orthopedic surgery.

METHODS

Pertinent randomized controlled trials were retrieved from PubMed, Cochrane Central, Embase, Medline, Scopus and CINAHL from their inception until September 10, 2023. Two authors independently conducted study selection, data extraction, and methodological quality assessment. This review was registered in PROSPERO (CRD42023470282).

RESULTS

A total of 37 RCTs were included with 27 of them being pooled for meta-analysis. Low certainty of evidence indicated that there was a small effect of preoperative education (standardized mean difference = - 0.23, 95 % CI = [- 0.39, - 0.07], p = 0.004) or combined preoperative intervention (standardized mean difference = - 0.25, 95 % CI = [- 0.41, - 0.09], p = 0.003) on postoperative pain relief.

CONCLUSIONS

Preoperative education and combined preoperative intervention only had a short-term effect on postoperative pain relief, while they were not superior to usual care in postoperative functional recovery, either short-term or long-term.

PRACTICE IMPLICATIONS

Both preoperative education and combined preoperative intervention are effective in pain control around a week postoperatively. However, optimal contents, durations, and dose of education warrant further investigation.

摘要

目的

系统评价术前教育对减少骨科手术患者短期和长期术后疼痛和残疾的效果。

方法

从 PubMed、Cochrane 中心、Embase、Medline、Scopus 和 CINAHL 数据库中检索从建库至 2023 年 9 月 10 日的相关随机对照试验。两位作者独立进行研究选择、数据提取和方法学质量评估。本综述已在 PROSPERO(CRD42023470282)注册。

结果

共纳入 37 项 RCT,其中 27 项进行了荟萃分析。低确定性证据表明,术前教育(标准化均数差=-0.23,95%CI:[-0.39,-0.07],p=0.004)或联合术前干预(标准化均数差=-0.25,95%CI:[-0.41,-0.09],p=0.003)对术后疼痛缓解有较小的影响。

结论

术前教育和联合术前干预仅对术后疼痛缓解有短期影响,而在术后短期或长期功能恢复方面并不优于常规护理。

实践意义

术前教育和联合术前干预在术后一周左右的疼痛控制方面均有效。然而,还需要进一步研究最佳的教育内容、时长和剂量。

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