Preoperative opioid education has no effect on opioid use in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial

Objectives: Opioid analgesics are frequently utilized among orthopaedic surgeons to mitigate postoperative pain. These drugs are well-known for their addictive potential and recent literature has suggested that preoperative patient-focused education on narcotic consumption may decrease post-operative opioid use. The purpose of this study was to determine whether preoperative opioid education reduces consumption following arthroscopic rotator cuff (ARTC) repair in the context of our current environment of limiting post-operative narcotic consumption. Methods: This is a single center randomized controlled trial. Opioid-naïve patients undergoing ARTC repair were randomized into one of two groups. Preoperatively, the control group received our institution’s standard of care for pain management education while the experimental group was shown a brief educational video on the proper use and dangers of opioids. All patients were discharged with 30 tabs of oxycodone-acetaminophen (5mg/325mg) prescribed as 1-2 tablets every 4-6 hours as needed for pain. They were contacted daily and asked to report opioid use, VAS pain, and satisfaction with overall pain management. A chart review was conducted at 3 months post-op to see if patients had been given narcotic refills after the initial postoperative period. Results: Our institution enrolled 106 patients, 87 of whom completed the study (41 control, 46 experimental). There were no statistically significant differences (p>0.05) with respect to patient demographics between groups (age at time of surgery, gender, ASA, or BMI). Additionally, there was no statistically significant difference with respect to Visual Analogue Scale (VAS) pain between groups preoperatively (p=0.85) or at 1-week follow up (p=0.29). Additionally, patients in each group were equally satisfied with their post-operative pain medication management (p=0.71). Patients in the education group did not utilize a statistically significant different number of narcotics than the control group throughout the first post-operative week (14.74 pills experimental vs. 13.71 pills control, p=0.68). At 3-month follow up, patients in the experimental group (n=9) were equally likely to have utilized at least one narcotic prescription refill as the control group (n=5) (odds ratio 1.65, p=0.56). Conclusion: The findings of this study suggest that preoperative video-based opioid education may have no effect on reducing the number of narcotic pills consumed following ARTC repair. As such, this form of intervention may not be of use with respect to mitigating the current opioid crisis.

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The Efficacy of a Forgiveness Bibliotherapy: A Randomized Controlled Trial with Nursing Students

Journal of Holistic Nursing ◽

10.1177/08980101211072288 ◽

2022 ◽

pp. 089801012110722

Author(s):

Jichan J. Kim ◽

Lora M. Mullen ◽

Shanna W. Akers ◽

Rachel A. Joseph ◽

Lauren B. Bishop ◽

...

Keyword(s):

Nursing Students ◽

Controlled Trial ◽

Cost Effective ◽

Treatment Manual ◽

Control Group ◽

Undergraduate Nursing ◽

Significant Difference ◽

Anxiety Depression ◽

Experimental Group

Purpose of study: The need for forgiveness education for nursing self-care and forgiveness facilitation has risen. Therefore, the present pilot study tested the efficacy of an 8-week forgiveness bibliotherapy with a small number of undergraduate nursing students. Design of study: Matched pairs of nursing students were randomly assigned to either the experimental group or no-contact control group. The experimental group, using 8 keys to forgiveness by R. Enright (2015) as the treatment manual, read one chapter a week for 8 weeks and provided weekly reflections. Forgiveness and forgiveness-related outcome measures were administered at pretest, posttest, and one-month follow-up. Findings: At the posttest, the experimental group had significantly greater improvement in forgiveness compared to the control group with a large effect size, which was maintained at one month follow-up. There was no other significant difference between the two groups. Within-group comparisons of the experimental group showed improvement in forgiveness, anxiety, depression, and fatigue from pre to post testing periods and forgiveness, anger, anxiety, depression, and fatigue from pre to follow-up testing periods. Conclusion: Use of bibliotherapy may be a cost-effective way to promote the virtue of forgiveness for students in nursing programs.

