Web-based nursing intervention for self-management of pain after cardiac surgery: pilot randomized controlled trial

Géraldine Martorella, José Côté, Mélanie Racine, Manon Choinière, Géraldine Martorella, José Côté, Mélanie Racine, Manon Choinière

Abstract

Background: 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).

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Home page of the SOULAGE-TAVIE website showing the determine profile function and start intervention function.
Figure 2
Figure 2
Screening page of the SOULAGE-TAVIE website.
Figure 3
Figure 3
Animated integration page of the SOULAGE-TAVIE website displaying case history and nurse’s advice.
Figure 4
Figure 4
CONSORT flow diagram of participants.

References

    1. International Association for the Study of Pain (IASP) IASP. 2010. Oct 01, [2011-04-15]. What is the problem? Global Year Againt Acute Pain 2010-2011 .
    1. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth Analg. 2007 Jul;105(1):205–21. doi: 10.1213/01.ane.0000268145.52345.55.
    1. Carr DB, Goudas LC. Acute pain. Lancet. 1999 Jun 12;353(9169):2051–8. doi: 10.1016/S0140-6736(99)03313-9.
    1. Cashman JN, Dolin SJ. Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth. 2004 Aug;93(2):212–23. doi: 10.1093/bja/aeh180.
    1. Gélinas C. Management of pain in cardiac surgery ICU patients: have we improved over time? Intensive Crit Care Nurs. 2007 Oct;23(5):298–303. doi: 10.1016/j.iccn.2007.03.002.
    1. Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006 Oct;105(4):794–800.
    1. Milgrom LB, Brooks JA, Qi R, Bunnell K, Wuestfeld S, Beckman D. Pain levels experienced with activities after cardiac surgery. Am J Crit Care. 2004 Mar;13(2):116–25.
    1. Yorke J, Wallis M, McLean B. Patients' perceptions of pain management after cardiac surgery in an Australian critical care unit. Heart Lung. 2004;33(1):33–41. doi: 10.1016/j.hrtlng.2003.09.002.
    1. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. The Lancet. 2006 May 13;367(9522):1618–25. doi: 10.1016/S0140-6736(06)68700-X.
    1. Taillefer MC, Carrier M, Bélisle S, Levesque S, Lanctôt H, Boisvert AM, Choinière M. Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: a cross-sectional study. J Thorac Cardiovasc Surg. 2006 Jun;131(6):1274–80. doi: 10.1016/j.jtcvs.2006.02.001.
    1. Watt-Watson J, Stevens B, Katz J, Costello J, Reid GJ, David T. Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery. Pain. 2004 May;109(1-2):73–85. doi: 10.1016/j.pain.2004.01.012.
    1. Manias E, Botti M, Bucknall T. Patients' decision-making strategies for managing postoperative pain. J Pain. 2006 Jun;7(6):428–37. doi: 10.1016/j.jpain.2006.01.448.
    1. Manias E, Bucknall T, Botti M. Nurses' strategies for managing pain in the postoperative setting. Pain Manag Nurs. 2005 Mar;6(1):18–29. doi: 10.1016/j.pmn.2004.12.004.
    1. Sommer M, de Rijke JM, van Kleef M, Kessels AG, Peters ML, Geurts JW, Patijn J, Gramke HF, Marcus MA. Predictors of acute postoperative pain after elective surgery. Clin J Pain. 2010 Feb;26(2):87–94. doi: 10.1097/AJP.0b013e3181b43d68.
    1. Khan RS, Skapinakis P, Ahmed K, Stefanou DC, Ashrafian H, Darzi A, Athanasiou T. The association between preoperative pain catastrophizing and postoperative pain intensity in cardiac surgery patients. Pain Med. 2012 Jun;13(6):820–7. doi: 10.1111/j.1526-4637.2012.01386.x.
    1. Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJ, Gross M. Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag. 2008;13(4):335–41.
    1. Crowe L, Chang A, Fraser JA, Gaskill D, Nash R, Wallace K. Systematic review of the effectiveness of nursing interventions in reducing or relieving post-operative pain. Int J Evid Based Healthc. 2008 Dec;6(4):396–430. doi: 10.1111/j.1744-1609.2008.00113.x.
    1. Oshodi TO. The impact of preoperative education on postoperative pain. Part 1. Br J Nurs. 2007;16(12):706–10.
    1. Oshodi TO. The impact of preoperative education on postoperative pain. Part 2. Br J Nurs. 2007;16(13):790–7.
    1. Krebs P, Prochaska JO, Rossi JS. A meta-analysis of computer-tailored interventions for health behavior change. Prev Med. 2010;51(3-4):214–21. doi: 10.1016/j.ypmed.2010.06.004.
