Preoperative education for total hip and knee replacement patients.
OBJECTIVE
Psychoeducational preparation is known to improve postoperative outcome. We tested two common psychoeducational procedures in elderly orthopedic patients, examining how best to match interventions to patients by psychological type.


METHODS
Two hundred twenty-two elderly patients undergoing total hip or knee replacement were randomly assigned to 1) a slide-tape with information on the postoperative, in-hospital rehabilitation experience, or 2) training in Benson's Relaxation Response with a bedside audiotape, in a 2 x 2 factorial design.


RESULTS
The relaxation response did not influence postoperative outcomes. The educational intervention reduced length of stay and pain medication use for patients who exhibited most denial (tendency to avoid thinking about unpleasant events), and reduced postoperative anxiety and cognitive errors on the Mini-Mental State Exam for patients with most baseline anxiety. There was no effect on postoperative pain.


CONCLUSIONS
The importance of attending to the patient's psychological state and level of preparation before orthopedic surgery is reinforced. Patients who exhibit most denial and highest anxiety may benefit from educational interventions, but patients' directly expressing desire for information may be a poor guide in deciding which patients would benefit, compared with more formal psychological testing for denial and anxiety.
Multipurpose Arthritis and Musculoskeletal and Skin Diseases Center, Harvard Medical School, USA.
L H
LH
Daltroy
C I
CI
Morlino
H M
HM
Eaton
R
R
Poss
M H
MH
Liang
D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010353:Patient Education as Topic / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D015397:Program Evaluation; D011446:Prospective Studies; D012064:Relaxation Therapy / Q000193:education*