A randomized clinical trial of a new perioperative practice model on anxiety and health-related quality of life in arthroplasty patients.

The anaesthesia nurses knew which patients were in the intervention group, so they could not be blinded to the care model. Baseline anxiety and quality-of-life measures were taken two to three weeks before surgery, not on the day of surgery, so the study may not have captured the highest surgery-related anxiety. Follow-up was only three months, and knee replacement recovery can take six months to one year, so later changes in anxiety or quality of life may have been missed. Follow-up response rates were lower than baseline: 15D response was 65% in the intervention group and 61% in the control group, and state anxiety response was 67% and 61%, respectively. The study was done in one operating department in a university hospital in southern Finland and included only patients having surgery under spinal anaesthesia, so results may not apply to other settings or anaesthetic types. Friday operations were excluded from the intervention group because postoperative visits could not be done during the weekend, which may limit how the model fits other scheduling systems. Analyses by gender and surgery type were done after the trial, so they are exploratory rather than pre-specified.

Do not read the significant improvements in state anxiety or quality-of-life dimensions as evidence that the continuity model caused them. Both groups improved, and the between-group comparison was not statistically significant. Both groups also received the same medical care, nursing care, pain control, rehabilitation, exercise, and wound care.