    1. Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res. 2010;12(2):e23. doi: 10.2196/jmir.1286.
    1. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4. doi: 10.2196/jmir.1376.
    1. Côté J. Using interactive health communication technology in a renewed approach to nursing. Can J Nurs Res. 2007 Mar;39(1):135–6.
    1. Lustria ML, Cortese J, Noar SM, Glueckauf RL. Computer-tailored health interventions delivered over the Web: review and analysis of key components. Patient Educ Couns. 2009 Feb;74(2):156–73. doi: 10.1016/j.pec.2008.08.023.
    1. Devine EC. Effects of psychoeducational care for adult surgical patients: a meta-analysis of 191 studies. Patient Educ Couns. 1992 Apr;19(2):129–42.
    1. Martorella G, Côté J, Choinière M. SOULAGE-TAVIE: Development and validation of a virtual nursing intervention to promote self-management of postoperative pain after cardiac surgery. Computers, Informatics, Nursing. 2013 (forthcoming)
    1. Côté J, Ramirez-Garcia P, Rouleau G, Saulnier D, Guéhéneuc YG, Hernandez A, Godin G. A nursing virtual intervention: real-time support for managing antiretroviral therapy. Comput Inform Nurs. 2011;29(1):43–51. doi: 10.1097/NCN.0b013e3181f9dc02.
    1. Hawkins RP, Kreuter M, Resnicow K, Fishbein M, Dijkstra A. Understanding tailoring in communicating about health. Health Educ Res. 2008 Jun;23(3):454–66. doi: 10.1093/her/cyn004.
    1. Petty RE, Rucker DD, Bizer GY, Cacioppo JT. The elaboration likelihood model of persuasion. In: Seiter JS, Gass RH, editors. Perspectives on Persuasion, Social Influence, and Compliance Gaining. Boston: Pearson/Allyn and Bacon; 2004. pp. 65–93.
    1. Gunnarsdottir S, Donovan HS, Serlin RC, Voge C, Ward S. Patient-related barriers to pain management: the Barriers Questionnaire II (BQ-II) Pain. 2002 Oct;99(3):385–96.
    1. Sullivan MJ, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and Validation. Psychological Assessment. 1995;7(4):524–532. doi: 10.1037/1040-3590.7.4.524.
    1. Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008 Apr;31(2):180–91. doi: 10.1002/nur.20247.
    1. Friedman S, Samuelian JC, Lancrenon S, Even C, Chiarelli P. Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiatry Res. 2001 Nov 30;104(3):247–57.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–70.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69–77.
    1. Jensen MP. Pain assessment in clinical trials. In: Carr DL, Wittink H, editors. Pain Management: Evidence, Outcomes, and Quality of Life: A Sourcebook. Edinburgh: Elsevier; 2008. pp. 57–82.
    1. Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R, editors. Handbook of Pain Assessment, Second Edition. New York: The Guilford Press; 2001. pp. 15–34.
    1. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, Carr DB, Chandler J, Cowan P, Dionne R, Galer BS, Hertz S, Jadad AR, Kramer LD, Manning DC, Martin S, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robbins W, Robinson JP, Rothman M, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Wernicke J, Witter J, IMMPACT Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005 Jan;113(1-2):9–19. doi: 10.1016/j.pain.2004.09.012.
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994 Mar;23(2):129–38.
    1. Larue F, Colleau SM, Brasseur L, Cleeland CS. Multicentre study of cancer pain and its treatment in France. BMJ. 1995 Apr 22;310(6986):1034–7.
    1. Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. Validation of the brief pain inventory in patients six months after cardiac surgery. J Pain Symptom Manage. 2007 Dec;34(6):648–56. doi: 10.1016/j.jpainsymman.2007.01.010.
    1. Ward S, Donovan H, Gunnarsdottir S, Serlin RC, Shapiro GR, Hughes S. A randomized trial of a representational intervention to decrease cancer pain (RIDcancerPain) Health Psychol. 2008 Jan;27(1):59–67. doi: 10.1037/0278-6133.27.1.59.
    1. Griffee DT. Questionnaire translation and questionnaire validation: are they the same?. Proceedings of the Annual Meeting of the American Association of Applied Linguistics; Annual Meeting of the American Association of Applied Linguistics; February 24-27, 2001; St Louis, MO. 2001.
