Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Research Protocol
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : UK01 - UK03 Full Version

Assessment of Behavioural Preparedness on Recovery Outcomes in Patients Undergoing Abdominal Surgeries


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/59853.17262
KS Uplabdh Gopal, Shreya Vikas Venurkar, Aditij Dhamija, Suhas Narayandas Jajoo

1. Intern, Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 2. Undergraduate Student, Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 3. Undergraduate Student, Department of Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, Karnataka, India. 4. Professor, Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.

Correspondence Address :
KS Uplabdh Gopal,
Intern, Department of Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
E-mail: uplabdhgopal@gmail.com

Abstract

Introduction: Behavioural preparedness is the process of preparing patients for the psychological and emotional challenges that may be encountered during and after surgery. This can include providing education about the surgical procedure and postoperative recovery, as well as training in coping strategies and techniques to manage anxiety, fear, and other negative emotions. Prior sensitisation is a form of behavioural preparedness that involves providing patients with information about the potential outcomes of their surgery in advance, in order to help them better understand and prepare for potential challenges. It has been suggested that providing this type of education and training may reduce patient anxiety, increase co-operation with medical staff, and improve recovery, potentially leading to shorter hospital stays and reduced medication needs.

Aim: To assess the effects of behavioural preparedness and prior sensitisation on psychological aspects, recovery outcomes, and user satisfaction in patients undergoing abdominal surgeries.

Materials and Methods: The study will be undertaken on patients in the Inpatient Department (IPD) of Department of Surgery in a rural tertiary care hospital in central India, during a period spanning two months. All adult patients (aged 18-60) undergoing elective abdominal surgical procedures under anaesthesia in the IPD of surgery will be eligible. The patients will be randomly selected and interviewed preoperatively, dividing them into two groups those receiving the intervention and those receiving standard care with no intervention. The investigator will provide an oral presentation to the intervention group regarding their recovery outcomes and expectations. Subjects will be evaluated with a Visual Analog Scale (VAS) scale for pain, RAND Short Form health Survey (SF-36) questionnaire for physical mobility, RAND Patient Satisfaction Questionnaire III (PSQ-18) instrument for user satisfaction, length of hospital stay and analgesic switchover time on a survey form and the Spielberger State-Trait Anxiety Inventory (STAI) forms Y1 and Y2 for comparison of preoperative and postoperative negative affects. Effects of the intervention on recovery outcomes will be compared via the Chi-square test, the Mann-Whitney U test for comparison of qualitative data between the two groups and the Student’s Unpaired t-test for comparison of quantitative data between the groups. Wilcoxon’s Signed Rank test and the Student’s paired t-test will be used for analysing qualitative and quantitative input between preoperative and postoperative states.

Conclusion: The study seeks to determine if a significant difference occurs from providing patients withprior knowledge about their outcomes and establishing the benefits of psychological preparedness as a cost-effective method in improving outcomes and postoperative recovery.

Keywords

Elective surgery, Postoperative pain, Recovery outcomes, User satisfaction

Surgery and invasive medical approaches are unconscionably daunting and psychologically threatening. They may have a negative impact on the patient’s ability to take care of themselves, their socio-economic status, and their family structure, which might have long-term consequences. Patients undergoing such procedures may be prone to overwhelming emotions such as anxiety, aggression, and fear, which, in a medical setting, might render them unable to co-operate with doctors and other medical staff translating to illeffects, failure in compliance with treatment and/or an upturn in medications. Human behaviour is of paramount importance in the determination of health and hence, behavioural interventions that influence the adaptive responses of patients to dire stress and its outcomes have become the need of the hour. Cognitive, behavioural strategies as a form of “evidence-based” interventions to better delve into the information processing of the patient to their milieu, are required to engage in our understanding of perception, user satisfaction and personality variables like denial and anger.

A rational approach to injuries can be encouraged by challenging the negative aspects of its consequences and focusing on mitigating irrational patterns. Potential benefits from such a method are large and may have considerable applications such as the one to be discussed in this study seeking to modify postoperative feelings of pain, duration of stay and other parameters via prior sensitisation and/or training of the patients regarding the outcomes of their morbidities. Patient beliefs relating to the surgery and their ability to comprehend and better process emotional states during recovery are directly related to hastened recovery and early physical mobility (1).

