Total joint replacement (TJR) is one of the most frequently performed surgeries in the United States. Many hospitals offer "joint classes"; to prepare patients for TJR procedures. No recent synthesis of evidence of the effectiveness of these classes in promoting postoperative outcomes has been published. With such a large number of people having this procedure, a synthesis of evidence of outcomes of TJR classes is needed.
The purpose of this evidence-based literature review is to synthesize available evidence to address the following PICO question: (P) In preoperative patients undergoing total joint replacement surgery (I) what effect do preoperative educational classes have on (O) postoperative patient outcomes?
Key words derived from the PICO question were used for free text searching in several databases including CINAHL, EMBASE, PubMed, Cochrane Collaboration Products, PsycINFO, and ProQuest Dissertations.
Randomized controlled trials and quasi-experimental studies comparing educational class interventions given preoperatively to patients undergoing total hip or total knee replacement surgery were included in the review. Any study not reporting measured outcomes (qualitative), including a postoperative intervention, not published in English, or not published in the past 10 years were excluded from the review.
Significant results were found concerning anxiety, patient satisfaction, patient knowledge, and empowerment (Johansson, K., Salantera, S., & Katajisto, J., 2005; Sjoling, Slover, J. D., Rubash, H. E., Malchau, H., & Bosco, J. A., 2003; Thomas & Sethares, 2008). These results fall within the psychological realm, whereas the results that fell within the physiological realm—pain and falls—and healthcare associated realm—postop rehab utilization and medication utilization—were found to be insignificant. Physical function and length of stay provided contradictory results (Beaupre, L. A., Lier, D., Davies, D. M., & Johnston, D. 2005; Clarke, H. D., Timm, V. L., Goldberg, B. R., & Hattrup, S. J., 2012; Giraudet-Le Quintrec et al., 2003; Johansson et al., 2007; Jones et al., 2011; Sjoling et al., 2003; Thomas & Sethares, 2008; Yoon et al., 2010).
There is insufficient evidence for or against the use of preoperative educational classes to improve postoperative outcomes with regards to physical recovery or healthcare associated outcomes. There is support for the use of preoperative educational classes in psychological outcomes including anxiety, patient satisfaction, patient knowledge and empowerment based upon several studies that measured these two outcomes.