    1. French DJ, Noël M, Vigneau F, French JA, Cyr CP, Evans RT. L'échelle de dramatisation face à la douleur PCS-CF: Adaptation canadienne en langue française de l'échelle 'Pain Catastrophizing Scale'. Canadian Journal of Behavioral Science. 2005;37(3):181–92.
    1. Sullivan MJ, Stanish WD. Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program. Clin J Pain. 2003;19(2):97–104.
    1. Sullivan MJ, Ward LC, Tripp D, French DJ, Adams H, Stanish WD. Secondary prevention of work disability: community-based psychosocial intervention for musculoskeletal disorders. J Occup Rehabil. 2005 Sep;15(3):377–92.
    1. MacIntyre PE, Schug SA. Acute Pain Management: A Practical Guide. Edinburgh: Elsevier Saunders; 2007.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG, Consolidated Standards of Reporting Trials Group CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010 Aug;63(8):e1–37. doi: 10.1016/j.jclinepi.2010.03.004.
    1. Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995 May;61(2):277–84.
    1. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003 Dec 6;362(9399):1921–8. doi: 10.1016/S0140-6736(03)14966-5.
    1. Kehlet H, Wilmore DW. Fast-track surgery. Br J Surg. 2005 Jan;92(1):3–4. doi: 10.1002/bjs.4841.
    1. Haythornthwaite JA, Fauerbach JA. Assessment of acute pain, pain relief and patient satisfaction. In: Turk DC, Melzack R, editors. Handbook of Pain Assessment, Second Edition. New York: The Guilford Press; 2001. pp. 417–30.
    1. Tormala ZL, Petty RE. Resistance to persuasion and attitude certainty: the moderating role of elaboration. Pers Soc Psychol Bull. 2004 Nov;30(11):1446–57. doi: 10.1177/0146167204264251.
    1. Dijkstra A. Working mechanisms of computer-tailored health education: evidence from smoking cessation. Health Educ Res. 2005 Oct;20(5):527–39. doi: 10.1093/her/cyh014.
    1. Loiselle CG, Edgar L, Batist G, Lu J, Lauzier S. The impact of a multimedia informational intervention on psychosocial adjustment among individuals with newly diagnosed breast or prostate cancer: a feasibility study. Patient Educ Couns. 2010 Jul;80(1):48–55. doi: 10.1016/j.pec.2009.09.026.
    1. Dawson R, Spross JA, Jablonski ES, Hoyer DR, Sellers DE, Solomon MZ. Probing the paradox of patients' satisfaction with inadequate pain management. J Pain Symptom Manage. 2002 Mar;23(3):211–20.
    1. Donovan HS, Kwekkeboom KL, Rosenzweig MQ, Ward SE. Nonspecific effects in psychoeducational intervention research. West J Nurs Res. 2009 Dec;31(8):983–98. doi: 10.1177/0193945909338488.
    1. George SZ, Robinson ME. Preference, expectation, and satisfaction in a clinical trial of behavioral interventions for acute and sub-acute low back pain. J Pain. 2010 Nov;11(11):1074–82. doi: 10.1016/j.jpain.2010.02.016.
    1. Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, Ogedegbe G, Orwig D, Ernst D, Czajkowski S, Treatment Fidelity Workgroup of the NIH Behavior Change Consortium Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004 Sep;23(5):443–51. doi: 10.1037/0278-6133.23.5.443.
    1. Lewis M, Morley S, van der Windt DA, Hay E, Jellema P, Dziedzic K, Main CJ. Measuring practitioner/therapist effects in randomised trials of low back pain and neck pain interventions in primary care settings. Eur J Pain. 2010 Nov;14(10):1033–9. doi: 10.1016/j.ejpain.2010.04.002.
    1. Fredericks S, Guruge S, Sidani S, Wan T. Patient demographics and learning needs: examination of relationship. Clin Nurs Res. 2009 Nov;18(4):307–22. doi: 10.1177/1054773809341730.
    1. Fredericks S, Sidani S. An exploration of the relationship between coronary artery bypass graft patients' self-sought educational resources and outcomes. J Cardiovasc Nurs. 2008;23(5):422–31. doi: 10.1097/01.JCN.0000317447.80026.4d.
    1. Fredericks S, Sidani S, Shugurensky D. The effect of anxiety on learning outcomes post-CABG. Can J Nurs Res. 2008 Mar;40(1):127–40.
    1. Eysenbach G, CONSORT-EHEALTH Group CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel