Please use this identifier to cite or link to this item:
http://hdl.handle.net/11434/1717
Title: | Patient activation intervention to facilitate participation in recovery after total knee replacement (MIME): a cluster randomised cross-over trial. |
Epworth Authors: | de Steiger, Richard |
Other Authors: | Reynolds, J. Redley, Bernice Livingston, P. M. Hutchinson, Ana Botti, Mari |
Keywords: | Bedside Multimedia Intervention MyStay Clinician-Facilitated Multimedia MIME High-Quality Healthcare Outcomes Health Services Research Information Technology IT Patient-Centred Care Cluster Trials Unmasked Cluster Randomisation Cross-Over Trial Simultaneous Process Evaluation Statistical Analysis Total Knee Replacement Surgery Total Knee Replacement TKR Surgery Numerical Rating Scale NRS American Pain Society Patient Outcome Questionnaire APSOQ-R Pain Management Oxford Knee Score OKS Department of Surgery, Epworth Healthcare Centre for Quality and Safety Research, Epworth Partnership, Deakin University, Geelong, Victoria, Australia. Epworth HealthCare, Vic, Australia |
Issue Date: | Apr-2019 |
Publisher: | 2019 BMJ Publishing Group Ltd & the Health Foundation |
Citation: | (2019). Patient activation intervention to facilitate participation in recovery after total knee replacement (MIME): a cluster randomised cross-over trial. BMJ Qual Saf, 28:782-792. |
Abstract: | Patient participation in care is a fundamental element of safe and high-quality healthcare with the potential to enhance health outcomes and improve patient satisfaction. To test the efficacy of a clinician-facilitated, bedside multimedia (MyStay) intervention designed to support patient participation in their recovery after total knee replacement surgery. The primary outcome was patients' reported worst pain intensity on postoperative day 3. Secondary outcomes were patient activation, length of hospital stay, knee function and satisfaction with care. Unmasked, cluster randomised, four-period cross-over trial with a simultaneous process evaluation within in a large private, not-for-profit, metropolitan teaching hospital. Statistical analyses used linear mixed models with random effects for wards, cohorts within wards and patients within cohorts and fixed effects for treatment and period. 241 patients were recruited between March 2014 and June 2015. Patients were admitted to intervention (104) or control (137) clusters. Intervention group patients reported significantly lower mean pain intensity scores on postoperative day 3 (6.1 vs 7.1, 95% CI -1.94 to -0.08, p=0.04). The percentages of patients who reported severe pain (score ≥7) were 43.7% and 64.2% in the intervention and control groups, respectively (χ2 9.89, p=0.002; generalised linear mixed model Wald test, p=0.05). Intervention group patients on average stayed in hospital one less day (5.3 vs 6.3, 95% CI 0.05 to 1.94, p=0.04), reported higher activation (45.1% vs 27.1% at level 4 activation) (p=0.04) and higher overall satisfaction with care (9.3 vs 8.6, 95% CI 1.09 to 0.219, p=0.01), and were more likely to refer family or friends to the health service (9.3 vs 8.7, 95% CI 1.07 to 0.13, p=0.02). |
Description: | Open Access Article |
URI: | http://hdl.handle.net/11434/1717 |
DOI: | 10.1136/bmjqs-2018-008975 |
PubMed URL: | https://www.ncbi.nlm.nih.gov/pubmed/30975730 |
ISSN: | 2044-5423 |
Journal Title: | BMJ Quality & Safety |
Type: | Journal Article |
Affiliated Organisations: | Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Safety Research, Deakin University, Geelong, Victoria, Australia The University of Melbourne, Melbourne, Victoria, Australia Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Safety Research, Epworth Partnership, Deakin University, Geelong, Victoria, Australia |
Type of Clinical Study or Trial: | Cluster Randomised Cross-Over Trial Linear Mixed Models |
Appears in Collections: | Health Informatics Musculoskeletal |
Files in This Item:
File | Description | Size | Format | |
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PatientActivationInterventionToRecovery_April2019_BMJ.pdf | 2.8 MB | Adobe PDF | ![]() View/Open |
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