Effect of Feedback Health Education on Postoperative Rehabilitation of Patients With Lumbar Disc Herniation
Condition: Lumbar Disc Herniation
MeSH terms: Intervertebral Disc Displacement; Hernia
Study type: Interventional

Summary: 
      Aims and Objective: A theoretical model based on guided postoperative rehabilitation with
      feedback was developed for patients with lumbar intervertebral disc protrusion to explore the
      effects of feedback-based health education. Patients were assessed in terms of disease
      knowledge, general self-efficacy, medical behaviour, and the Oswestry disability index (ODI).
      During postoperative rehabilitation, nursing staff provided health education regarding lumbar
      intervertebral disc protrusion.
    

Detailed description: 
      Grouping method For the surgical treatment of lumbar intervertebral disc protrusion. The age
      of the included patients was greater than or equal to 18 years. Patients were cluster
      randomized by a coin toss into an experimental group that underwent spine surgery and a
      control group; 38 cases were included in each group for a total of 76 cases, and patients
      were assigned to the experimental and control groups in a 1:1 ratio, ensuring balance between
      groups. During implementation of the intervention, 1 patient in the control group voluntarily
      requested to withdraw from the study midway through the study, and the loss to follow-up rate
      was 2.6%. Finally, a total of 75 patients were included in this study, including 38 in the
      experimental group and 37 in the control group.

      3 Test group

      (1) Implementation of the feedback method includes information transmission, patient
      feedback, clarification and correction, and confirmation of understanding

      ① Conveying health information Medical terms were transformed into plain language so that
      patients could easily understand the health education content. The feedback method was used
      to explain the pathogenesis of LDH as protrusion or degeneration of the collodium supporting
      the lumbar spine and rupture of the cartilage protecting the lumbar spine. The protruding
      collodium compresses the nerve root, leading to pain in the back and leg.

        -  Patient feedback After a health message was delivered, the patient was asked to repeat
           the information back in his own words with the following question: To make sure I'm
           clear, could you repeat the pathogenesis for me?

           ③ Educator clarification and correction If the patient had mastered the relevant
           information, the health education session was ended. If the patient understood some or
           no information, the steps were repeated, and the educator continued to explain the
           concept to the patient but changed the way he or she expressed it.

           ④ Checking understanding Finally, open questions such as the following were used to
           confirm the patient's understanding: Do you have any other questions? The patients were
           then given a chance to sort out the health information.

           (2) Patients in the test group received health education according to the feedback
           method, and the intervention contents and time were as follows:

           ① One day before surgery: Health education team members provided bedside one-on-one
           education for patients, 15-20 min per session, twice a day. Health education manuals and
           other tools were used to explain information related to lumbar intervertebral disc
           herniation, including the pathogenesis of LDH, clinical manifestations, the significance
           of relevant examinations, the principle of surgical treatment, and the importance of
           exercising according to the guidance of doctors, to the patient. The main problem before
           LDH was pain in the waist and legs, so the patients were advised to take medication and
           taught how to take neurotropin, mecobalamine, Celebrex and other drugs.

        -  One week after surgery: One-on-one education on rehabilitation exercise was conducted
           for the patients by the health education team members, 15-20 min per session, twice a
           day.

      Day of surgery: The main concerns of the patients were wound pain and axial rolling. After
      returning to the ward, the patients were taught about pain and the correct use of the
      analgesic pump.

      One week after surgery: The main concerns of the patients were waist circumference and
      methods of rehabilitation exercise. Patients were instructed to perform straight leg raising
      exercises, ankle pump exercises and quad contraction exercises, 10~20 times/session, 3
      sessions/day. If the patient understood the relevant knowledge and completed the
      rehabilitation exercise, the patient was affirmed and encouraged in the form of award
      certificates, and the "Best Cooperation Award", "Best Progress Award", "Most Confidence
      Award", "Three Good Fellow Award", etc., were used to enhance the patient's self-confidence,
      sense of honour and sense of achievement in rehabilitation exercise. In terms of discharge
      guidance, patients were told to go home and continue to perform functional exercise.

      ③ Two to four weeks after surgery: The main concerns of patients were functional exercise and
      daily life activities. The health education group members guided the patients through
      functional rehabilitation exercises via WeChat. Each intervention lasted 20-30 min. The
      patients interacted once through WeChatB1, and their questions were answered at any time.
      Patients were instructed to perform head lifting training in the prone position, a wood
      rolling exercise, walking training (waist-assisted) and supine hip flexion and knee flexion
      exercises, 5-10 min/session, 3 sessions/day. Patients were required to sign in after
      receiving new exercises and give feedback. Patients were required to "send a video of
      themselves performing functional exercise to the group", and the health education team
      members corrected any incorrect movement or frequency, answered their questions, and
      confirmed whether they understood until they had fully mastered the correct methods for the
      functional exercise. WeChat pushed small pieces of information twice via a link.

      ④ Five to 12 weeks after surgery: the main concerns of patients were functional exercise
      methods, such as five-point support, and other matters needing attention. The health
      education group members guided patients through the functional rehabilitation exercises via
      WeChat. Each intervention lasted 20~30 min, and WeChat was used for both sessions.

      4 Control group: The patients underwent routine health education.
    

Intervention name(s): Feedback-based health education; Routine health education
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This study was approved by the Tianjin Hospital Ethics Committee, (2019082).The CONSORT 2010 statement: extension to cluster-randomised trials checklist.(Campbell et al., 2012) was used to guide reporting outcomes (File S1).Specific measures have been listed above.; Routine health education was given to the patients, and the content of health education was the same as that of the experimental group, including the introduction of the disease, clinical manifestations, significance of examination, therapeutic principles of operative methods, psychological nursing, and postoperative rehabilitation exercise, etc. To verify the effect of health education by feedback method.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The methods were based on previous research on the feedback method of health education. A cluster randomized controlled trial design was used. From March 2019 to January 2020, patients who underwent spinal surgery at Tianjin Hospital were enrolled, and 76 met the inclusion criteria for lumbar disc disease (lumbar disc herniation, LDH). Patients were divided into an experimental group and a control group, with 38 patients in each group. Feedback-based health education was conducted for the experimental group, and routine health education was provided for the control group.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Feedback method; Health education; Functional exercise