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The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol

Majid, Norhaini RN, MN; Lee, Susan RN, PhD; Plummer, Virginia RN, PhD

Author Information
JBI Database of Systematic Reviews and Implementation Reports: January 2015 - Volume 13 - Issue 1 - p 122-133
doi: 10.11124/jbisrir-2015-1950
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Inclusion criteria

Types of participants

This review will consider studies that include adult patients above 18 years old requiring elective orthopedic surgery in inpatient and outpatient settings.

Types of interventions

This review will consider studies that evaluate education programs of any type and any duration including:

1. Patient education (includes pre or post admission education interventions)

2. Perioperative education (includes pre or post-operative education interventions)

3. Discharge education.

Education program offered by multidisciplinary health professionals such as nurses, physiotherapists, or physicians will be included in this review.

Types of outcomes

This review will consider studies that include the following outcome measures:

1. Length of stay (e.g. discharge standard)

2. Satisfaction (e.g. Cantril Life Satisfaction Ladder)

3. Pain level (e.g. Visual Analogue Scale [VAS])

4. Cost of care (e.g. a Preoperative Costs [PC] instrument)

5. Functional abilities (e.g. the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC])

6. Knowledge (e.g. Orthopedic Patient Knowledge Instrument)

7. Anxiety (e.g. State-Trait Anxiety Scale Inventory [STAI])

8. Quality of life (e.g. Short Form [36] Health Survey [SF-36]).

Types of studies

This review will consider both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross-sectional studies for inclusion.

This review will also consider descriptive study designs including case series, individual case reports and descriptive cross sectional studies for inclusion.

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. Due to the limited resources available to undertake this review, only studies published in English will be considered for inclusion in this review. Studies from 2003 to 2013 will be included in this review following systematic review by Johansson et al.7 which had covered published studies until 2003.

The databases to be searched include:







The search for unpublished studies will include:


Grey literature

National Medical Research Registry (Malaysia)

Monash repository.

Initial keywords to be used will be:

patient education

health education

discharge education

pre-operative education

post-operative education

orthopedic nursing

length of stay


pain level

cost of care

functional ability



quality of life.

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

Data collection

Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question, and specific objectives.

Data synthesis

Quantitative data will, where possible be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard Chi-square and also explored using subgroup analyses based on the different study designs included in this review. Where statistical pooling is not possible the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

Conflicts of interest

The authors have no relevant disclosures to make and there is no conflict of interest regarding this systematic review.


This review will partially fulfil degree requirements for successful completion of the Doctor of Philosophy at Monash University, School of Nursing and Midwifery, Australia.


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                  Appendix I: Appraisal instruments

                  MAStARI appraisal instrument

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                  Appendix II: Data extraction instruments

                  MAStARI data extraction instrument

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                  orthopaedic; patient education; pre-operative education

                  © 2015 by Lippincott williams & Wilkins, Inc.