title: No major effects of preoperative education in patients undergoing hip or knee replacement--a systematic review.
abstract: BACKGROUND
  The outcome of total hip (THA) and knee arthroplasty (TKA) may be optimised through preoperative patient education (PPE). It is hypothesised that PPE reduces anxiety, ensures realistic patient expectations and enhances post-operative outcome. The objective was to determine whether the literature supports a positive effect of PPE on post-operative outcomes including anxiety, pain, length of hospital stay (LOS), patient satisfaction, post-operative complications, mobility, and expectations.
  
  
  METHODS
  PubMed and Embase searches were performed on 1 October 2014. Randomised studies of preoperative edu-cation (written, verbal and audiovisual) imparted by health professionals to patients were included.
  
  
  RESULTS
  A total of twelve studies including 1,567 participants were identified. Six studies involved patients undergoing THA, five studies involved both THA and TKA, and one study TKA only. No convincing evidence in favour of PPE on outcomes regarding pain, LOS, patient satisfaction, post-operative complications, mobility and expectations was found. However, there was evidence for a reduction in preoperative anxiety.
  
  
  CONCLUSIONS
  PPE has not been shown to affect post-operative outcomes - except for a significant reduction in preoperative anxiety. However, this conclusion may be flawed by the general heterogeneity of the pooled studies. Hence, there is a strong need for properly designed randomised and controlled studies that are sufficiently powered, performed in generalised optimised hospital settings including optimised logistics and clinical enhancements that allow for discrimination between outcome parameters.
authors.affiliation: Ortopædkirurgisk Afdeling, Hvidovre Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark. doguay@hotmail.com.
authors.forename: Dogu
authors.initials: D
authors.lastname: Aydin
authors.forename: Jakob
authors.initials: J
authors.lastname: Klit
authors.forename: Steffen
authors.initials: S
authors.lastname: Jacobsen
authors.forename: Anders
authors.initials: A
authors.lastname: Troelsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Husted
mesh_terms: D000368:Aged; D001007:Anxiety / Q000517:prevention & control; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000193:education; D057234:Preoperative Period; D016896:Treatment Outcome