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Preoperative education for orthopaedic patients: systematic review
Abstract
Aims. This paper presents a systematic review whose aim was to describe the scope and methods of the current literature on preoperative patient education and to identify the effects of this education. Background. Preoperative patient education is a common and important intervention in surgical nursing, yet there is very limited systematic evidence on its precise role. Methods. The Medline, CINAHL, Eric, Psycinfo and Social Sciences Index databases and the Cochrane Library were searched, covering the period from the beginning of each database to April 2003. Studies were included if they concerned adult orthopaedic patients, preoperative nursing patient education and were based on randomized controlled or clinical trials. Meta‐analysis was carried out where appropriate. Results. We identified 11 articles involving 1044 participants. Most studies included one experimental and one control group; only two had more than one experimental and control group. The educational interventions varied widely, but the majority were based on written materials alone, or written materials in combination with other teaching methods. The most common outcome measures related to pain, knowledge, anxiety, exercises and length of stay, and the least common to self‐efficacy and empowerment. The methodological quality of the studies varied. Almost all reported one or more statistically significant effects. Based on the findings of the meta‐analysis, preoperative education appears to have some impacts on patients’ anxiety and knowledge levels. Conclusions. The review clearly highlights the need for well‐designed, methodologically sound research into the outcomes of patient education. It also points to the need to study patient education from the point of view of empowerment.
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“However, most of the evidence focused on general surgery.6, 7”
From A Multimedia Self-management Intervention to Prepare Cancer Patients and Family Caregivers for Lung Surgery and Postoperative Recovery (2017) · cites this paper as [7]
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“Considering that this review showed a limited effect for preoperative education changing postoperative pain in THA and TKA surgery, and that the education delivery methods were similar to other types of surgery, it could be argued that the limited efficacy might be attributable to the content of the education.”
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“Historically, being informed in advance of events has aided the patients’ ability to manage anxiety more effectively (Lee et al. 2003, Johansson et al. 2005).”
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Barriers and Facilitators to Cochlear Implant Uptake in Australia and the United Kingdom
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“Furthermore, clinical outcomes such as pain and functioning do not improve following patient education [26,28,30], just as patient education also does not decrease anxiety in a clinically meaningful way [26,28].”
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“In recent years, empowerment has been seen as increasingly important in patient education [1–5].”
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“Published reports describe a positive relation between preoperative teaching and improved outcomes for patients and indicate that preoperative teaching is a cost-effective approach.(7) Table 1 lists the relevant studies reviewed for this project and their respective level of evidence.”
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“Educational interventions were proposed to reduce barriers to effective pain management (Johansson et al. 2005, Carr 2007) and pain levels (Wong et al. 2010).”
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“However, most of the evidence focused on general surgery.(6,7) Family caregivers frequently report unmet needs in all QOL domains.”
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Preoperative therapeutic neuroscience education for lumbar radiculopathy: A single-case fMRI report
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“…with a focus on procedural information and informed consent have demonstrated limited benefit for post-surgical outcomes (Douglas, Mann, and Hodge, 1998; Johansson et al, 2005; Krupp, Spanehl, Laubach, and Seifert, 2000; LaMontagne, Hepworth, Salisbury, and Cohen, 2003; Walters and Coad, 2006).”
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“The current study supports the previous study findings that preoperative education increases knowledge.(21) It is plausible that the knowledge gained through preoperative education allowed the participants to anticipate their postoperative environments and procedures, perhaps enabling better adaptation to postoperativ…”
ResultPsychometric Properties of the Swedish Rheumatic Disease Empowerment Scale, SWE‐RES‐23
Arvidsson, S., Bergman, S., Arvidsson, B., Fridlund, B., & Tingström, P. (2012) · Musculoskeletal Care · doi:10.1002/msc.1005 · Cited by 38
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“…education had a positive effect on preoperative anxiety levels and patient knowledge, but no changes to postoperative outcomes, including pain, range of motion (ROM), function or length of hospital stay, when compared to “usual care” (Johansson et al, 2005; McDonald, Hetrick, and Green, 2004).”
BackgroundResultPatient Anxiety and Conscious Surgery
Mitchell, M. (2009) · Journal of Perioperative Practice · doi:10.1177/175045890901900601 · Cited by 38
“Previous studies have revealed that being informed in advance of anaesthesia has aided the more effective management of anxiety (Lee et al 2003, Johansson et al 2005), that is, the sequential order of events being explained and patients being provided, where possible, with some choice (McKenna…”
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“It also reduces patients’ anxiety and increases their knowledge level (Johansson et al., 2005).”
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“Preoperative education in total joint arthroplasty has been proposed as a method to reduce anxiety in the preoperative period.(105,106) However, the same authors acknowledge that this positive effect on preoperative anxiety and knowledge level has yet to be linked to changes in postoperative outcomes including pain, r…”
Preoperative education for lumbar surgery for radiculopathy
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“A recent systematic review of all preoperative education programs in the orthopedic domain found only studies relating to total knee and total hip replacements and no studies on spinal surgery populations (Johansson et al 2005).”
