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Meta-Analysis
. 2016 May 26;2016(5):CD008646.
doi: 10.1002/14651858.CD008646.pub2.

Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia

Affiliations
Meta-Analysis

Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia

Rachael Powell et al. Cochrane Database Syst Rev. .

Abstract

Background: In a review and meta-analysis conducted in 1993, psychological preparation was found to be beneficial for a range of outcome variables including pain, behavioural recovery, length of stay and negative affect. Since this review, more detailed bibliographic searching has become possible, additional studies testing psychological preparation for surgery have been completed and hospital procedures have changed. The present review examines whether psychological preparation (procedural information, sensory information, cognitive intervention, relaxation, hypnosis and emotion-focused intervention) has impact on the outcomes of postoperative pain, behavioural recovery, length of stay and negative affect.

Objectives: To review the effects of psychological preparation on postoperative outcomes in adults undergoing elective surgery under general anaesthetic.

Search methods: We searched the Cochrane Register of Controlled Trials (CENTRAL 2014, Issue 5), MEDLINE (OVID SP) (1950 to May 2014), EMBASE (OVID SP) (1982 to May 2014), PsycINFO (OVID SP) (1982 to May 2014), CINAHL (EBESCOhost) (1980 to May 2014), Dissertation Abstracts (to May 2014) and Web of Science (1946 to May 2014). We searched reference lists of relevant studies and contacted authors to identify unpublished studies. We reran the searches in July 2015 and placed the 38 studies of interest in the `awaiting classification' section of this review.

Selection criteria: We included randomized controlled trials of adult participants (aged 16 or older) undergoing elective surgery under general anaesthesia. We excluded studies focusing on patient groups with clinically diagnosed psychological morbidity. We did not limit the search by language or publication status. We included studies testing a preoperative psychological intervention that included at least one of these seven techniques: procedural information; sensory information; behavioural instruction; cognitive intervention; relaxation techniques; hypnosis; emotion-focused intervention. We included studies that examined any one of our postoperative outcome measures (pain, behavioural recovery, length of stay, negative affect) within one month post-surgery.

Data collection and analysis: One author checked titles and abstracts to exclude obviously irrelevant studies. We obtained full reports of apparently relevant studies; two authors fully screened these. Two authors independently extracted data and resolved discrepancies by discussion.Where possible we used random-effects meta-analyses to combine the results from individual studies. For length of stay we pooled mean differences. For pain and negative affect we used a standardized effect size (the standardized mean difference (SMD), or Hedges' g) to combine data from different outcome measures. If data were not available in a form suitable for meta-analysis we performed a narrative review.

Main results: Searches identified 5116 unique papers; we retrieved 827 for full screening. In this review, we included 105 studies from 115 papers, in which 10,302 participants were randomized. Mainly as a result of updating the search in July 2015, 38 papers are awaiting classification. Sixty-one of the 105 studies measured the outcome pain, 14 behavioural recovery, 58 length of stay and 49 negative affect. Participants underwent a wide range of surgical procedures, and a range of psychological components were used in interventions, frequently in combination. In the 105 studies, appropriate data were provided for the meta-analysis of 38 studies measuring the outcome postoperative pain (2713 participants), 36 for length of stay (3313 participants) and 31 for negative affect (2496 participants). We narratively reviewed the remaining studies (including the 14 studies with 1441 participants addressing behavioural recovery). When pooling the results for all types of intervention there was low quality evidence that psychological preparation techniques were associated with lower postoperative pain (SMD -0.20, 95% confidence interval (CI) -0.35 to -0.06), length of stay (mean difference -0.52 days, 95% CI -0.82 to -0.22) and negative affect (SMD -0.35, 95% CI -0.54 to -0.16) compared with controls. Results tended to be similar for all categories of intervention, although there was no evidence that behavioural instruction reduced the outcome pain. However, caution must be exercised when interpreting the results because of heterogeneity in the types of surgery, interventions and outcomes. Narratively reviewed evidence for the outcome behavioural recovery provided very low quality evidence that psychological preparation, in particular behavioural instruction, may have potential to improve behavioural recovery outcomes, but no clear conclusions could be reached.Generally, the evidence suffered from poor reporting, meaning that few studies could be classified as having low risk of bias. Overall,we rated the quality of evidence for each outcome as 'low' because of the high level of heterogeneity in meta-analysed studies and the unclear risk of bias. In addition, for the outcome behavioural recovery, too few studies used robust measures and reported suitable data for meta-analysis, so we rated the quality of evidence as `very low'.

