Web-Based Nursing Intervention for Self-Management of Pain After Cardiac Surgery: Pilot Randomized Controlled Trial

Abstract

BackgroundMost adults undergoing cardiac surgery suffer from moderate to severe pain for up to 6 days after surgery. Individual barriers and attitudes regarding pain and its relief make patients reluctant to report their pain and ask for analgesic medication, which results in inadequate pain management. More innovative educational interventions for postoperative pain relief are needed. We developed a Web-based nursing intervention to influence patient’s involvement in postoperative pain management. The intervention (SOULAGE-TAVIE) includes a preoperative 30-minute Web-based session and 2 brief face-to-face postoperative booster sessions. The Web application generates reflective activities and tailored educational messages according to patients’ beliefs and attitudes. The messages are transmitted through videos of a virtual nurse, animations, stories, and texts.ObjectiveThe aim of this single-blinded pilot randomized trial was to investigate the preliminary effects of a virtual nursing intervention (SOULAGE-TAVIE) to improve pain relief in patients undergoing cardiac surgery.MethodsParticipants (N = 60) were adults scheduled for their first cardiac surgery. They were randomly assigned to the experimental group using SOULAGE-TAVIE (n = 30) or the control group using usual care, including an educational pamphlet and postoperative follow-up (n = 30). Data were collected through questionnaires at the time of admission and from day 1 to day 7 after surgery with the help of a blinded research assistant. Outcomes were pain intensity, pain interference with daily activities, patients’ pain barriers, tendency to catastrophize in face of pain, and analgesic consumption.ResultsThe two groups were comparable at baseline across all demographic measures. Results revealed that patients in the experimental group did not experience less intense pain, but they reported significantly less pain interference when breathing/coughing (P = .04). A severe pain interference with breathing/coughing (pain ranked ≥ 7/10) was reported on day 3 after surgery by 15% of the patients in the experimental group (4/27), as compared to 44% (7/16) in the control group. On day 7 after surgery, participants in the experimental group also exhibited fewer pain-related barriers as measured by the Barriers Questionnaire-II (mean 10.6, SD 8.3) than patients in the control group (mean 15.8, SD 7.3, P = .02). No difference was found for pain catastrophizing. However, in both groups, means revealed a lower tendency to catastrophize pain before surgery as measured by the Pain Catastrophizing Scale (control group mean 1.04, SD 0.74; experimental group mean 1.10, SD 0.95) and after surgery (control group mean score 1.19, SD 0.94; experimental group mean score 1.08, SD 0.99). Finally, the experimental group consumed more opioid medication (mean 31.2 mg, SD 23.2) than the control group (mean 18.8 mg, SD 15.3, P = .001).ConclusionsThis pilot study provides promising results to support the benefits of this new Web-tailored approach that can increase accessibility to h...

Internet-based interventions for pain management: A systematic review of randomised controlled trial (RCTs) conducted from 2010 to 2014

“…Other studies were related to multiple sclerosis, burn pain, cancer and cardiac surgery related pain (Kroenke et al, 2010;Miller et al, 2010;Miller et al, 2011, Martorella et al, 2012 …”

“…Table 1 shows the result of scoring. Most of the studies included in our review had scored 3 (Gerber, 2006;Lamb et al, 2010, Stinson et al, 2010Elander et al, 2011;Bromberg et al, 2012;Carpenter et al, 2012;Krein et al, 2013;Kroenke et al, 2012;Law et al, 2012;Martorella et al, 2012;Ruehlman et al, 2012) as blinding was not possible in most of the studies. Only two studies scored less on Jadad score (Miller et al, 2011;Shigaki et al, 2013) ( Table 2).…”

“…(Chiauzzi et al, 2010;Lamb et al, 2010;Elander et al, 2011;Martorella et al, 2012;Buhrman et al, 2013;Davis and Zautra, 2013;Nazzal et al, 2013).…”

“…Kroenke et al designed centralized telecare management by nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or internet for depression and cancer related pain (Kroenke et al, 2010). Miller Debora used secure electronic messaging plus the new MCCO components for patients having MS (Miller et al, 2011) and Geraldine used SOULAGE-TAVIE intervention for patients who had gone for first cardiac surgery (Martorella et al, 2012). Kroenke and Miller also reported reduction in pain intensity in treatment arm and reduction in distress score (Kroenke et al, 2010;Miller K et al, 2011).…”

“…Miller Deborah reported higher general healthrelated quality of life (Miller et al, 2011). Martorella reported reduction in pain along with better functioning (Martorella et al, 2012).…”