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“Previous research has demonstrated that preoperative education is a promising method to improve postsurgical outcomes, such as decreasing levels of anxiety and depression, improving recovery, and increasing patient satisfaction [11-15].”
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“Rehabilitation programs are supported by evidence of effectiveness in the presurgical hospitalization [11] and at home [12,13] and in the postsurgical period as early and intensive [14], long-term [15], and at home [16].”
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Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner
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“Studies have shown that thorough preoperative patient education results in improved postoperative outcomes after different orthopaedic procedures.(17) Thus, orthopaedic surgeons can play a crucial role in improving patient-related outcomes after HTO by preoperatively discussing expectations and recommendations, includ…”
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Patients’ expectations of osteotomies around the knee are high regarding activities of daily living
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Self-citationDoctor–patient communication, patient knowledge and health literacy: how difficult can it all be?
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The Quality of Patient Education in Day Surgery by Adult Patients
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Pain, nausea, vomiting, thirst, cold, … the challenge of well-being in post-operative patients
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Psychological care of patients undergoing elective surgery
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“This is supported by earlier research, which confirms that there has been very little systematic research on effectiveness of orthopaedic patient education (Johansson et al. 2005).”
ResultTotal Joint Arthroplasty Patients’ Perception of Received Knowledge of Care
Montin, L., Johansson, K., Kettunen, J. A., Katajisto, J., & Leino‐Kilpi, H. (2010) · Orthopaedic Nursing · doi:10.1097/nor.0b013e3181e51868 · Cited by 22
Self-citationBagheri, H., Ebrahimi, H., Abbasi, A., Atashsokhan, G., Salmani, Z., & Zamani, M. (2018) · Journal of PeriAnesthesia Nursing · doi:10.1016/j.jopan.2018.04.005 · Cited by 22
“Different studies have demonstrated that the lack of appropriate nursing interventions for anxiety reduction causes a greater level of anxiety in patients when approaching the time of surgery, demonstrating the necessity of using nonpharmacologic methods for easing anxiety.(11) Given that most of the factors pertainin…”
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“However, previous studies focus on patients experiencing chronic pain or planned surgery (Freeman & Freeman 2005; Johansson et al. 2005).”
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“ASS (ACL Specific Score) scores as very good (21-25), good (16-20), moderate (11-15), poor (6-10), and very poor (0-5).”
BackgroundMethodInfluentialPre-operative preparation of patients for total knee replacement: An action research study
Lucas, B., Cox, C. L., Perry, L., & Bridges, J. (2012) · International Journal of Orthopaedic and Trauma Nursing · doi:10.1016/j.ijotn.2012.08.005 · Cited by 22
“Patient knowledge has been increased by provision of written information prior to admission (Hodgkinson et al., 2000; Johansson et al., 2005) although effects were relatively moderate.”
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Evidence‐Based Patient Education: Knowledge Transfer to Endodontic Patients
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Arvidsson, S. (2011) · Cited by 19
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“A systematic review of preoperative education for orthopedic patients showed a positive relationship between well-designed preoperative teachings and patients’ anxiety and knowledge levels [6].”
BackgroundPreoperative pain neurophysiology education for lumbar radiculopathy: A randomized-controlled trial
Saraçoğlu, İ., Kaya, İ., Cingöz, İ. D., & Aydın, H. E. (2021) · Turkish Journal of Physical Medicine and Rehabilitation · doi:10.5606/tftrd.2021.5495 · Cited by 18
“However, systematic reviews conducted to examine the effectiveness of these education methods revealed that they had no additional effects on patients undergoing surgery.[14]”
BackgroundÜnver, S., Kıvanç, G., & Alptekin, H. M. (2018) · Europe PMC (PubMed Central) · Cited by 18
Ambulatory Orthopaedic Surgery Patient Education and Cost of Care
Heikkinen, K., Salanterä, S., Suomi, R., Lindblom, A., & Leino‐Kilpi, H. (2011) · Orthopaedic Nursing · doi:10.1097/nor.0b013e318205747f · Cited by 18
Self-citationPeople's experiences of suffering a lower limb fracture and undergoing surgery
Forsberg, A., Söderberg, S., & Engström, Å. H. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12292 · Cited by 18
Yadav, S., & Shrestha, S. (2017) · Journal of Natural Science Biology and Medicine · doi:10.4103/0976-9668.198358 · Cited by 17
“This finding was different from the result of other preoperative education study where a reduced preoperative anxiety was reported.[16] In fact, one of the patients showed increased anxiety after an explanation of risks and complications of the surgery was provided by the surgeon.”
