Furdock Ryan, Alejo Andrew, Hoffa Matthew, Vergon Anna, Romeo Nicholas M, Vallier Heather A
Department of Orthopaedics, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Northeast Ohio Medical University, Rootstown, Ohio.
J Bone Joint Surg Am. 2024 Nov 20;106(22):2136-2143. doi: 10.2106/JBJS.23.01366. Epub 2024 Aug 27.
Orthopaedic trauma patients may experience poor recall regarding their injury and treatment, impairing postoperative outcomes. We sought to evaluate the impact of a standardized postoperative educational protocol on patient recall, adherence to the treatment plan, and satisfaction.
Two hundred and twenty adult, English-speaking patients with surgically treated lower-extremity fractures were prospectively included. One hundred and ten patients in the educational intervention cohort met with a non-physician study member after surgery but before hospital discharge. They were given a written questionnaire evaluating knowledge of key aspects of their injury and treatment plan. For incorrectly answered questions, the study team member told the patient the correct answer (e.g., "No, you broke your tibia."). Immediately after, the patient was verbally asked the question again (e.g., "Which bone did you break?"), repeating the process until the answer was correct. The 110 patients in the control cohort did not receive this "teach-back" protocol. During their first postoperative appointment, all 220 patients completed a follow-up questionnaire assessing recall, adherence to the treatment plan, and satisfaction.
The control cohort correctly answered 64% of recall-oriented questions versus 89% in the intervention cohort (p < 0.001). Eighty-two percent of control patients versus 89% patients in the intervention cohort adhered to postoperative weight-bearing restrictions (p = 0.09). Eighty-four percent of controls adhered to their deep venous thrombosis prophylaxis regimen versus 99% of the intervention cohort (p < 0.001). On a 5-point Likert scale, controls were less satisfied with their overall orthopaedic care compared with patients in the intervention cohort (mean of 4.38 ± 0.84 versus 4.54 ± 0.63 points; p = 0.02), although this difference was less than the minimal clinically relevant difference of 10% that was defined at study onset. On propensity score-weighted multivariable analysis, receipt of the postoperative educational intervention was the only modifiable factor associated with improvement in patient recall (26% improvement [95% confidence interval, 20% to 31%]; p < 0.001).
Some orthopaedic trauma patients' nonadherence to surgeon recommendations and dissatisfaction with care may be mitigated by postoperative education. This standardized postoperative educational protocol improves orthopaedic trauma patients' recall, adherence to their treatment plan, and satisfaction in a manner requiring minimal time.
Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
骨科创伤患者可能对其损伤和治疗的记忆较差，这会影响术后结果。我们旨在评估标准化术后教育方案对患者记忆、治疗计划依从性和满意度的影响。
前瞻性纳入220名接受手术治疗的下肢骨折成年英语患者。教育干预组的110名患者在术后但出院前与一名非医生研究人员会面。他们收到一份书面问卷，评估其对损伤和治疗计划关键方面的了解。对于回答错误的问题，研究团队成员告知患者正确答案（例如，“不，你胫骨骨折了。”）。之后，立即再次口头询问患者该问题（例如，“你哪根骨头骨折了？”），重复该过程直到答案正确。对照组的110名患者未接受这种“反馈式教学”方案。在他们术后的首次预约中，所有220名患者都完成了一份后续问卷，评估记忆、治疗计划依从性和满意度。
对照组正确回答了64%的记忆导向性问题，而干预组为89%（p<0.001）。对照组82%的患者与干预组89%的患者遵守了术后负重限制（p = 0.09）。对照组84%的患者遵守了其深静脉血栓预防方案，而干预组为99%（p<0.001）。在5分李克特量表上，与干预组患者相比，对照组对其整体骨科护理的满意度较低（平均4.38±0.84分对4.54±0.63分；p = 0.02），尽管这种差异小于研究开始时定义的最小临床相关差异10%。在倾向评分加权多变量分析中，接受术后教育干预是与患者记忆改善相关的唯一可改变因素（改善26%[95%置信区间，20%至31%]；p<0.001）。
术后教育可能会减轻一些骨科创伤患者不遵守外科医生建议的情况以及对护理的不满。这种标准化术后教育方案以最少的时间改善了骨科创伤患者的记忆、治疗计划依从性和满意度。
预后II级。有关证据水平的完整描述，请参阅作者指南。