Authors' conclusions: The evidence suggested that psychological preparation may be beneficial for the outcomes postoperative pain, behavioural recovery, negative affect and length of stay, and is unlikely to be harmful. However, at present, the strength of evidence is insufficient to reach firm conclusions on the role of psychological preparation for surgery. Further analyses are needed to explore the heterogeneity in the data, to identify more specifically when intervention techniques are of benefit. As the current evidence quality is low or very low, there is a need for well-conducted and clearly reported research.

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Conflict of interest statement

Rachael Powell designed a study, whilst she was a post‐doctoral researcher at the University of Auckland, that would have been eligible for inclusion in this review had it been completed. However, the study did not progress due to recruitment problems (very few data sets were completed and the study was halted). As noted in Sources of support funding from two sources was received to support research assistants working on the review.

Neil W Scott's institution received National Health Service (NHS) Grampian Endowment Research Grants for statistical analysis.

Anne Manyande was the first author on two studies that we considered for inclusion in this review (Manyande 1995; Manyande 1998). We excluded these studies because participants were not randomly allocated to condition.

Julie Bruce: none known.

Marie Johnston and Claus Vögele carried out a systematic review and meta‐analysis in this area (Johnston 1993), but searching techniques have since become more sophisticated due to technological developments.

Lucie Byrne‐Davis: none known.

Mary Unsworth had financial support as a Research Assistant at Aston University and the University of Manchester for part of the submitted work.

Christian Osmer is deceased; no declarations of interest available.

Figures

1
1
`Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Study flow diagram.
3
3
`Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Pain (any psychological preparation intervention versus control). B: behavioural instruction; C: cognitive interventions; E: emotion‐focused interventions; H: hypnosis; P: procedural information; R: relaxation; S: sensory information.
5
5
Negative affect (any psychological preparation intervention versus control). B: behavioural instruction; C: cognitive interventions; E: emotion‐focused interventions; H: hypnosis; P: procedural information; R: relaxation; S: sensory information.
6
6
Length of stay (any psychological preparation intervention versus control). B: behavioural instruction; C: cognitive interventions; E: emotion‐focused interventions; H: hypnosis; P: procedural information; R: relaxation; S: sensory information.
1.1
1.1. Analysis
Comparison 1 Any psychological preparation intervention versus control, Outcome 1 Pain.
1.2
1.2. Analysis
Comparison 1 Any psychological preparation intervention versus control, Outcome 2 Length of stay (days).
1.3
1.3. Analysis
Comparison 1 Any psychological preparation intervention versus control, Outcome 3 Negative affect.
2.1
2.1. Analysis
Comparison 2 Procedural information versus control, Outcome 1 Pain.
2.2
2.2. Analysis
Comparison 2 Procedural information versus control, Outcome 2 Length of stay (days).
2.3
2.3. Analysis
Comparison 2 Procedural information versus control, Outcome 3 Negative affect.
3.1
3.1. Analysis
Comparison 3 Sensory information versus control, Outcome 1 Pain.
3.2
3.2. Analysis
Comparison 3 Sensory information versus control, Outcome 2 Length of stay (days).
3.3
3.3. Analysis
Comparison 3 Sensory information versus control, Outcome 3 Negative affect.
4.1
4.1. Analysis
Comparison 4 Behavioural instruction versus control, Outcome 1 Pain.
4.2
4.2. Analysis
Comparison 4 Behavioural instruction versus control, Outcome 2 Length of stay (days).
4.3
4.3. Analysis
Comparison 4 Behavioural instruction versus control, Outcome 3 Negative affect.
5.1
5.1. Analysis
Comparison 5 Cognitive interventions versus control, Outcome 1 Pain.
5.2
5.2. Analysis
Comparison 5 Cognitive interventions versus control, Outcome 2 Length of stay (days).
5.3
5.3. Analysis
Comparison 5 Cognitive interventions versus control, Outcome 3 Negative affect.
6.1
6.1. Analysis
Comparison 6 Relaxation versus control, Outcome 1 Pain.
6.2
6.2. Analysis
Comparison 6 Relaxation versus control, Outcome 2 Length of stay (days).
6.3
6.3. Analysis
Comparison 6 Relaxation versus control, Outcome 3 Negative affect.
7.1
7.1. Analysis
Comparison 7 Hypnosis versus control, Outcome 1 Negative affect.
8.1
8.1. Analysis
Comparison 8 Emotion‐focused interventions versus control, Outcome 1 Pain.
8.2
8.2. Analysis
Comparison 8 Emotion‐focused interventions versus control, Outcome 2 Length of stay (days).
8.3
8.3. Analysis
Comparison 8 Emotion‐focused interventions versus control, Outcome 3 Negative affect.

Update of

  • doi: 10.1002/14651858.CD008646

References

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Oetker‐Black 2003 {published and unpublished data}
    1. Oetker‐Black SL, Jones S, Estok P, Ryan M, Gale N, Parker C. Preoperative teaching and hysterectomy outcomes. AORN Journal 2003;77(6):1215‐31. - PubMed
Oliphant 2013 {published data only}
    1. Oliphant SS, Lowder JL, Ghetti C, Zyczynski HM. Effect of a preoperative self‐catheterization video on anxiety: a randomised controlled trial. International Urogynecology Journal 2013;24:419‐24. - PubMed
Omlor 2000 {published data only}
    1. Omlor G, Kiewitz S, Pietschmann S, Roesler S. The benefit of preoperative psychotherapy on surgical outcome after inguinal hernia repair and thyroid gland surgery [Einfluss einer präoperativen Visualisierungstherapie auf die postoperativen Ergebnisse nach Leistenherniotomie und Strumaresektion]. Zentralblatt für Chirurgie 2000;125:380‐6. - PubMed
Oosting 2012 {published and unpublished data}
    1. Oosting E, Jans MP, Dronkers JJ, Naber RH, Dronkers‐Landman CM, Appelman‐de Vries SM, et al. Preoperative home‐based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomised controlled trial. Archives of Physical Medicine and Rehabilitation 2012;93:610‐6. - PubMed
Osinowo 2003 {published data only}
    1. Osinowo HO, Olley BO, Adejumo AO. Evaluation of the effect of cognitive therapy on perioperative anxiety and depression among Nigerian surgical patients. West African Journal of Medicine 2003;22(4):338‐42. - PubMed
Parthum 2006 {published data only}
    1. Parthum A, Weinzierl A, Gräßel E, Koppert W. Preoperative pain training. No influence on postoperative pain perception in patients undergoing cardiac surgery [Präoperative Schmerzschulung: Fehlender Einfluss auf postoperative erlebtes Schmerzempfinden kardiochirurgischer Patienten]. Der Schmerz 2006;20:301‐26. - PubMed
Pellino 1998 {published and unpublished data}
    1. Pellino T, Tluczek A, Collins M, Trimborn S, Norwick H, Engelke ZK, et al. Increasing self‐efficacy through empowerment: preoperative education for orthopaedic patients. Orthopaedic Nursing 1998;17(4):48‐59. - PubMed
Pellino 2005 {published data only}
    1. Pellino TA, Gordon DB, Engelke ZK, Busse KL, Collins MA. Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty. Orthopaedic Nursing 2005;24(3):182‐90. - PubMed
Perri 1979 {published data only}
    1. Perri KD, Perri MG. Use of relaxation training to reduce pain following vaginal hysterectomy. Perceptual and Motor Skills 1979;48:478. - PubMed
Postlethwaite 1986 {published and unpublished data}
    1. Postlethwaite R, Stirling G, Peck CL . Stress inoculation for acute pain: a clinical trial. Journal of Behavioral Medicine 1986;9(2):219‐27. - PubMed
Rajendran 1998 {published data only}
    1. Ranjendran AJ, Pandurangi UM, Murali R, Gomathi S, Vijayan VK, Cherian KM. Pre‐operative short‐term pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery. Indian Heart Journal 1998;50:531‐4. - PubMed
Reading 1982 {published data only}
    1. Reading AE. The effects of psychological preparation for pain and recovery after minor gynaecological surgery: a preliminary report. Journal of Clinical Psychology 1982;38(3):504‐12. - PubMed
Ridgeway 1982 {published and unpublished data}
    1. Ridgeway V, Mathews A. Psychological preparation for surgery: a comparison of methods. British Journal of Clinical Psychology 1982;21:271‐80. - PubMed
Roman 2012 {published data only}
    1. Roman A, Moldovan R, Balázsi R, Câmpian R, Soanca A, Stratul S, et al. The role of cognitive behavioural therapy in the periodontal surgical treatment: a randomized clinical trial. Journal of Cognitive and Behavioral Psychotherapies 2012;12(1):1‐14.
Rosenfeldt 2011 {published data only}
    1. Rosenfeldt F, Braun L, Spitzer O, Bradley S, Shepherd J, Bailey M, et al. Physical conditioning and mental stress reduction – a randomised trial in patients undergoing cardiac surgery. BMC Complementary and Alternative Medicine 2011;11:20. - PMC - PubMed
Schmitt 1973 {published data only}
    1. Schmitt EF, Wooldridge PJ. Psychological preparation of surgical patients. Nursing Research 1973;22(2):108‐16. - PubMed
