Self-Management of Pain After Cardiac Surgery

The Journal of Medical Internet Research article titled, Web Based Nursing Intervention for Self-Management of Pain After Cardiac Surgery: Pilot Randomized Trial, utilizes an intervention to address the attitudes, and false information surrounding pain and pain management after surgery to determine whether pain will be affected (Craig & Smyth, 2012).
Appraisal of key aspects of the study is helpful in determining validity, reliability, bias and interpretation of results (Placeholder1). The focused study question sought to assess the SOULAGE-TAVIE intervention’s effect on pain as evaluated by several measurement tools such as pain intensity as measured by a numeric scale, pain’s interference with recovery activities such as coughing and walking, barriers to pain, and catastrophizing about pain, and analgesics administered (Craig & Smyth, 2012). The population of patients were adult, French speaking, undergoing elective, first time cardiac surgery (sternotomy) (Craig & Smyth, 2012). The pilot study was a randomized controlled trial (RCT) and single-blinded (Craig & Smyth, 2012), a factor that strengthens the study’s reliability; it is an appropriate method for a quantitative study such as this (Placeholder1). The participants completed baseline measurements and provided descriptive information such as socioeconomic, demographic, and psychological data; then based on the data they were assigned to a group by use of computer using randomization software that (Craig & Smyth, 2012).The groups were determined to have equivalence between the groups (Craig & Smyth, 2012). An associate not involved with this study prepared the lists and the associated envelopes (Craig & Smyth, 2012). The research assistant who gathered the information during the two face-to-face sessions was blinded; the nurse who reviewed the medical records was blinded to those in each group but the records themselves were not blinded (Craig & Smyth, 2012). The principal researcher’s and assistant’s roles were not known to the staff and they were blinded to the members in each group (Craig & Smyth, 2012). All the approached patients, as well as, participants were accounted for in the study (Craig & Smyth, 2012). There were 60 participants with 30 participants in each group; 52 participants were analyzed, four participants who failed to receive the designated intervention in the control group, and eight participants were not analyzed because pain evaluations were unavailable (Craig & Smyth, 2012). To rule out the results being determined by chance, a power calculation was not planned because this was a pilot study (Craig & Smyth, 2012).Bias could have been compromised during the post-operative face-to-face sessions (Craig & Smyth, 2012). Pain assessments were obtained from the same person which could contribute to a bias towards practitioner effect; conversely, this same situation could increase the consistency in interventions received (Craig & Smyth, 2012).
Overall, most of the appraisal questions strengthened the study’s validity; however, several considerations diminished the study’s validity such as not computing a power calculation for number of participants to determine statistical significance (although this was not required for a pilot study), four participants who did not receive the designated intervention in control group, and possible areas of study bias (Craig & Smyth, 2012). Overall, the study was reliable because 52 of participants received interventions and evaluations consistent with the allocated group (Craig & Smyth, 2012); additionally, the study could be repeated (Placeholder2).
Results were obtained by the analyses completed utilizing an alpha =.05 level of significance (Craig & Smyth, 2012). In addition, the pain outcomes and associated evolution was measured with 2-way analysis of variance (ANOVA) (Craig & Smyth, 2012). There was no significant difference between the control group in pain intensity and catastrophizing about the pain; however, the experimental group stated that pain interfered less when coughing and walking than the control group (Craig & Smyth, 2012). The experimental group also reported fewer pain barriers and received higher levels of opioid medications than the control group (Craig & Smyth, 2012). The SOULAGE-TAVIE web based intervention did not result in less intense pain; however, it did decrease pain interference with activities, coughing and walking, critical to postoperative recovery in the experimental group (Craig & Smyth, 2012). The experimental group also received more analgesic suggesting that attitudes towards pain and pain management had changed (Craig & Smyth, 2012).
The study shows promise in assisting patients in the management of acute pain through this innovative web based delivery system that targets attitudes and misinformation about pain relief medications; although, further study is required to determine efficacy (Craig & Smyth, 2012).

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