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Does soft tissue mobilization assist static stretching to improve hamstring flexibility? A randomized controlled trial

Journal of Complementary and Integrative Medicine ◽

10.1515/jcim-2019-0288 ◽

2020 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Shibili Nuhmani

Keyword(s):

Soft Tissue ◽

Controlled Trial ◽

Knee Extension ◽

Repeated Measure ◽

Control Group ◽

Static Stretching ◽

Significant Difference ◽

Hamstring Flexibility ◽

Soft Tissue Mobilization ◽

Experimental Group

AbstractObjectivesObjective of the study is to investigate whether Soft tissue mobilization (STM) can assist with static stretching to improve hamstring flexibly.MethodsThe design of the study was repeated measure design. The study was conducted at the physical therapy laboratory of Jamia Hamdard University, New Delhi. Participants included 78 healthy males with hamstring tightness, randomly assigned to either the control group (static stretching) or the experimental group (STM and static stretching). The experimental group received five sets of four different STM techniques, followed by two sets of 30-s static stretches 3 days per week over the course of 12 weeks. The control group received 5 min of sham ultrasound with an inactive probe prior to static stretching. Active knee extension test (AKE) was the outcome measure.ResultsBoth groups showed significant improvement in AKE compared with the baseline measurements. With ingroup analysis showed a significant difference in AKE across all measured time periods (weeks 4, 8, and 12) with pre-test in both groups (p<0.05). No significant difference in AKE improvement was found between groups (p>0.05).ConclusionThe results of this study show that STM prior to static stretching does not significantly improve hamstring flexibility among healthy individuals. Although this study cannot be generalized, the results may be useful for evidence-based practice in the management of hamstring tightness.

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Effect of Microcurrent Stimulation on Pain, Shoulder Function, and Grip Strength in Early Post-Operative Phase after Rotator Cuff Repair

Medicina ◽

10.3390/medicina57050491 ◽

2021 ◽

Vol 57 (5) ◽

pp. 491

Author(s):

Donghyun Yi ◽

Hwanyong Lim ◽

Jongeun Yim

Keyword(s):

Rotator Cuff ◽

Grip Strength ◽

Rotator Cuff Repair ◽

Controlled Trial ◽

Shoulder Function ◽

Control Group ◽

Simple Shoulder Test ◽

General Physical ◽

Cuff Repair ◽

Experimental Group

Background and Objectives: The purpose of this study was to investigate the effects of microcurrent stimulation on pain, shoulder function, and grip strength in patients with rotator cuff repair. Materials and Methods: This randomized single-blind controlled trial was conducted on inpatients of the rehabilitation department, and included 28 patients who underwent rotator cuff repair. Participants were randomly assigned to the experimental group (n = 14), treated with microcurrent stimulation, and the control group (n = 14), treated with false microcurrent stimulation. The microcurrent stimulation administered to the experimental group underwent general physical therapy and microcurrent stimulation three times a week for 4 weeks. Results: Changes in pain, range of motion in shoulder, simple shoulder test, and grip strength were assessed before and after the intervention. Both groups showed a significant decrease in pain and shoulder function (t = 27.412, 22.079, 19.079, and 18.561; p < 0.001), and grip strength showed a significant increase (t = −8.251 and −9.946; p < 0.001). The experimental group that underwent microcurrent stimulation exhibited a significant effect on pain, shoulder function, and grip strength compared with the control group that underwent false microcurrent stimulation (t = −2.17, −2.22, and 2.213; p = 0.039, 0.035, and 0.036). Conclusions: This study confirmed that microcurrent stimulation is effective for the treatment of rotator cuff repair patients.

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Capsular closure versus unrepaired interportal capsulotomy after hip arthroscopy in patients with femoroacetabular impingement, results of a patient-blinded randomised controlled trial

Hip International ◽

10.1177/11207000211005762 ◽

2021 ◽

pp. 112070002110057

Author(s):

Niels H Bech ◽

Inger N Sierevelt ◽

Sheryl de Waard ◽

Boudijn S H Joling ◽

Gino M M J Kerkhoffs ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Controlled Trial ◽