Schwartz‐B'tt 1994 {published data only}
    1. Schwartz‐Barcott D, Fortin JD, Kim HS . Client‐nurse interaction: testing for its impact in preoperative instruction. International Journal of Nursing Studies 1994;31(1):23‐35. - PubMed
Seers 2008 {published data only}
    1. Seers K, Crichton N, Tutton L, Smith L, Saunders T. Effectiveness of relaxation for postoperative pain and anxiety: randomized controlled trial. Journal of Advanced Nursing 2008;62(6):681‐8. - PubMed
Shelley 2007 {published data only}
    1. Shelley M, Pakenham K. The effects of preoperative preparation on postoperative outcomes: the moderating role of control appraisals. Health Psychology 2007;26(2):183‐91. - PubMed
Shuldham 2002 {published and unpublished data}
    1. Shuldham CM, Fleming S, Goodman H. The impact of pre‐operative education on recovery following coronary artery bypass surgery: a randomized controlled clinical trial. European Heart Journal 2002;23(8):666‐74. - PubMed
Vukomanović 2008 {published and unpublished data}
    1. Vukomanović A, Popović Z, Đurović A, Krstić L. The effects of short‐term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergoing total hip arthroplasty [Alternative title: Efekti kratkotrayne preoperativne fizikalne terapije I edukacije na rani funkcijski oporavak bolesnika mlađih od 70 godina sa totalnom artroplastikom kuka]. Vojnosanitetski Pregled 2008;65(4):291‐7. - PubMed
Watt‐Watson 2000 {published and unpublished data}
    1. Watt‐Watson J, Stevens B, Costello J, Katz J, Reid G. Impact of preoperative education on pain management outcomes after coronary artery bypass graft surgery: a pilot. Canadian Journal of Nursing Research 2000;31(4):41‐56. - PubMed
Watt‐Watson 2004 {published and unpublished data}
    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;109:73‐85. - PubMed
Wells 1982 {published data only}
    1. Wells N. The effect of relaxation on postoperative muscle tension and pain. Nursing Research 1982;31(4):236‐8. - PubMed
Wijgman 1994 {published data only}
    1. Wijgman AJ, Dekkers GHG, Waltje E, KrekelsT, Arens HJ. No positive effect of preoperative physical therapy and instruction of patients to be subjected to hip arthroplasty [Geen positief effect van properatieve oefentherapie en instructive bij patiënten die heupartroplastiek zullen ondergaan]. Ned Tijdschr Geneeskd 1994;138(19):949‐52. - PubMed
Wilson 1981 {published and unpublished data}
    1. Wilson JF. Behavioural preparation for surgery: benefit or harm?. Journal of Behavioral Medicine 1981;4(1):79‐101. - PubMed
Yang 2012 {published data only}
    1. Yang C‐L, Tan Y‐H, Jiang X‐X, Meng F‐Y, Wu Y‐L, Chen, Q‐L, et al. Pre‐operative education and counselling are associated with reduced anxiety symptoms following carotid endarterectomy: a randomized and open‐label study. European Journal of Cardiovascular Nursing 2012;11(3):284‐8. - PubMed
Zhang 2012 {published data only}
    1. Zhang C‐Y, Jiang Y, Yin Q‐Y, Chen F‐J, Ma L‐L, Wang L‐X. Impact of nurse‐initiated preoperative education on postoperative anxiety symptoms and complications after coronary artery bypass grafting. Journal of Cardiovascular Nursing 2012;27(1):84‐8. - PubMed
Ziemer 1982 {published data only}
    1. Ziemer M. Providing patients with information prior to surgery and the reported frequency of coping behaviors and development of symptoms following surgery. Dissertation Abstracts International 1983;43:2465B.
    1. Ziemer MM. Providing Patients with Information Prior to Surgery and the Reported Frequency of Coping Behaviors and Development of Symptoms Following Surgery [Dissertation for Degree of Doctor of Nursing Science]. School of Nursing, University of Pennsylvania, 1982.
    1. Ziemer MM. Effects of information on postsurgical coping. Nursing Research 1982;32(5):282‐7. - PubMed
Zieren 2007 {published data only}
    1. Zieren J, Menenakos C, Mueller JM. Does an informative video before inguinal hernia surgical repair influence postoperative quality of life? Results of a prospective randomized study. Quality of Life Research 2007;16:725‐9. - PubMed

