Patient activation intervention to facilitate participation in recovery after total knee replacement (MIME): a cluster randomised cross-over trial

Abstract

BackgroundPatient participation in care is a fundamental element of safe and high-quality healthcare with the potential to enhance health outcomes and improve patient satisfaction.ObjectivesTo test the efficacy of a clinician-facilitated, bedside multimedia (MyStay) intervention designed to support patient participation in their recovery after total knee replacement surgery. The primary outcome was patients’ reported worst pain intensity on postoperative day 3. Secondary outcomes were patient activation, length of hospital stay, knee function and satisfaction with care.MethodsUnmasked, cluster randomised, four-period cross-over trial with a simultaneous process evaluation within in a large private, not-for-profit, metropolitan teaching hospital. Statistical analyses used linear mixed models with random effects for wards, cohorts within wards and patients within cohorts and fixed effects for treatment and period.Results241 patients were recruited between March 2014 and June 2015. Patients were admitted to intervention (104) or control (137) clusters. Intervention group patients reported significantly lower mean pain intensity scores on postoperative day 3 (6.1 vs 7.1, 95% CI −1.94 to −0.08, p=0.04). The percentages of patients who reported severe pain (score ≥7) were 43.7% and 64.2% in the intervention and control groups, respectively (χ2 9.89, p=0.002; generalised linear mixed model Wald test, p=0.05). Intervention group patients on average stayed in hospital one less day (5.3 vs 6.3, 95% CI 0.05 to 1.94, p=0.04), reported higher activation (45.1% vs 27.1% at level 4 activation) (p=0.04) and higher overall satisfaction with care (9.3 vs 8.6, 95% CI 1.09 to 0.219, p=0.01), and were more likely to refer family or friends to the health service (9.3 vs 8.7, 95% CI 1.07 to 0.13, p=0.02).ConclusionThe clinician-facilitated, MyStay bedside multimedia intervention enhanced patients’ activation and participation in their care after surgery; pain intensity and length of stay in hospital were reduced and patients were more satisfied with their care.Trial registrationACTRN12614000340639 (http://www.anzctr.org.au/default.aspx).

Usability and feasibility of multimedia interventions for engaging patients in their care in the context of acute recovery: A narrative review

“…One indirect measure of patient participation in care and recovery is improvements in clinical outcomes and acute care length of stay . In one study of an e‐health platform intervention by Cook et al, patients whose self‐reported mobility scale scores were higher also had a shorter length of stay in hospital compared to standard practice (Table ).…”

The Impact of Patient Interactive Systems on the Management of Pain in an Inpatient Hospital Setting: A Systematic Review

“…[39][40][41] One system described using interactive music therapy, 42 two other described a Web-based virtual nurse designed for patient-provider communication and patient education, 42,43 and one described a bedside educational multimedia program intervention accessed through iPads. 44 Finally, one paper described a personalized patient-controlled analgesia (PCA) device for oral medications. 45…”

“…Two studies investigated the development of a virtual nursing Web-based intervention to improve pain relief in cardiac surgery patients and reported on the preliminary effects of the system. 42,44 The Web application generates reflective personalized activities and specific educational messages designed for patients based on their beliefs and attitudes. The system messages are transmitted through videos of a virtual nurse, animations, stories, and texts.…”

“…The intervention is designed to engage patients in their recovery process after total knee replacement surgery. 44 Personalized PCA Device One study described a novel oral PCA dispenser providing ondemand pain medication at the bedside. The device has three main features: a drug dispensing unit, a radiofrequency identification wristband used for patient's registration, and a PillBox; "a patient-specific, mouth-actuated, disposable receptacle from which the patient receives the pill."…”

“…A recent study by McDonall et al evaluated the efficacy of a clinician-facilitated, bedside multimedia intervention for patients recovering from total knee replacement surgery. 44 The study described changes in pain-reported outcomes postoperative day 3 as a main outcome measure using three different measures: pain intensity (Numerical Rating Scale), pain quality (American Pain Society Outcome Questionnaire-Revised), and pain treatment analgesic management (medical record audit). Patients in the intervention group reported a lower mean worst pain score (6.05) than the control group (7.05, p ¼ 0.04).…”