Original ArticleEffects of Educational Intervention on State Anxiety and Pain in People Undergoing Spinal Surgery: A Randomized Controlled Trial
Introduction
People tend to worry about the future because it is unknown (Carleton, Norton, & Asmundson, 2007), especially when it is related to their health. Therefore, patients who will undergo surgery easily become anxious (Ali et al., 2014, Theunissen et al., 2012, Valenzuela Millán et al., 2010). Moreover, increased anxiety might cause pathophysiological responses such as hypertension (Pan et al., 2015), pain sensitivity (Chieng, Chan, Klainin-Yobas, & He, 2014), additional medication requirements, reduced compliance with procedures (Maranets & Kain, 1999), or refusal to undergo a planned surgery (Julian, 2011, McCleane and Cooper, 1990). Helping patients cope with their anxieties and fears is important. It has been suggested that health care providers minimize the fear for patients on their upcoming procedures by using effective preoperative interventions (Cheung et al., 2003, Gürsoy et al., 2016).
Preoperative interventions primarily use educational techniques with the following components: providing relevant health care information, teaching skills (e.g., deep breathing for relaxation), and psychosocial support (Devine, 1992). In addition, preoperative educational intervention reduces anxiety, reduces pain, improves psychological well-being, and increases patient satisfaction (Cheung et al., 2003, Guo, 2015, Guo et al., 2012, Kekecs et al., 2014). The intervention effects, however, might not be similar across different types of patients: different patients have different concerns and different types of anxiety (Lin, Yang, Lai, Su, & Wang, 2017). Therefore, we wanted to determine the effects of preoperative educational intervention on patients undergoing spinal surgery.
To the best of our knowledge, only a few studies have examined the effects of educational intervention on the anxiety levels of patients undergoing spinal surgery, and none of them used a randomized controlled trial (Chao et al., 2009, Papanastassiou et al., 2011). Patients undergoing spinal surgery, which involves complicated procedures, often have high levels of anxiety (Lee et al., 2016). The source might be the surgery's possible complications—such as paralysis and disability—and wound pain after surgery (Deyo et al., 2010). The wound pain might also inhibit a good recovery, reduce functions for activities of daily living, or both (Tan, Law, & Gan, 2015). Therefore, taking good care of preoperative anxiety and postoperative pain for patients undergoing spinal surgery has recently been emphasized (Chao et al., 2009, Papanastassiou et al., 2011). The promising effects of preoperative education on postoperative anxiety were reported by Chao et al. (2009), and its effects on postoperative pain control were reported by Papanastassiou et al. (2011). However, the Chao study was quasi-experimental and not randomized, and the Papanastassiou study was retrospective. In other words, there was insufficient evidence for health care professionals to clinically implement preoperative education for patients undergoing spinal surgery.
To determine the effects of preoperative educational intervention on the anxiety and pain of patients undergoing spinal surgery, we conducted a randomized controlled trial. Moreover, several physical indicators—including heart rate, respiration rate, and blood pressure—were taken into account as secondary endpoints.
Section snippets
Methods
This study was approved by the Chung Shan Medical University Hospital Institutional Review Board (IRB number: CS11136) and was conducted from April to December 2012.
Results
There were no significant differences in demographic or clinical characteristics (Table 1). There were no significant differences in baseline levels of anxiety, pain, and physical indicators on the day before surgery (Table 2).
Anxiety and pain were significantly lower in the Intervention group than in the Control group 30 minutes before surgery (t = 3.45 and 2.30; p = .001 and .024, respectively) and on the day after surgery (t = 2.68 and 4.81; p = .009 and <.001, respectively). In addition,
Discussion
To the best of our knowledge, this is the first randomized controlled study to examine the effects of preoperative education on anxiety and pain for patients undergoing spinal surgery. Our encouraging results suggest that education can reduce preoperative anxiety as well as postoperative pain.
Some studies have reported that state anxiety is highest on the day of surgery (e.g., Cheung et al., 2003, Yilmaz et al., 2011) and that the closer some patients are to undergoing scheduled surgery, the
References (38)
- et al.
Fearing the unknown: A short version of the Intolerance of Uncertainty Scale
Journal of Anxiety Disorders
(2007) - et al.
A controlled trial of psycho-educational interventions in preparing Chinese women for elective hysterectomy
International Journal of Nursing Studies
(2003) Effects of psychoeducational care for adult surgical patients: A meta-analysis of 191 studies
Patient Education and Counseling
(1992)- et al.
A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: A randomized controlled trial
International Journal of Nursing Studies
(2012) - et al.
Preoperative stress: An operating room nurse intervention assessment
Journal of PeriAnesthesia Nursing
(2016) - et al.
Salivary cortisol as a biomarker in stress research
Psychoneuroendocrinology
(2009) - et al.
Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia
British Journal of Anaesthesia
(2010) - et al.
Effects of patient education and therapeutic suggestions on cataract surgery patients: A randomized controlled clinical trial
Patient Education and Counseling
(2014) - et al.
Cortisol and behavior: Application of a latent state-trait model to salivary cortisol
Psychoneuroendocrinology
(1990) - et al.
Effects of preoperative education on spinal surgery patients
SAS Journal
(2011)
The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy
Journal of Anesthesia
Accuracy, validity, and reliability of an electronic visual analog scale for pain on a touch screen tablet in healthy older adults: A clinical trial
Interactive Journal of Medical Research
Effect of operation health education on anxiety in patients with spinal surgery
Fu-Jen Journal of Medicine
Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures: A quantitative systematic review
Journal of Advanced Nursing
Modified state-trait anxiety inventory study
Psychological Testing
Preoperative education for total hip and knee replacement patients
Arthritis Care & Research
Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults
Journal of American Medical Association
G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences
Behavioral Research Methods
Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: A review of randomized controlled trials
Journal of Clinical Nursing
Cited by (38)
Healthcare delivery gaps in pain management within the first 3 months after discharge from inpatient noncardiac surgeries: a scoping review
2023, British Journal of AnaesthesiaPatient and healthcare provider experience and perceptions of a preoperative rehabilitation class for lumbar discectomy: A qualitative study
2023, Musculoskeletal Science and PracticeExperience of Pain and Satisfaction with Pain Management in Patients After a Lumbar Disc Herniation Surgery
2021, Journal of Perianesthesia NursingPre-operative patient education does not necessarily reduce length of stay or pain after spinal surgery
2021, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :This study adds valuable information on the potential impact of a single 1-hour session led by an experienced nurse practitioner. While many previous studies have neutral or positive findings towards the management of pain with preoperative education, this study suggests otherwise [6,7,12]. The HCAHPS patient satisfaction survey, created by the Centers for Medicare and Medicaid, was intended to allow for better transparency, improved consumer decision making, and to incentivize hospitals to deliver a higher quality of care [21].
Patient Education in Neurosurgery: Part 2 of a Systematic Review
2021, World NeurosurgeryCitation Excerpt :Figure 2 shows the countries of origin of the included studies. Nine studies discussed print materials.12-20 Six studies examined written materials.
Anesthesia for spine surgery
2021, Essentials of Evidence-Based Practice of Neuroanesthesia and Neurocritical Care