Impact of a Smartphone App Reminder on Adherence to Aspirin Prescribed as Antithrombotic Therapy.

BACKGROUND: Many patients are discharged with aspirin (ASA) as an anticoagulant after joint replacement surgery. In studies in which ASA was prescribed, doses were frequently missed. Adherence to postoperative ASA regimen is critical to preventing thrombotic complications. This randomized controlled study evaluated the impact of an existing medication adherence smartphone application (app) on adherence to twice daily ASA 81 mg for 35 days after knee or hip arthroplasty. METHODOLOGY: Patients were randomized to either the app (intervention) group or the usual care (control) group. All patients received a baseline interview with a survey and demographics collected prior to randomization, a 36-day follow-up call for phone pill count, and a 6-week in-office interview with surveys and an in-person pill count. A convenience sample of 195 patients enrolled; 122 completed pill counts at both baseline and end of study. Ages ranged from 29 to 89 (mean: 60.4, SD: 10.1) years. The majority had a bachelor's degree or higher (59.3%), made more than $75,000 (or were retired; 51.9%), were of White race (75.9%), and female (53.8%). There were no significant demographic differences between the groups. RESULTS: There were no significant group differences in final pill counts, adherence (reasons for missed pills), or ASA Medication self-efficacy scores. However, the intervention group scored significantly higher on the ASA Adherence measure (general ease in and ability to take ASA; p = .020). Higher ASA Adherence scores were associated with lower pill counts at the end of study (better adherence) in the intervention group. There was a high rate of attrition related to failure to bring the ASA to hospital or to the follow-up appointment. CONCLUSIONS: Although there were no significant differences in final pill counts between groups, the app group reported more ease in taking pills. With smartphone use virtually ubiquitous, this project provided an opportunity to educate patients and nurses about how technology can support medication adherence. It was also an excellent opportunity to involve clinical nurses in a funded research project.

Randomized Controlled Trial of a Natural Food-Based Fiber Solution to Prevent Constipation in Postoperative Spine Fusion Patients.

BACKGROUND: Constipation after orthopaedic surgery occurs frequently, likely due to a combination of high levels of opioid medications for severe pain management and mobility limitations after surgery. It can result in serious complications, increased cost, and patient discomfort. PURPOSE: This study evaluated a natural food-based fiber solution to prevent constipation in postoperative orthopaedic patients. METHODS: A posttest control group-randomized study design was used. Dependent variables were presence of postoperative constipation, time to first bowel movement (BM), and total number of postoperative BMs. Descriptive statistics, Student's t tests, and Mann-Whitney nonparametric 2-group tests with chi-square analysis were used. Level of significance for all tests was p < .05. Forty-six participants were evaluated. RESULTS: Ages were similar for both the intervention and control groups. Bowel Function Index (BFI) scores were not significantly different (p = .448). No significant group differences were present for the individual BFI item scores (p > .05). The number of patients with a BM during the first 3 days was not significantly different (p = .489). There were no significant differences found between the 2 groups regarding laxative administration (p > .05 for all laxatives). CONCLUSION: Further studies are indicated that address natural fibers and pharmaceutical methods for the prevention of constipation after spinal surgery.

Impact of a Preset Daily Cell Phone Alarm on Medication Adherence for Aspirin as Antithrombotic Therapy.

The ability of patients to adhere to medication regimens is considered critical to achieving optimal results. Many patients are discharged with aspirin (ASA) as an anticoagulant for venous thrombosis embolism prophylaxis after joint replacement surgery. In studies where ASA was prescribed as an antithrombotic after selected orthopaedic surgeries, both lack of understanding and missing doses were identified as factors that affected adherence rates (D. , ). The purpose of this study was to explore the preliminary impact of a preset telephone alarm on medication adherence in adults prescribed ASA for 35 days after knee or hip arthroplasty. This was a randomized controlled trial (n = 79). Adherence was measured with a four-question self-reporting tool. Average age was 61 years. The majority were female (59.5%) and Caucasian (62.0%) with college or graduate degree-level education (78.5%). When comparing the groups, there were no significant differences between the two groups for the demographics of age, gender, and race. The alarm group had significantly better adherence rates, with fewer people who forgot to take their ASA; only 29.7% of the alarm group ever forgot to take their medication compared with 59.5% of the no-alarm group (p = .008). It seems that simple cell phone alarms can serve as effective reminders to patients to take selected medications as prescribed.

Self-Reported Rates of Adherence to Aspirin Prescribed as an Antithrombotic Therapy Following Postoperative Total Joint Replacement.

BACKGROUND: Patients may not understand the importance of medication adherence when discharged with aspirin (ASA) as an anticoagulant for venous thromboembolism (VTE) prophylaxis after joint replacement surgery. PURPOSE: The purpose of this study was to examine self-reported rates of adherence to postoperative use of ASA for VTE prophylaxis. METHODS: This was an exploratory, descriptive study using a convenience sample of 99 participants. Adherence was measured with a 4-question self-reporting tool. RESULTS: Thirty-seven percent were male and 76% were Caucasian, and median age was 63 years. Ninety-two percent had the dosage correct, 76% knew how long to take the medication, and 100% of the sample was still taking the ASA; 40% had forgotten to take 1 or more doses of the medication. No associations were noted. Overall compliance was 44%. CONCLUSION: A significant number missed 1 or more doses. This is an opportunity for nurses to work with patients on innovative ways to improve adherence.