References to studies excluded from this review

Anderson 1987 {published data only}
    1. Anderson EA. Preoperative preparation for cardiac surgery facilitates recovery, reduces psychological distress, and reduces the incidence of acute postoperative hypertension. Journal of Consulting and Clinical Psychology 1987;55(4):513‐20. - PubMed
Blay 2005 {published data only}
    1. Blay N, Donoghue J. The effect of pre‐admission education on domiciliary recovery following laparoscopic cholecystectomy. Australian Journal of Advanced Nursing 2005;22(4):14‐9. - PubMed
Boore 1978 {published data only}
    1. Boore JRP. An Investigation Into the Effect of Some Aspects of Pre‐operative Preparation of Patients on Post‐operative Stress and Recovery [PhD thesis]. University of Manchester, 1976.
    1. Boore JRP. Prescription for Recovery: The Effect of Pre‐Operative Preparation of Surgical Patients on Post‐Operative Stress, Recovery and Infection. Royal College of Nursing Research Series. London: Royal College of Nursing, 1978.
Burton 1991 {published data only}
    1. Burton MV, Parker RW, Wollner JM. The psychotherapeutic value of a "chat": a verbal response modes study of a placebo attention control with breast cancer patients. Psychotherapy Research 1991;1(1):39‐61.
Burton 1994 {published data only}
    1. Burton MV, Parker, RW. Satisfaction of breast cancer patients with their medical and psychological care. Journal of Psychosocial Oncology 1994;12(1/2):41‐63.
Croog 1994 {published data only}
    1. Croog SH, Baume RM, Nalbandian J. Pain response after psychological preparation for repeated periodontal surgery. Journal of the American Dental Association 1994;125:1353‐60. - PubMed
Domar 1987 {published data only}
    1. Domar AD, Noe JM, Ransil B, Benson H. The preoperative use of the relaxation response with ambulatory surgery patients. Journal of Human Stress 1987;13(3):101‐7. - PubMed
Enqvist 1995 {published data only}
    1. Enqvist B, Konow L, Bystedt H . Pre‐ and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery. International Journal of Clinical and Experimental Hypnosis 1995;43(3):284‐94. - PubMed
Eremin 2009 {published data only}
    1. Eremin O, Walker MB, Simpson E, Heys SD, Ah‐See AK, Hutcheon AW, et al. Immuno‐modulatory effects of relaxation training and guided imagery in women with locally advanced breast cancer undergoing multimodality therapy: a randomised controlled trial. The Breast 2000;18(1):17‐25. - PubMed
Huang 2012 {published data only}
    1. Huang S‐W, Chen P‐H, Chou Y‐H. Effects of a preoperative simplified home rehabilitation education program on length of stay for total knee arthroplasty patients. Orthopaedics & Traumatology: Surgery & Research 2012;98:259‐64. - PubMed
Johnson 1978a {published data only}
    1. Johnson JE, Fuller SS, Endress MP, Rice VH. Altering patients’ responses to surgery: an extension and replication. Research in Nursing and Health 1978;1(3):111‐21. - PubMed
Lengacher 2008 {published data only}
    1. Lengacher CA, Bennett MP, Gonzalez L, Gilvary D, Cox CE, Cantor A, et al. Immune responses to guided imagery during breast cancer treatment. Biological Research Nursing 2008;9(3):205‐14. - PubMed
Liu 2013 {published data only}
    1. Liu L, Li J. Observation of the postoperative analgesic effect of Lornoxicam preemptive analgesia combined with psychotherapy for elderly cancer patients. Chinese Journal of Clinical Oncology 2013;40(11):664‐7.
Manyande 1995 {published data only}
    1. Manyande A, Berg S, Gettins D, Stanford SC, Mazhero S, Marks DF, et al. Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery. Psychosomatic Medicine 1995;57:177‐82. - PubMed
Manyande 1998 {published data only}
    1. Manyande A, Salmon P. Effects of pre‐operative relaxation on post‐operative analgesia: immediate increase and delayed reduction. British Journal of Health Psychology 1998;3(3):215‐24.
Mitchell 2000 {published data only}
    1. Mitchell M. Psychological preparation for patients undergoing day surgery. Ambulatory Surgery 2000;8:19‐29.
Montgomery 2002 {published data only}
    1. Montgomery GH, Weltz CR, Seltz M, Bovbjerg DH. Brief presurgical hypnosis reduces distress and pain in excisional breast biopsy patients. International Journal of Clinical and Experimental Hypnosis 2002;50(1):17‐32. - PubMed
Montgomery 2007 {published data only}
    1. Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, Weltz CR, et al. A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute 2007;99(17):1304‐12. - PubMed
    1. Montgomery GH, Hallquist MN, Schnur JB, David, D, Silverstein JH, Bovbjerg DH. Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: response expectancies and emotional distress. Journal of Consulting and Clinical Psychology 2010;78(1):80‐8. - PMC - PubMed
Sheard 2006 {published data only}
    1. Sheard C, Garrud P. Evaluation of generic patient information: effects on health outcomes, knowledge and satisfaction. Patient Education and Counselling 2006;64:43‐7. - PubMed
Shelley 2009 {published data only}
    1. Shelley M, Pakenham KI, Frazer I. Cortisol changes interact with the effects of a cognitive behavioural psychological preparation for surgery on 12‐month outcomes for surgical heart patients. Psychology and Health 2009;24(10):1139‐52. - PubMed
Stergiopoulou 2006 {published data only}
    1. Stergiopoulou A, Birbas K, Katostaras T, Diomidous M, Mantas J. The effect of a multimedia health educational program on the postoperative recovery of patients undergoing laparoscopic cholecystectomy. Studies in Health Technology & Informatics 2006;124:920‐5. - PubMed
Sugai 2013 {published data only}
    1. Sugai DY, Deptula PL, Parsa AA, Don Parsa, F. The importance of communication in the management of postoperative pain. Hawai’i Journal of Medicine and Public Health 2013;72(6):180‐4. - PMC - PubMed
Surman 1974 {published data only}
    1. Surman OS, Hackett TP, Silverberg EL, Behrendt DM. Usefulness of psychiatric intervention in patients undergoing cardiac surgery. Archives of General Psychiatry 1974;30:830‐5. - PubMed
Timmons 1993 {published data only}
    1. Timmons ME, Bower FL. The effect of structured preoperative teaching on patients' use of patient‐controlled analgesia (PCA) and their management of pain. Orthopaedic Nursing 1993;12(1):23‐31. - PubMed
Voshall 1980 {published data only}
    1. Voshall B. The effects of preoperative teaching on postoperative pain. Topics in Clinical Nursing 1980;2:39‐43. - PubMed
Wang 2002 {published data only}
    1. Wang AW, Gilbey HJ, Ackland TR. Perioperative exercise programs improve early return of ambulatory function after total hip arthroplasty. A randomized, controlled trial. American Journal of Physical Medicine and Rehabilitation 2002;81(11):801‐6. - PubMed
Wells 1986 {published data only}
    1. Wells JK, Howard GS, Nowlin WF, Vargas MJ. Presurgical anxiety and postsurgical pain and adjustment: effects of a stress inoculation procedure. Journal of Consulting and Clinical Psychology 1986;54(6):831‐5. - PubMed

