Patient Empowerment
Conditions
Brief summary
One of the most challenging issues in modern medicine is the current opioid epidemic. Given the association between opioid use after surgery and the development of opioid addiction, an essential goal of the medical community should be to develop strategies aimed at instructing the safe use of opioids. In addition, instructions on how to use non-opioid painkillers and exercises and techniques to better cope with pain can be used to reduce the patients opioid requirements after surgery. This study aims to evaluate the effect of providing an online educational video presentation to patients prior to surgery. This will be a 30 minute video which will provide the study participants with instructions on how best to use their opioid and non-opioid medication for pain and also teach the study participants exercises and techniques to better cope with their pain. This intervention will be used with a view to reduce the amount of opioids used by patients following hip or knee replacement surgery. Participants will be followed during their immediate phase after surgery to determine how much pain killers the participants have used and at six weeks the participants will be asked to return their unused opioids to see how much the participants have used in total.
Interventions
OTHEROpioid Counseling and Pain Coping Skills Video
The intervention will be in the form of a video of a PowerPoint presentation with instructions and exercises designed to coach patients about catastrophizing, coping skills, mindfulness and behavioral modification techniques, in addition to providing education regarding postoperative analgesia and opioid use.
Sponsors
Sunnybrook Health Sciences Centre
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients must be adults (\> 18 years of age) undergoing knee or hip arthroplasty. * Patients will be ASA 1-3 undergoing elective surgery. * English speaking patients with internet and computer access at home will be included. * Patients with pre-existing psychological conditions who receive either pharmaceutical or talk-based therapy will be included. * Patients must meet a minimum cognitive capacity to understand the instructions for the Opioid Counseling and Pain Coping Skills presentation. This will be assessed by the administration of the Montreal Cognitive Assessment during screening (MoCA), whereby a minimum score of 18 will be required to meet inclusion into the study.
Exclusion criteria
* Significant cognitive impairment. * Chronic pain, long-term opioid therapy * Renal replacement therapy * Standing opioid requirements * Neuropathic pain * Fractures requiring emergency surgery * End stage cardiac or respiratory disease * Severe hepatic dysfunction, * Patients with severe psychiatric disorders * Vision loss * Allergy to local anesthesia. * Patients who refuse to consent to neuraxial anesthesia and/or peripheral nerve blocks will also be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post operative opioid consumption | From surgery until 72 hours postoperatively. | Total opioid consumption during the first 72 hours following THA or TKA surgery, measured in oral morphine equivalents. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain | On postoperative days 1/2/3, and 1- and 6-week follow-up. | Using the Visual Analog Scale (VAS) for Pain Assessment from 0 to 10 with 0 being no pain and 10 being extreme pain. |
| Length of hospital stay | From day of admission until 72 hours postoperatively. | Length of Stay from day of hospital admission to day of hospital discharge. |
| Time to first opioid demand dose | In the first 24 hours after surgery. | The number of hours from the time of surgery to the participants requesting their first opioid dose, either in the post-anesthesia care unit or the ward. |
| Post-operative complication rate | 24 hours after surgery, and 1/6 week follow-ups. | The incidence of postoperative complications, including events possibly related to opioid consumption. |
| Total opioid consumption at 6-week follow-up | 6 weeks after surgery. | The total opioid consumption, reported at the 6 week follow-up. |
| Need for rescue opioid breakthrough therapy | From surgery until 24 hours postoperatively. | The need for rescue opioid breakthrough therapy in the first 24 hours after surgery, assessed as a binary (yes/no) outcome. |
| Participant Compliance | Day of surgery | Participant compliance, defined as whether or not participants in the experimental group viewed the study video. |
| Participant satisfaction at baseline | Baseline (up to 1 week before surgery). | Participants' satisfaction with the study video, assessed using a questionnaire. The questionnaire contains seven statements regarding the acceptability of the study video, with responses on a 5-point Likert scale from "highly agree" to "highly disagree." Only participants in the experimental group complete the satisfaction questionnaire. |
| Participant satisfaction at 1 week | 1 week after surgery. | Participants' satisfaction with the study video, assessed using a questionnaire. The questionnaire contains seven statements regarding the acceptability of the study video, with responses on a 5-point Likert scale from "highly agree" to "highly disagree." Only participants in the experimental group complete the satisfaction questionnaire. |
| Participant satisfaction at 6 weeks | 6 weeks after surgery. | Participants' satisfaction with the study video, assessed using a questionnaire. The questionnaire contains seven statements regarding the acceptability of the study video, with responses on a 5-point Likert scale from "highly agree" to "highly disagree." Only participants in the experimental group complete the satisfaction questionnaire. |
Countries
Canada
Outcome results
None listed