Poor Quality ◽

Control Group ◽

Treatment Groups ◽

Significant Difference ◽

Randomised Controlled

Background: Hip capsular management after hip arthroscopy remains a topic of debate. Most available current literature is of poor quality and are retrospective or cohort studies. As of today, no clear consensus exists on capsular management after hip arthroscopy. Purpose: To evaluate the effect of routine capsular closure versus unrepaired capsulotomy after interportal capsulotomy measured with NRS pain and the Copenhagen Hip and Groin Outcome Score (HAGOS). Materials and methods: All eligible patients with femoroacetabular impingement who opt for hip arthroscopy ( n = 116) were randomly assigned to one of both treatment groups and were operated by a single surgeon. Postoperative pain was measured with the NRS score weekly the first 12 weeks after surgery. The HAGOS questionnaire was measured at 12 and 52 weeks postoperatively. Results: Baseline characteristics and operation details were comparable between treatment groups. Regarding the NRS pain no significant difference was found between groups at any point the first 12 weeks after surgery ( p = 0.67). Both groups significantly improved after surgery ( p < 0.001). After 3 months follow-up there were no differences between groups for the HAGOS questionnaire except for the domain sport ( p = 0.02) in favour of the control group. After 12 months follow-up there were no differences between both treatment groups on all HAGOS domains ( p > 0.05). Conclusions: The results of this randomised controlled trial show highest possible evidence that there is no reason for routinely capsular closure after interportal capsulotomy at the end of hip arthroscopy. Trial Registration: This trial was registered at the CCMO Dutch Trial Register: NL55669.048.15.

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Effectiveness Of Topical Application Of Chlorhexidine And Prevailing Practices On Episiotomy Wound Among Postnatal Mothers

Asian Journal of Health Sciences ◽

10.15419/ajhs.v2i1.422 ◽

2014 ◽

Vol 2 (1) ◽

Author(s):

Rincy Michael ◽

Soney N Toppo ◽

Varsha Hariharan

Keyword(s):

Wound Healing ◽

Topical Application ◽

Controlled Trial ◽

Demographic Data ◽

Assessment Scale ◽

Research Centre ◽

Control Group ◽

Significant Difference ◽

Postnatal Mothers ◽

Experimental Group

Puerperium is a period when the mother experiences intense physical and emotional stress due to exhaustion, anxiety and excitement. Each mother has to adjust to physical changes in her own body due to involution and lactation as well as cope up with the new demands on her time and emotions made by the new born baby. Episiotomy, despite evidences that it is an unnecessary intervention, is one of the most common surgical procedures performed during the second stage of labour, especially in primigravida woman. Thus, a randomized controlled trial to assess the effectiveness of topical application of chlorhexidine and prevailing practices on episiotomy wound among postnatal mothers at selected hospital of Indore was undertaken. True experimental approach with pre test post test research design was adopted. Simple random sampling was taken to select 40 postnatal mothers with episiotomy wound and three days postpartum hospital stay in Choithram Hospital & Research Centre, Indore as per the inclusion criteria. Data was collected with help of questionnaire for socio demographic data and obstetrical data and the wound healing was assessed by REEDA wound healing assessment scale. Samples in the experimental group were applied with chlorhexidine on episiotomy wound and the samples in the control group received routine care with betadine or nadoxin. Post assessment score was taken on third day (evening) by REEDA wound assessment scale. Finding of the study related to effectiveness of chlorhexidine among postnatal mothers in experimental group revealed that there was a significant difference in the healing of episiotomy wound by the application of chlorhexidine among postnatal mothers in experimental group at t19 = 11.40 at the level of p< 0.001. Hence it was inferred that topical application of chlorhexidine on episiotomy wound promotes wound healing.

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Effects of a steps/day programme with evaluation in physical education on body mass index in schoolchildren 11-12 years of age

Kinesiology ◽

10.26582/k.48.1.2 ◽

2016 ◽

Vol 48 (1) ◽

pp. 132-141 ◽

Cited By ~ 1

Author(s):