References to studies awaiting assessment

Akinci 2015 {published data only}
    1. Akinci B, Yeldan I, Bayramoglu Z, Akpinar TB. The effects of posture and relaxation training on sleep, dyspnoea, pain and, quality of life in the short‐term after cardiac surgery: a pilot study. European Journal of Preventive Cardiology 2015;22(S1):S171‐2.
Angioli 2014 {published data only}
    1. Angioli R, Plotti F, Capriglione S, Aloisi A, Aloisi ME, Luvero D, et al. The effects of giving patients verbal or written pre‐operative information in gynecologic oncology surgery: a randomized study and the medical‐legal point of view. European Journal of Obstetrics & Gynecology and Reproductive Biology 2014;177:67‐71. - PubMed
Attias 2014 {published data only}
    1. Attias S, Keinan‐Boker L, Sroka G, Matter I, Arnon Z, Schiff E. The effectiveness of a generic guided imagery CD compared with individualized complementary therapies and standard of care for reducing preoperative anxiety: preliminary results. Journal of Alternative and Complementary Medicine 2014;20(5):A137.
Bergin 2014b {published data only}
    1. Bergin C, Speroni KG, Travis T, Bergin J, Sheridan MJ, Kelly K, et al. Effect of preoperative incentive spirometry patient education on patient outcomes in the knee and hip joint replacement population. Journal of Perianesthesia Nursing 2014;29(1):20‐7. - PubMed
Calsinski Assis 2014 {published data only}
    1. Calsinski Assis C, Lima Lopes J, Nogueira‐Martins L A, Bottura Leite de Barros AL. Embracement and anxiety symptoms in patients before cardiac surgery [Acolhimento e sintomas de ansiedade em pacientes no pré‐operatório de cirurgia cardíaca]. Revista Brasileira de Enfermagem 2014;67(3):401‐7. - PubMed
Chevillon 2014 {published data only}
    1. Chevillon C, Hellyar M, Madani C, Kerr K, Son Chae K. Preoperative education on postoperative delirium, anxiety, and knowledge in pulmonary thromboendarterectomy patients. American Journal of Critical Care 2015;24(2):164‐71. - PubMed
Chow 2014 {published data only}
    1. Chow KM, Chan CWH, Chan JCY, Choi KKC, Siu KY. A feasibility study of a psychoeducational intervention program for gynecological cancer patients. European Journal of Oncology Nursing 2014;18(4):385‐92. - PubMed
Dathatri 2014 {published data only}
    1. Dathatri S, Gruberg L, Anand J, Romeiser J, Sharma S, Finnin E, et al. Informed consent for cardiac procedures: deficiencies in patient comprehension with current methods. Annals of Thoracic Surgery 2014;97(5):1505‐12. - PubMed
Eckhouse 2014 {published data only}
    1. Eckhouse DR, Hurd M, Cotter‐Schaufele S, Sulo S, Sokolowski M, Barbour L. A randomized controlled trial to determine the effects of music and relaxation interventions on perceived anxiety in hospitalized patients receiving orthopaedic or cancer treatment. Orthopaedic Nursing 2014;33(6):342‐51. - PubMed
El Azem 2014 {published data only}
    1. Azem A, Benington PCM, Khambay BS, Ayoub AF. Evaluation of an interactive multi‐media device for delivering information on Le Fort I osteotomy. Journal of Cranio‐Maxillofacial Surgery 2014;42(6):885‐9. - PubMed
Ellett 2014 {published data only}
    1. Ellett L, Villegas R, Beischer A, Ong N, Maher P. Use of a multimedia module to aid the informed consent process in patients undergoing gynecologic laparoscopy for pelvic pain: randomized controlled trial. Journal of Minimally Invasive Gynecology 2014;21(4):602‐11. - PubMed
Foji 2015 {published data only}
    1. Foji S, Tadayonfar MA, Mohsenpour M, Rakhshani MH. The study of the effect of guided imagery on pain, anxiety and some other hemodynamic factors in patients undergoing coronary angiography. Complementary Therapies in Clinical Practice 2015;21(2):119‐23. - PubMed
Fraval 2015 {published data only}
