Does preoperative hip rehabilitation advice improve recovery and patient satisfaction?1

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Abstract

The goal of the current study was to investigate whether preoperative rehabilitation advice reinforced by a patient information booklet can aid recovery after total hip arthroplasty in terms of pain, function, satisfaction, and quality of life. Thirty-five patients awaiting primary total hip arthroplasty were recruited into this study and randomly allocated before admission to receive either the standard pathway of care or the rehabilitation program and booklet. All patients showed increases in function and psychological variables with time. The preoperative class and booklet, however, seemed to have the greatest impact on length of hospital stay, reducing the hospital stay by 3 days, and therapy input required, significantly influencing the cost of the procedure (the rehabilitation class led to a cost saving of 587 British pounds; approximately $810, per patient). In addition, patients attending the class reported higher levels of satisfaction (99% satisfied in the preoperative rehabilitation class compared with 80% in the control group 3 months postoperatively) and had more realistic expectations of surgery.

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Study population

Thirty-five patients undergoing THA (10 men, 25 women; mean age, 71.9 ± 9.3 years; age range, 51–92 years) were recruited into this study at the authors’ institution. Written informed consent and ethical approval were obtained. The mean duration of symptoms was 40.0 ± 40.3 months, and patients spent on average 10.9 ± 12.1 months on the waiting list. Patients undergoing revision arthroplasty or bilateral arthroplasty, patients with previous hip joint arthroplasty, coexisting morbidity such as a

Preadmission expectations in each group

Patients in group A showed a nonsignificant trend toward lower expectations at admission compared with preadmission, which may be attributed to the information provided in the class and information booklet.

Postoperative satisfaction with surgery

Patients in group A reported higher levels of satisfaction than patients in group B (P<.01) at discharge and 3-month postoperative review (Fig. 1).

Comparison of expected and actual satisfaction with surgery

The calculated difference between expected and actual satisfaction (before and after surgery) was negative in group A and positive in group B,

Discussion

This study showed that the inclusion of a preoperative advice class and booklet improves patient expectations and satisfaction levels. Researchers have reported that patients who underwent hip and knee arthroplasty have unrealistic preoperative expectations of recovery, including pain and function 1, 14. Where patients get information on recovery and outcome is not known, but it is often attributed to information provided at surgery, experiences of family and friends, and information provided

Acknowledgements

The authors would like to thank Naffis Anjarawalla and Helena Aarons for their help with this study.

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1

Benefits or funds were received in partial or total support of the research material described in this article. These benefits and/or support were received from the National Health Service Executive, London Research and Development Program, London, UK. The views expressed in this article are those of the authors and may not reflect the views of the National Health Service Executive.

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