Alberto Grao-Cruces ◽

Rafael Ruiz-López ◽

José-Enrique Moral-García ◽

Alberto Ruiz-Ariza ◽

Emilio J. Martínez-López

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Physical Education ◽

Body Mass ◽

Controlled Trial ◽

Control Group ◽

Education Students ◽

Minimum Number ◽

Experimental Group

The aim of the study was to assess the effects that a steps/day programme may have on body mass index (BMI) among primary education students (11.37±0.48 years). A six-week controlled trial with a follow-up was completed with an experimental group (N=66, pedometer + steps/day programme + reinforcement programme in their physical education (PE) marks + weekly follow-up in PE), and a control group (N=76). Omron HJ-152-E2 pedometers were used. Normoweight students complied with programme requirements to a greater extent than their overweight counterparts (72.7 vs 59.1%). The programmed minimum number of 12,000 steps/day for boys and 10,000 for girls was exceeded by 83% of boys and 60% of girls. The differences in the number of steps/day between boys (14,274) and girls (10,626) were significant across all the measured periods (p<.05). The results show that the teenagers who complied with the programme requirements reduced their BMI significantly after the intervention (p<.001) and this reduction persisted for six weeks after the programme (p<.001). In conclusion, the six-week programme of 12,000 steps/day for boys and 10,000 for girls, jointly with a reinforcement programme in their PE marks and weekly follow-up by their PE teacher, reduces BMI significantly in 11-12-year-old schoolchildren. Monitored steps/day programmes in the PE curriculum increase out-of-school physical activity and reduce BMI in 11-12-year-old schoolchildren.

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Effect of manual therapy in patients with hemophilia and ankle arthropathy: a randomized clinical trial

Clinical Rehabilitation ◽

10.1177/0269215519879212 ◽

2019 ◽

Vol 34 (1) ◽

pp. 111-119 ◽

Cited By ~ 1

Author(s):

Elena Donoso-Úbeda ◽

Javier Meroño-Gallut ◽

José Antonio López-Pina ◽

Rubén Cuesta-Barriuso

Keyword(s):

Manual Therapy ◽

Joint Pain ◽

Controlled Trial ◽

Control Group ◽

Load Bearing ◽

Intention To Treat ◽

Joint Health ◽

Experimental Group ◽

Treat Analysis

Objective: The aim of this study was to evaluate the effects of a manual therapy using fascial therapy on joint bleeding, joint pain and joint function in patients with hemophilic ankle arthropathy. Setting: Hemophilia patient associations. Design: Randomized, controlled trial, multicenter and intention-to-treat analysis. Participants: A total of 65 patients with hemophilic ankle arthropathy. Intervention: The experimental group ( n = 33) received one fascial therapy session per week for three weeks. The control group ( n = 32) received no treatment. Outcome measure: The primary outcome was frequency of joint bleeding measured using self-reporting. Secondary outcomes were joint pain (under load-bearing and non-load-bearing conditions) measured using the visual analog scale; joint condition was measured using the Hemophilia Joint Health Score. Outcomes were measured at baseline, posttreatment and after five months of follow-up. Results: Improvements in the frequency joint bleeding at T0, T1 and T2 were significantly higher in the experimental group (T0: mean (SD) = 1.56 (1.30); T1: mean (SD) = 0.00 (0.00); T2: mean (SD) = 0.27 (0.57)) compared to the control group (T0: mean (SD) = 1.70 (1.78); T1: mean (SD) = 0.05 (0.21); T2: mean (SD) = 0.58 (0.85)). Mean improvement of joint state after the study period was 1.74 points (±1.66) for patients in the experimental group, while the control group exhibited a joint deterioration with 0.43 points (±0.85). Ankle joint pain under load-bearing and non-load-bearing conditions improved in the experimental group with −1.72 (±1.86) and −0.50 (±1.39) points, respectively. Conclusion: The study showed that fascial therapy is favorable for patients with hemophilic ankle arthropathy.

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Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546517695789 ◽

2017 ◽

Vol 45 (9) ◽

pp. 2000-2009 ◽

Cited By ~ 22

Author(s):

Pietro Randelli ◽

Carlo Alberto Stoppani ◽

Carlo Zaolino ◽

Alessandra Menon ◽

Filippo Randelli ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Randomized Controlled Trial ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Controlled Trial ◽

Resonance Imaging ◽

Randomized Controlled ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. Purpose: To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. Results: Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). Conclusion: No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical repair of the rotator cuff. Registration: NCT01815177 ( ClinicalTrials.gov identifier).

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A Randomized Controlled Trial of Conbercept Pretreatment before Vitrectomy in Proliferative Diabetic Retinopathy

Journal of Ophthalmology ◽

10.1155/2016/2473234 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Xiaochun Yang ◽

Jianbiao Xu ◽

Ruili Wang ◽

Yan Mei ◽

Huo Lei ◽

...