    1. Fraval A, Chandrananth J, Chong YM, Tran P, Coventry LS. Internet based patient education improves informed consent for elective orthopaedic surgery: a randomized controlled trial. BMC Musculoskeletal Disorders 2015;16:14. - PMC - PubMed
Furuya 2015 {published data only}
    1. Furuya RK, Arantes EC, Dessotte CAM, Ciol MA, Hoffman JM, Schmidt A, et al. A randomized controlled trial of an educational programme to improve self‐care in Brazilian patients following percutaneous coronary intervention. Journal of Advanced Nursing 2015;71(4):895‐908. - PubMed
Gade 2014 {published data only}
    1. Gade H, Hjelmesæth J, Rosenvinge JH, Friborg O. Effectiveness of a cognitive behavioral therapy for dysfunctional eating among patients admitted for bariatric surgery: a randomized controlled trial. Journal of Obesity 2014;2014:127936. - PMC - PubMed
Gillis 2014 {published data only}
    1. Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 2014;121(5):937‐47. - PubMed
Gyulaházi 2015 {published data only}
    1. Gyulaházi J, Varga K, Iglói E, Redl P, Kormos J, Fülesdi B. The effect of preoperative suggestions on perioperative dreams and dream recalls after administration of different general anesthetic combinations: a randomized trial in maxillofacial surgery. BMC Anesthesiology 2015;15:11. - PMC - PubMed
Hansen 2015 {published data only}
    1. Hansen MM. A feasibility pilot study on the use of complementary therapies delivered via mobile technologies on Icelandic surgical patients' reports of anxiety, pain, and self‐efficacy in healing. BMC Complementary & Alternative Medicine 2015;15:92. - PMC - PubMed
Henney 2014 {published data only}
    1. Henney S, Irving R. Prospective, randomised, controlled trial comparing delivery of patient information for functional endoscopic sinus surgery via website versus printed leaflet. Journal of Laryngology & Otology 2014;128(3):249‐54. - PubMed
Heras 2014 {published data only}
    1. Heras P, Natsis V, Sirbilantze T. Preventing anxiety and depression in breast cancer: a randomized controlled trial. Supportive Care in Cancer 2014;22:S175‐6.
Hoppe 2014 {published data only}
    1. Hoppe DJ, Denkers M, Hoppe FM, Wong IH. The use of video before arthroscopic shoulder surgery to enhance patient recall and satisfaction: a randomized‐controlled study. Journal of Shoulder and Elbow Surgery 2014;23(6):e134‐9. - PubMed
Huber 2015 {published data only}
    1. Huber EO, Roos EM, Meichtry A, Bie RA, Bischoff‐Ferrari HA. Effect of preoperative neuromuscular training (NEMEX‐TJR) on functional outcome after total knee replacement: an assessor‐blinded randomized controlled trial. BMC Musculoskeletal Disorders 2015;16:101. - PMC - PubMed
Johansson 2007 {published data only}
    1. Johansson K, Salanterä S, Katajisto J. Empowering orthopaedic patients through preadmission education: results from a clinical study. Patient Education and Counseling 2007;66:84‐91. - PubMed
Kol 2014 {published data only}
    1. Kol E, Alpar SE, Erdoğan A. Preoperative education and use of analgesic before onset of pain routinely for post‐thoracotomy pain control can reduce pain effect and total amount of analgesics administered postoperatively. Pain Management Nursing 2014;15(1):331‐9. - PubMed
Lai Ngor 2014 {published data only}
    1. Lai Ngor C, Lai CKY. The effect of patient education with telephone follow‐up on wound healing in adult patients with clean wounds: a randomized controlled trial. Journal of Wound, Ostomy & Continence Nursing 2014;41(4):345‐55. - PubMed
Lookinland 1998 {published data only}
    1. Lookinland S, Pool M . Study on effect of methods of preoperative education in women. Association of Operating Room Nurses Journal 1998;67(1):203‐13. - PubMed
Louw 2014 {published data only}
    1. Louw A, Diener I, Landers MR, Puentedura EJ. Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1‐year follow‐up. Spine 2014;39(18):1449‐57. - PubMed
Mohammadi 2014 {published data only}
