title: Clinical effectiveness of individual patient education in heart surgery patients: A systematic review and meta-analysis.
abstract: The objective of this systematic review was to compare the effectiveness of individualized patient education interventions to standardized patient education interventions on the rate of readmission, performance of specific health behaviours, depression, anxiety, and cognition during the post-hospital discharge recovery period following cardiovascular surgery.
  
  
  METHODS
  Randomized controlled trials that included study participants who underwent their first bypass and/or valve replacement surgery; were eighteen years of age or older; and were recovering in the community.
  
  
  METHODS
  For all data analyzed, data was entered based on the principle of intention to treat. To be included in a given comparison, outcome data had to have been available for at least 80% of those who were randomized. Assessment of statistical heterogeneity was tested. Generic inverse variance methods based on random effects models were used to pool effect estimates across included studies.
  
  
  RESULTS
  Seventeen trials involving 2624 study participants where individualized patient education was the primary interventional intent was included in this review. Four studies that included 930 participants reported on hospital readmissions. The sources of bias that remain unclear or were judged as containing high risk of bias most frequently across included trials were blinding of outcome assessment, incomplete outcome data, and selective reporting. An effect of the individualized patient education in reducing hospital readmission rates (Mean Difference: -1.28, 95% CI -1.87 to -0.68, p<0.00), depression (Mean Difference: -23.32, 95% CI -23.70 to -22.95, p<0.00), and anxiety (Mean Difference: -19.34, 95% CI -20.46 to -18.23, p<0.00) was noted. While an increase in the performance of specific health behaviours (Mean Difference: 3.45, 95% CI 3.27-3.63, p<0.00) and cognition (Mean Difference: 11.17, 95% CI 10.66-11.68, p<0.00) was found. Most effect estimates were prone to statistical heterogeneity among the trials.
  
  
  CONCLUSIONS
  The findings from this systematic review suggest favorable effects on the readmission rates. However, a major limitation notes in the current body of evidence relates to the small number of or even lacking number of trials for clinically important outcomes. As well, the individualized patient education intervention is effective in promoting statistically significant changes in quality of life, performance of health behaviours, depression, and anxiety.
authors.affiliation: Daphne Cockwell, School of Nursing, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada. Electronic address: sfrederi@ryerson.ca.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Fredericks
authors.affiliation: University Health Network, Toronto General Hospital, 4N-470, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. Electronic address: terry.yau@uhn.ca.
authors.forename: Terrence
authors.initials: T
authors.lastname: Yau
mesh_terms: D015982:Bias; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D010353:Patient Education as Topic; D010359:Patient Readmission; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic
keywords: Complications; Heart surgery; Patient education; Readmission; Systematic reviews