The effectiveness of an educational intervention on pain management and post -operative outcomes of Chinese patients with fracture limb.

摘要

Background. Fracture limb and undergoing surgery is the common problem after injury. It is the most common source of pain and anxiety and research continues to demonstrate a high prevalence of unrelieved pain in injured patients who have undergone surgery. Patient's belief in pain is the major barrier in pain management. Strategies directed to have appropriate educational interventions are urgently needed to improve patient outcomes for those suffering acute pain after surgery for traumatic limb fracture.;Aim. The overall aims of this study were to develop a tailor-made educational intervention and to examine its effectiveness on short- and longer-term outcomes among Chinese patients with traumatic limb fractures who had undergone surgery.;Method. The study was conducted in the orthopaedic wards of two regional hospitals in Hong Kong and comprised two phases. In phase one, qualitative interviews were conducted with twenty-six Chinese patients who had traumatic limb fractures and were undergoing surgery regarding their experiences of and beliefs about pain management. Ten orthopaedic nurses were also interviewed about their perceived pain management practices and the barriers that prevented better pain control among patients. The findings from these qualitative interviews were used to develop a cognitive behavioural approach educational intervention (C-BEI). C-BEI was used to enhance knowledge of pain, modify their beliefs about pain management and promote positive coping thoughts and behaviour. The C-BEI consisted of two sessions. The first was a 30-minute session comprised a combination of patient education and breathing relaxation exercise and conducted at T0 (1 day before surgery). A 30-minute reinforcement session was conducted at day 7 after surgery (T3).;The main study was conducted in phase II which consisted of outcomes and process evaluation. A quasi-experimental design of two groups' pre-test and post-test between subjects was employed for the outcomes evaluation. All participants in the experimental group received the C-BEI and usual care, whereas those in the control group received usual care only. The short-term outcomes were treated as primary outcomes and evaluated in terms of the participants' pain barrier score, pain level (Visual Analogue Pain Scale: VAS, anxiety level (State-Trait Anxiety Inventory:STAI), sleep satisfaction, self-efficacy in pain management (General Self Efficacy Scale: GSE), and frequency of analgesic use. All of which were measured at T0, T1 (day 2), T2 (day 4), and T3 (day 7) after surgery. The total length of stay in hospital of the two groups was also compared. Longer-term outcomes were further evaluated over three months at T4 (1 month) and T5 (3 months), and included the VAS pain level, STAI, sleep satisfaction, GSE and health-related quality of life (SF36).The intention-to-treat method was adopted. The process evaluation involved a qualitative study using telephone interviews.;Results. A total of 125 participants completed the study, with 62 in the experimental group and 63 in the control group. The participants were homogenous in terms of demographic data (P > 0.05) and baseline clinical characteristics (p > 0.05). The short-term outcomes (from T0 to T3) for the participants in the experimental group were a statistically significant with lower pain barrier (p = .003), lower level of pain (p = .003), lower level of anxiety (p < .001), and better sleep satisfaction (p = .001) than the control group. The experimental group had a significantly higher frequency of analgesic use at T2 (p < .001) and better self-efficacy in pain management at T3 (p = .011) than the control group. There were no statistically significant differences in the total length of stay in hospital, although the mean length of stay was shorter in the experimental group than in the control group (8.1 day VS 10.1 days). For longer-term effects, the C-BEI was effective at the post-operative stage in anxiety reduction ( p = .002) and sleep satisfaction improvement (p = .002). There were no statistically significant differences for the VAS pain level, GSE scores, physical health summary component (PCS) and mental health summary component (MCS) of the SF36 between two groups over three months, although the experimental group had better scores in the mental health dimension. Findings of the process evaluation showed that most participants perceived the C-BEI as effective in enhancing their knowledge on pain management and the use of analgesics, and helping them to cope with pain, the could sleep better and regain self-control.;Conclusion. The C-BEI was effective in terms of reducing the pain barrier, providing post-operative pain relief, reducing anxiety, and improving sleep satisfaction in patients with fractured limbs during their first week of hospitalization after surgery. This study has generated evidence supporting the use of a C-BEI in acute pain management.