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Controlled Trial ◽

Control Group ◽

Intraoperative Bleeding ◽

Significant Difference ◽

Pars Plana ◽

Effective Adjunct

Purpose.To determine the efficacy and safety of preoperative intravitreal conbercept (IVC) injection before vitrectomy for proliferative diabetic retinopathy (PDR).Methods.107 eyes of 88 patients that underwent pars plana vitrectomy (PPV) for active PDR were enrolled. All patients were assigned randomly to either preoperative IVC group or control group. Follow-up examinations were performed for three months after surgery. The primary bioactivity measures were severity of intraoperative bleeding, incidence of early and late recurrent VH, vitreous clear-up time, and best-corrected visual acuity (BCVA) levels. The secondary safety measures included intraocular pressure, endophthalmitis, rubeosis, tractional retinal detachment, and systemic adverse events.Results.The incidence and severity of intraoperative bleeding were significantly lower in IVC group than in the control group. The average vitreous clear-up time of early recurrent VH was significantly shorter in IVC group compared with that in control group. There was no significant difference in vitreous clear-up time of late recurrent VH between the two groups. Patients that received pretreatment of conbercept had much better BCVA at 3 days, 1 week, and 1 month after surgery than control group. Moreover, both patients with improved BCVA were greater in IVC group than in control group at each follow-up.Conclusions.Conbercept pretreatment could be an effective adjunct to vitrectomy in accelerating postoperative vitreous clear-up and acquiring stable visual acuity restoration for PDR.

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The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair and Patient Opioid Education

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00258 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0025

Author(s):

Danielle G. Weekes ◽

Jenna A. Feldman ◽

Richard E. Campbell ◽

Michael DeFrance ◽

Fotios P. Tjoumakaris ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Shoulder Function ◽

Arthroscopic Rotator Cuff Repair ◽

Prescription Data ◽

Opioid Use ◽

Significant Difference ◽

Chronic Opioid Use ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Objectives: Opioids are commonly prescribed for pain management following Arthroscopic Rotator Cuff Repair (ARCR). While their efficacy outweighs their risks in the short term, chronic opioid use is associated with significant adverse effects, such as dependence, endocrine imbalance or respiratory depression. The rate of chronic opioid use and dependence following ARCR is unknown. The purpose of this study is to determine the rate of chronic opioid use following ARCR and establish the effect of preoperative opioid education on reducing chronic consumption. A secondary aim is to determine if any correlation exists between chronic opioid use and shoulder functionality. Methods: A prospective, randomized study of 140 patients undergoing ARCR was performed with a minimum follow-up of 24 months. Patients were randomized to receive preoperative opioid education (risks of abuse, dependence, etc.) or no education. State registry database opioid prescription data monitoring software were utilized to search for all opioid prescriptions following ARCR in our patient population and this was compared to our electronic medical database for accuracy/discrepancy. The total number of opioid prescriptions and number of tablets was determined as well as time from surgery to most recent prescription. Patients were contacted to determine a shoulder Single Assessment Numeric Evaluation (SANE) score and Visual Analog Scale (VAS) pain score. Categorical data was analyzed via chi-squared tests as appropriate. Numeric data was analyzed using t-tests as appropriate. Results: Forty-five patients (32%) continued to fill opioid prescriptions chronically following ARCR. Seventeen (38%) of these patents received pre-operative opioid educated, whereas twenty-eight (62%) did not (p=0.05). Sixty percent of patients with a history of pre-operative opioid use continued to take opioids, while 23% of opioid naive patients continued (p< 0.01). There was no significant difference in SANE (p= 0.53) or VAS (p= 0.65) scores between the education and control group. Patients taking opioids prior to surgery had worse SANE scores (71.28) than the non-users (86.28), p< 0.01. Conclusion: Almost a third of patients will chronically use opioids following ARCR, including 23% of opioid naive patients. Preoperative opioid use is strongly associated with chronic opioid utilization, as well as decreased shoulder function 2 years after ARCR. Preoperative opioid education significantly decreased the rate of chronic opioid use; however, there is no effect on long-term shoulder function. [Table: see text]

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