The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol

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Review objectiveThe objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on:length of staysatisfactionpain levelcost of carefunctional abilitiesknowledgeanxietyquality of life in orthopedic settings.BackgroundPatient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre-admission, peri-operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self-care using the experience and guidance of the multidisciplinary team.1With an effective and well-structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care.2-6 According to Huang et al.3 a simplified pre-operative education program reduced the length of stay and cost of care. Similarly, Jones et al.4 found that length of stay of a patient who received pre-operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre-operative education to five days in patients who received pre-operative education. These results suggest that pre-operative education programs are an effective method in reducing the length of stay of orthopedic patients.Johansson et al.7 also described pre-operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self-efficacy, patient compliance, adherence and empowerment were all improved as a result of patient education.7 While Johansson et al.7 included studies up to 2003, the proposed systematic review will include studies from 2003 to 2013.Kruzik8 also reported benefits of decreased length of stay, reduced pain medication requested post-operatively together with increased patient and family member satisfaction. Bastable reported benefits of patient education, including increased patient satisfaction, improved quality of life, enhanced continuity of care, decreased anxiety, fewer complications, promotion of adherence to the plan of care, maximized independence, and empowerment.9Types of education involved in this systematic review are patient education, pre-operative education, and discharge education. Only one study discussed discharge education and the outcome from this review.10 The outcomes that have been discussed in this systematic review include length of stay,3,4,11-15 satisfaction,5,16-19 pain level,5,6,11,16,17,18,19,20,21, 21 cost of care,2,23 functional abilities,5,6,11,14,23,24 knowledge,16,19,25,26 anxiety,18,20,21,27,28 and quality of life.5,6,23Major outcomes discussed in these studies are length of stay,3,4,11-15 pain,5,6,11,16,17,18,19,20,21, 21 functional abilities,5,6,11,14,23,24 and anxiety.18,20,21,27,28 Most of these studies found significant results of reduced length of stay on those patients who received patient education compared to patient who did not received any patient education or information. Studies support the positive outcomes around length of stay.3,4,11-15Common orthopedic conditions that have been discussed are osteoarthritis with total arthroplasty either hip or knee or joint replacement.3,4,5,12,13,15,19,20,23,29,30 A study on spinal surgery patients and the effects of pre-operative education,17 which stated that although there are many studies on the effectiveness on patient education, there are missing data on spinal surgery. This study found that the implementation of patient education has positive impacts upon patient satisfaction especially in managing pain.This review will look specifically at the effectiveness of orthopedic patient education for length of stay, satisfaction, pain level, cost of care, functional ability, knowledge, anxiety, and quality of life.

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