ResultEffectiveness of patient education on total knee arthroplasty: A systematic review and meta‐analysis
Kim, T. W., & Kim, S. H. (2022) · Journal of Clinical Nursing · doi:10.1111/jocn.16324 · Cited by 17
Patients' perceptions of their postoperative recovery for one month
Forsberg, A., Vikman, I., Wälivaara, B., & Engström, Å. H. (2015) · Journal of Clinical Nursing · doi:10.1111/jocn.12793 · Cited by 16
Orthopaedic patients’ perceptions about \ntheir pre-operative information
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Aquilina, R., & Baldacchino, D. (2007) · Journal of Orthopaedic Nursing · doi:10.1016/j.joon.2007.08.014 · Cited by 16
Hines, S. J., Munday, J., & Kynoch, K. (2015) · The JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/01938924-201513060-00016 · Cited by 16
Intervention Focused on the Patient and Family for Better Postoperative Pain Relief
Grondin, F., Bourgault, P., & Bolduc, N. (2012) · Pain Management Nursing · doi:10.1016/j.pmn.2012.06.006 · Cited by 16
Best Practices in Orthopaedic Inpatient Care
Esoga, P. I., & Seidl, K. L. (2012) · Orthopaedic Nursing · doi:10.1097/nor.0b013e31825dfe23 · Cited by 16
Role of strengthening during nonoperative treatment of lateral epicondyle tendinopathy
McQueen, K. S., Powell, R. K., Keener, T., Whalley, R., & Calfee, R. P. (2021) · Journal of Hand Therapy · doi:10.1016/j.jht.2020.10.009 · Cited by 15
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Effectiveness of the Nursing Methodology in Pain Management after Major Ambulatory Surgery
Porras-González, M. H., Barón-López, F. J., García-Luque, M. J., & Morales‐Gil, I. M. (2014) · Pain Management Nursing · doi:10.1016/j.pmn.2014.09.013 · Cited by 14
Different expectations of patients and surgeons with regard to rotator cuff repair
Karpinski, K., Plachel, F., Gerhardt, C., Saier, T., Tauber, M., Auffarth, A., Akgün, D., & Moroder, P. (2022) · Journal of Shoulder and Elbow Surgery · doi:10.1016/j.jse.2021.12.043 · Cited by 14
«Prehabilitación» en cirugía de columna degenerativa: revisión de la literatura
López, P. D. D., Rodríguez-Salazar, A., & Castilla-Díez, J. M. (2019) · Neurocirugía · doi:10.1016/j.neucir.2018.11.008 · Cited by 14
Quality, Reliability, and Readability of Online Information on Rhinoplasty
Ahsanuddin, S., Cadwell, J. B., Povolotskiy, R., & Paskhover, B. (2021) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000007487 · Cited by 14
Ambulatory Orthopaedic Surgery Patients' Emotions When Using Two Different Patient Education Methods
Heikkinen, K., Salanterä, S., Leppänen, T., Vahlberg, T. J., & Leino‐Kilpi, H. (2012) · Journal of Perioperative Practice · doi:10.1177/175045891202200703 · Cited by 13
“In earlier studies, researchers most commonly only evaluated anxiety or fear (e.g. Shuldham 1999, Lee et al 2003, Johansson et al 2005).”
BackgroundResultInfluentialSelf-citationAkciğer Kanseri Nedeniyle Ameliyat Olan Hastalarda Konfor Düzeyi ve Konforu Etkileyen Faktörler
GÜNER, A., & Kumsar, A. K. (2021) · Online Türk Sağlık Bilimleri Dergisi · doi:10.26453/otjhs.763680 · Cited by 13
Kaakinen, P., Meriläinen, M. H., Putila, P., & Kääriäinen, M. (2019) · International Journal of Orthopaedic and Trauma Nursing · doi:10.1016/j.ijotn.2019.100717 · Cited by 13
Orthopaedic patient education practice
Eloranta, S., Katajisto, J., & Leino‐Kilpi, H. (2015) · International Journal of Orthopaedic and Trauma Nursing · doi:10.1016/j.ijotn.2015.08.002 · Cited by 13
Self-citation
Metadata
- Authors
- Johansson, K., Nuutila, L., Virtanen, H., Katajisto, J., & Salanterä, S.
- Affiliations
- University of Turku (FI)
- Venue
- Journal of Advanced Nursing
- Publisher
- Wiley
- Published
- 2005-03-17
- Volume
- 50
- Issue
- 2
- Pages
- 212-223
- ISSN
- 0309-2402 (ISSN-L)
- 1365-2648
- OpenAlex
- W2163485591
- Cited by
- 241
- References
- 42
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 13 · 2023: 6 · 2022: 13 · 2021: 13 · 2020: 10 · 2019: 13 · 2018: 17 · 2017: 11 · 2016: 13 · 2015: 20 · 2014: 22 · 2013: 12 · 2012: 18
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Advanced Nursing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Keywords
- preoperative patient education, orthopedic surgery, surgical nursing, patient anxiety, patient knowledge, written patient information, empowerment, length of hospital stay, postoperative pain, exercise adherence
- MeSH terms
- Anxiety, Humans, Patient Education as Topic, Preoperative Care, Perioperative Nursing, Orthopedic Procedures
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