PREVIEW NOTES
Effects of telemonitoring of the post-operative period of cataract surgery on the part of elderly patients: a randomized clinical trial
Tallita Mello Delphino1, Rosimere Ferreira Santana1
1Fluminense Federal University
ABSTRACT
Problem: Cataract extraction surgery has become increasingly frequent and, therefore, there is a need for strategies to assist surgical recovery and the post-operative follow-up of patients.
Aims: To test the effect of phonecall follow-up intervention compared with conventional treatment of elderly patients in the post-operative period of cataract surgery; to analyze the impact of nursing diagnosis on delayed surgical recovery over four weeks in a group monitored by phone and in a control group.
Method: a blind randomized clinical trial that is currently being conducted in a university hospital in the city of Niterói/RJ. The sample, obtained by sample calculation using the statistical analysis suggested by Pocock (1983), will be 48 individuals, equally and randomly divided into experimental and control groups.
Descriptors: Elderly; Cataract Extraction, Telenursing, Postoperative Care.
THE SITUATION AND ITS SIGNIFICANCE
As we age, the vulnerability to common diseases such as cataracts(1) - as well as their prevalence – increases on the part of the elderly. This condition can be reversed by cataract extraction surgery which enables the restoration of vision(1).
Certain strategies have been used to carry out the follow-up of such patients and the early and efficient detection of any problems. The use of telephone monitoring, which is related to the continuity of care in the post-operative period, involving the offer of relevant education and guidance as needed, is included in these strategies(2).
Given the above, the study is justified by the continuing increase in the elderly population and, consequently, the increase in surgical procedures such as cataract extraction, supported by the advancement of information technology in health, including telephony.
RESEARCH QUESTION
What is the effect of nursing follow-up telephone call intervention on the surgical recovery of cataract extraction elderly patients?
AIMS
METHOD
This is a randomized, blinded clinical trial to evaluate the use of follow-up by phone as an intervention in the surgical post-operative recovery of cataract surgery elderly patients, monitored in the ophthalmology clinic of a university hospital in the city of Niterói/RJ. For randomization, we used the software BioEstat 5.3.
The blind group will consist of two examiners expert in the diagnostic evaluation of delayed surgical recovery who had previously passed diagnostic training. Data collection will be undertaken between January and July 2015.
The sample will consist of 48 elderly patients hospitalized in order to undergo cataract extraction surgery (24 patients in the experimental group and 24 in the control group) determined by sample size calculation according to the Pocock’s statistical analysis (1983) (Figure 1), in which P1 = % of events in the experimental group, P2 = % of events in the control group and f = frequency of alpha and beta errors.
| Figure 1 - The formula for sample size calculation, according to Pocock’s statistical analysis (1983) |
The parameters used to calculate the sample were: level of significance of 5% (α); power of the statistical test of 80% (1-β) and the expected difference in delta incidence (end - start) between the groups of 30%, obtained by a pilot study involving 16 patients (8 in each group) carried out from October to December 2014.
Inclusion criteria: elderly patients treated by the hospital ophthalmology service and undergoing pre-operative cataract surgery, who have a cell phone or a landline available.
Exclusion criteria: diagnosis of dementia; hearing impairment without assistance to receive phone interventions; having undergone previous surgery for the treatment of pre-surgical complications; patients unaccompanied or without family members who can get the information if required.
Discontinuity criteria: receiving less than 75% of the phone calls; not having time to receive guidance on the phone.
The experimental group will have access to the intervention in terms of phone monitoring and also to conventional follow-up, both involving four contacts in the four-week period (Figure 2), monitored for delayed surgical recovery by the measurement instrument used in the clinic.
Legend: = Pre-operative evaluation;
= Post-operative evaluations with follow-up of delayed surgical recovery (RCR) by instrument;
= Telephone follow-up.
Figure 2 - Description of the research progress on the part of the experimental group (n=24), Niterói, 2014.
The control group will be monitored on an outpatient basis for four weeks after surgery for the diagnosis of delayed surgical recovery, with conventional treatment only (Figure 3).
| Figure 3 - Description of the research design on the control group n 24. Niterói, 2014 |
Legend: = Pre-operative evaluation;
= Post-operative evaluations with follow-up of delayed surgical recovery (RCR) by instrument.
Figure 3 - Description of the research design on the control group (n=24), Niterói, 2014.
The analysis will be made through simple and inferential descriptive statistics processed using the SAS® System version 6.11 statistical software. Initially, the normality test using the Shapiro-Wilk test will be performed.
Data will be expressed by the frequency (n) and percentage (%) for categorical data, and the mean, standard deviation, median, minimum and maximum for numeric data. To check for significant differences in the social and demographic variables between the groups, chi-square test for categorical data and Student's t-test with independent samples of the numeric data will be used. The McNemar corrected test will serve to analyze the evolution of the defining characteristics and related factors of diagnosis throughout treatment within each group. Values of p≤0.05 will be considered to be statistically significant.
The project was approved on 09.19.2014 by the Ethics Committee of the University Hospital Research Antonio Pedro, under opinion number 791 556, as recommended by the National Health Council Resolution 466/12.
REFERENCES
1. Pereira, MCSR, Krieger, MAL, Mariushi, AC, Moreira, H. Perfil epidemiológico de pacientes com catarata traumática no Hospital de Olhos do Paraná. Rev Bras Oftalmol. [ internet ] 2012 [ cited 2014 Jun 2 ] 71 (4): 236-40. Available from: http://www.scielo.br/scielo.php?pid=S0034-72802012000400006&script=sci_arttext. doi: http://dx.doi.org/10.1590/S0034-72802012000400006
2. Lin H, Chen W, Luo L, Congdon N, Zhang X, Zhong X, Liu Z, Chen W, Wu C, Zheng D, Deng D, Ye S, Lin Z, Zou X, Liu Y. Effectiveness of a short message reminder in increasing compliance with pediatric cataract treatment: a randomized trial. Ophthalmology. [ internet ] 2012 Dec [ cited 2014 Jun 9 ] 119(12):2463-70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22921386. doi: http://dx.doi.org/10.1016/j.ophtha.2012.06.046
3. Herdman TH, Kamitsuru S. NANDA International Nursing Diagnoses: Definitions & Classification 2015-2017. Oxford: Wiley Blackwell; 2014.
Project data
Examination board formed by prof. Dr. Rosimere Ferreira Santana (advisor), prof. Dr. Norma Valeria Souza Dantas de Oliveira (1st examiner) and prof. Dr. Rose Mary Costa Rosa Andrade Silva (2nd examiner).
Received: 01-12-2014
Revised: 01-13-2015
Approved: 01-23-2015