Impact of a Focused Approach for Discharge Teaching Regarding the Use of Aspirin as Anticoagulant After Joint Replacement Surgery.

BACKGROUND: Patient education for the use and administration of aspirin (ASA) as an anticoagulant may be deficient. PURPOSE: To pilot a knowledge assessment tool regarding the use of aspirin (ASA) as an anticoagulant and to evaluate the impact of a focused approach for discharge teaching. DESIGN: One-group pretest-posttest pilot study. SAMPLE: Convenience sample of patients hospitalized for total knee and total hip arthroplasty. MEASURE: Researcher developed ASA quiz. INTERVENTION: Focused education on aspirin as an anticoagulant. RESULTS: There was a statistically significant improvement in knowledge (Wilcoxon rank sum test Z = 3.880, p < .001).

Does the use of a brief cryotherapy intervention with analgesic administration improve pain management after total knee arthroplasty?

BACKGROUND: Prior studies have evaluated only the prolonged use of cryotherapy as a nonpharmacologic pain intervention. PURPOSE OF THE STUDY: The purpose of this study was to determine whether a 30-minute application of cryotherapy at the time pain medication was given after a total knee arthroplasty (TKA) provided better pain relief than analgesic drugs alone. METHODS: A pretest, posttest, randomized controlled trial study design with crossover was used to evaluate the effects of cryotherapy on postoperative pain and satisfaction with pain management. A convenience sample of postoperative knee replacement patients constituted participants in the study. Two sequential episodes of pain requiring analgesic administration were studied in each patient, one with a 30-minute cryotherapy application and the other without cryotherapy. Dependent variables were changes in pain (posttest minus pretest) and level of satisfaction with pain management. Data were analyzed with repeated-measures analysis of variance, with p < .05 considered significant. RESULTS: During two sequential treatments for postoperative pain, a total of 29 TKA patients received analgesic medication administration alone for one pain episode and analgesic medication administration with a brief cryotherapy administration for the other pain episode. No significant difference between the two treatments was found for changes in pain scores after the treatments or patient satisfaction with pain management (p > .05). The order in which the treatments were provided was found to be significant (p = .02) for scores on patient satisfaction with pain management, with cryotherapy as the treatment for the second pain episode having higher scores than when delivered for the first pain episode. Sixty minutes after analgesic administration with or without cryotherapy, average pain scores remained greater than 7. CONCLUSION: In TKA patients, the short-term application of cryotherapy with analgesic medication administration did not significantly decrease pain or improve patient satisfaction with pain management compared with analgesic medication administration only. Further study is necessary to determine whether short-term cryotherapy shortly after TKA is of benefit to pain relief and patient satisfaction.

The relationship between nonsurgical pain and interference with activity in patients undergoing a total knee arthroplasty.

BACKGROUND: Patients with nonsurgical pain (NSP) after a total knee arthroplasty (TKA) report different patterns of pain interference than those without NSP. PURPOSE: This study explores the severity and ways in which NSP interferes with activities 48 hours and 6-7 weeks post surgery. ANALYSIS: Univariate and multivariate analyses were used. The mean score for intensity at 48 hours was 1.78, and at 6-7 weeks it was 1.15. The mean score for interference with activities at 48 hours was 1.62 and at 6-7 weeks it was 0.91. Highest NSP pain interference at 48 hours was for "activity," "sleep," and "enjoyment of life." At 6-7 weeks, the highest scores were for "activity," "sleep," and "walking." No significant differences were noted for age, race, education, or gender. IMPLICATIONS: Although rated "mild," this pain should be addressed. The NSP indicates a baseline of chronic and persistent pain, which is an opportunity to work with our patients to mitigate this pain. Total knee arthroplasty, a common and effective treatment for painful knee conditions attributed to various forms of arthritis, is known to be a painful surgical procedure. Two of the major concerns voiced by patients awaiting TKA are about postoperative pain management and rehabilitation efforts after the procedure (). Healthcare providers offer a range of methods and strategies to deal with postoperative TKA pain, yet to date no single method offers complete satisfaction (; ; ; ).

Patients' experiences of pain in the 48 hours following total knee arthroplasty.

BACKGROUND: Previous research indicates that both pain severity and interference caused by pain should be addressed in the recovery period following total knee arthroplasty. PURPOSE: This research describes the range of pain severity of patients in the first 48 hours postoperation, ways in which pain interferes with activities, and the observed differences in pain experience by patients' age, level of education, race, and gender, using the Brief Pain Inventory. ANALYSIS: Descriptive statistics and multivariate analysis were used to assess the data. FINDINGS: Of the participants, 12% reported severe pain and 35% reported severe interference with general activities. Pain interfered most with walking, activities, and physical therapy. There were no differences by race, gender, or education. Older participants reported less pain and less interference. Participants reporting nonsurgical pain reported more interference with mood, walking, relationships with other people, and sleep. RECOMMENDATIONS: Pain evaluation should include an assessment of pain unrelated to the surgical procedure. Additional research exploring the impact of nonpostoperative surgical pain during the postoperative period is needed.