J. Med. Internet Res. - Web-based nursing intervention for self-management of pain after cardiac surgery: pilot randomized controlled trial.


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CKGROUND: Most adults undergoing cardiac surgery suffer from moderate to severe pain for up to 6 days after surgery. Individual barriers and attitudes regarding pain and its relief make patients reluctant to report their pain and ask for analgesic medication, which results in inadequate pain management. More innovative educational interventions for postoperative pain relief are needed. We developed a Web-based nursing intervention to influence patient's involvement in postoperative pain management. The intervention (SOULAGE-TAVIE) includes a preoperative 30-minute Web-based session and 2 brief face-to-face postoperative booster sessions. The Web application generates reflective activities and tailored educational messages according to patients' beliefs and attitudes. The messages are transmitted through videos of a virtual nurse, animations, stories, and texts.OBJECTIVE: The aim of this single-blinded pilot randomized trial was to investigate the preliminary effects of a virtual nursing intervention (SOULAGE-TAVIE) to improve pain relief in patients undergoing cardiac surgery.METHODS: Participants (N = 60) were adults scheduled for their first cardiac surgery. They were randomly assigned to the experimental group using SOULAGE-TAVIE (n = 30) or the control group using usual care, including an educational pamphlet and postoperative follow-up (n = 30). Data were collected through questionnaires at the time of admission and from day 1 to day 7 after surgery with the help of a blinded research assistant. Outcomes were pain intensity, pain interference with daily activities, patients' pain barriers, tendency to catastrophize in face of pain, and analgesic consumption.RESULTS: The two groups were comparable at baseline across all demographic measures. Results revealed that patients in the experimental group did not experience less intense pain, but they reported significantly less pain interference when breathing/coughing (P = .04). A severe pain interference with breathing/coughing (pain ranked = 7/10) was reported on day 3 after surgery by 15% of the patients in the experimental group (4/27), as compared to 44% (7/16) in the control group. On day 7 after surgery, participants in the experimental group also exhibited fewer pain-related barriers as measured by the Barriers Questionnaire-II (mean 10.6, SD 8.3) than patients in the control group (mean 15.8, SD 7.3, P = .02). No difference was found for pain catastrophizing. However, in both groups, means revealed a lower tendency to catastrophize pain before surgery as measured by the Pain Catastrophizing Scale (control group mean 1.04, SD 0.74; experimental group mean 1.10, SD 0.95) and after surgery (control group mean score 1.19, SD 0.94; experimental group mean score 1.08, SD 0.99). Finally, the experimental group consumed more opioid medication (mean 31.2 mg, SD 23.2) than the control group (mean 18.8 mg, SD 15.3, P = .001).CONCLUSIONS: This pilot study provides promising results to support the benefits of this new Web-tailored approach that can increase accessibility to health education and promote pain relief without generating more costs.TRIAL REGISTRATION: Clinicaltrials.gov NCT01084018; http://www.clinicaltrials.gov/ct2/show/NCT01084018 (Archived by WebCite? at http://www.webcitation.org/6CoTBkIoT).

Resumo Limpo

ckground adult undergo cardiac surgeri suffer moder sever pain day surgeri individu barrier attitud regard pain relief make patient reluct report pain ask analges medic result inadequ pain manag innov educ intervent postop pain relief need develop webbas nurs intervent influenc patient involv postop pain manag intervent soulagetavi includ preoper minut webbas session brief facetofac postop booster session web applic generat reflect activ tailor educ messag accord patient belief attitud messag transmit video virtual nurs anim stori textsobject aim singleblind pilot random trial investig preliminari effect virtual nurs intervent soulagetavi improv pain relief patient undergo cardiac surgerymethod particip n adult schedul first cardiac surgeri random assign experiment group use soulagetavi n control group use usual care includ educ pamphlet postop followup n data collect questionnair time admiss day day surgeri help blind research assist outcom pain intens pain interfer daili activ patient pain barrier tendenc catastroph face pain analges consumptionresult two group compar baselin across demograph measur result reveal patient experiment group experi less intens pain report signific less pain interfer breathingcough p sever pain interfer breathingcough pain rank report day surgeri patient experiment group compar control group day surgeri particip experiment group also exhibit fewer painrel barrier measur barrier questionnaireii mean sd patient control group mean sd p differ found pain catastroph howev group mean reveal lower tendenc catastroph pain surgeri measur pain catastroph scale control group mean sd experiment group mean sd surgeri control group mean score sd experiment group mean score sd final experiment group consum opioid medic mean mg sd control group mean mg sd p conclus pilot studi provid promis result support benefit new webtailor approach can increas access health educ promot pain relief without generat coststrial registr clinicaltrialsgov nct httpwwwclinicaltrialsgovctshownct archiv webcit httpwwwwebcitationorgcotbkiot

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