    1. Mohammadi A, Mirbagher Ajorpaz N, Torabi M, Mirsane A, Moradi F. Effects of music listening on preoperative state anxiety and physiological parameters in patients undergoing general surgery: a randomized quasi‐experimental trial. Central European Journal of Nursing & Midwifery 2014;5(4):156‐60.
Novick 2014 {published data only}
    1. Novick BJ, Angie M, Walker E, Kitay R, Monday K, Albert NM. The effect of intensive education on urinary incontinence following radical prostatectomy: a randomized control trial. Urologic Nursing 2014;34(5):246‐51. - PubMed
Paul 2015 {published data only}
    1. Paul L, Rongen S, Hoeken D, Deen M, Klaassen R, Biter LU, et al. Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. Contemporary Clinical Trials 2015;42:252‐6. - PubMed
Rolving 2014 {published data only}
    1. Rolving N, Nielsen CV, Christensen FB, Holm R, Bunger C, Østergaard L. Does a preoperative cognitive‐behavioural intervention affect postsurgical pain, mobilisation and length of hospitalisation in lumbar spinal fusion patients?. European Spine Journal 2014;23(5 (Suppl)):S572.
Saleh 2015 {published data only}
    1. Saleh AJ, Tang GX, Hadi SM, Yan L, Chen MH, Duan KM, et al. Preoperative cognitive intervention reduces cognitive dysfunction in elderly patients after gastrointestinal surgery: a randomized controlled trial. Medical Science Monitor 2015;21:798‐805. - PMC - PubMed
Shahmansouri 2014 {published data only}
    1. Shahmansouri N, Janghorbani M, Salehi Omran A, Karimi AA, Noorbala AA, Arjmandi A, et al. Effects of a psychoeducation intervention on fear and anxiety about surgery: randomized trial in patients undergoing coronary artery bypass grafting. Psychology, Health & Medicine 2014;19(4):375‐83. - PubMed
Umpierres 2014 {published data only}
    1. Umpierres CS, Ribeiro TA, Marchisio ÂE, Galvão L, Borges ÍNK, Souza Macedo CA, et al. Rehabilitation following total hip arthroplasty evaluation over short follow‐up time: randomized clinical trial. Journal of Rehabilitation Research & Development 2014;51(10):1567‐78. - PubMed
Van Acker 2014 {published data only}
    1. Acker MM, Kuriata MA. Video education provides effective wound care instruction pre‐ or post‐Mohs micrographic surgery. Journal of Clinical and Aesthetic Dermatology 2014;7(4):43‐7. - PMC - PubMed
West 2014 {published data only}
    1. West AM, Bittner EA, Ortiz VE. The effects of preoperative, video‐assisted anesthesia education in Spanish on Spanish‐speaking patients' anxiety, knowledge, and satisfaction: a pilot study. Journal of Clinical Anesthesia 2014;26(4):325‐9. - PubMed
Würtzen 2015 {published data only}
    1. Würtzen H, Dalton SO, Christensen J, Andersen KK, Elsass P, Flyger HL, et al. Effect of mindfulness‐based stress reduction on somatic symptoms, distress, mindfulness and spiritual wellbeing in women with breast cancer: results of a randomized controlled trial. Acta Oncologica 2015;54(5):712‐9. - PubMed
Xin 2015 {published data only}
    1. Xin YH, Xiao CR. Effect of holistic health education prescription in colorectal cancer patients undergoing surgery. World Chinese Journal of Digestology 2015;23(2):338‐42.

References to ongoing studies

Hansen 2013 {published data only}
    1. Hansen MM. Impact of complementary therapies via mobile technologies on Icelandic same day surgical patients' reports of anxiety, pain and self‐efficacy in healing: A randomized controlled trial in process. Studies in Health Technology & Informatics 2013;192:1165. - PubMed
Jong 2012 {published data only}
    1. Jong M, Pijl A, Gast H, Sjoling M. The effects of guided imagery on preoperative anxiety and pain management in patients undergoing laparoscopic cholecystectomy in a multi‐centre RCT study. BMC Complementary and Alternative Medicine 2012;12(Suppl 1):184.

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