The anxiety of a patient in the absence of information that enables him to make sense of his condition is a major factor in both, pre-and postoperative states. A single reason has not been found out but theories of patient aggression and fear preoperatively directly relating to postoperative adjustment have been proposed (1). Thus, adding a behavioural/cognitive component in the preparation of invasive surgeries reduces patient anxiety and increases co-operation, speeding up recovery and reducing the duration of hospital stay and analgesic requirement (1). The modern-day advent of cheap access to the internet, especially to multiple search engines, acts as a dual-edged sword by providing mere information to patients without a practical correlation to their present scenario, thus inviting anxiety and lack of a reasonable degree of care on their part. With a need for research and implementation of the same in India, safe, flexible, and effective preoperative education strategies are hence required to create awareness.

The main aim of the study is to compare the psychological aspects and variables in patients having prior sensitisation about their surgical outcomes to those not receiving the intervention in the adult age group and review the effects of behavioural preparedness on hospital stay, medication requirement, recovery and user satisfaction among patients of the two groups.

Material and Methods

The cross-sectional study will be undertaken on patients in the Inpatient Department (IPD) of the Department of Surgery in a rural tertiary care hospital in central India, during a period of two months. Due clearance from the Institutional Ethics Committee (IEC) has been taken for the study (Reference: DMIMS(DU)/IEC/2021/425).Informed consent for participation will be obtained from the patients before surgery, at the preoperative stage, and a careful and simple explanation of the study and its intended outcomes will also be provided to them.

Inclusion criteria:

• Adult patients (between ages of 18 and 60) undergoing elective abdominal surgical procedures under general anaesthesia.
• Patients attending the IPD of surgery.
• Willing and conscious patients consenting to the study.

Exclusion criteria:

• Patients requiring emergency surgeries or with severe morbidities requiring successive/extensive surgeries.
• Patients with clinically diagnosed psychiatric disorders.
• Patients receiving medication in the form of sedatives.

Proposed Intervention: Psychological/behavioural preparation are preoperative interventions involving a myriad of strategies designed to impact the cognition of a person and the following types of interventions will be employed as per findings (1),(2),(3). Procedural information, sensory information, behavioural instruction, relaxation techniques, cognitive and emotion-focused interventions (4).

• Procedural information: Describes the procedure that the patient will undergo explaining the “What, How and When” of the procedure.
• Sensory information: Describes how the procedure will feel like or other relevant experiences such as taste or smell sensations.
• Behavioural instruction: Will include informing the patients of facilities/ways that would enable a safe and efficient recovery, for example, proper usage of medical equipment.
• Cognitive interventions: Aim to change how the patients think and respond to the negative aspects of the process. This can be undertaken by cognitive reframing and distraction, for example, focusing thoughts on other things which also includes relaxation.
• Relaxation techniques: Involve instructions aimed at reducing sympathetic arousal, to cause muscle relaxation and a state of calmness and may be used to reduce tension and anxiety preoperatively. These include Guided imagery (visualisation/distraction to an imaginary “pleasant” place), breathing techniques (for example, diaphragmatic breathing), simple relaxation or meditation.
• Emotion-focused interventions: enable patients to become more equipped to process their emotional states and include discussion, acceptance and giving them context.
• Hypnosis: Not applicable in the current scenario.

Sample size: Due to a lack of a defined standard deviation and expected significant difference, the sample size will include at least 30 participants, divided into two groups, in an equal ratio of 15 per group reflecting on a previous study (5),(6).

The patients will be selected and interviewed preoperatively and postoperatively with due consent thus dividing them into two groups, one receiving the intervention, and one receiving standard care with no intervention.

(1) The control group will receive standard hospital care practices including preoperative check ups for anaesthesia and general 2concern about adverse activities such as coughing after surgery.
(2) The intervention group will receive a pamphlet or an oral presentation describing the sensations and effects likely to be experienced during the procedure and will include descriptions on skin and intravenous preparation, postoperative diet, effects of medications, relaxation techniques and information of the postoperative state (bloating, cramps, dryness of mouth).
(3) Data will be recorded on special e-survey forms designed by the author keeping the basic structure of the selected scales intact.

Consent will be obtained preoperatively along with an interview for the negative affects scale, to contrast with the one that will be conducted postoperatively.

Comparison: No treatment concurrent control groups (typically standard care and/or attention control).

Assessment criteria: The selected patients will be evaluated on certain psychological aspects and personality variables. They will also be assessed on postoperative pain and acceptance, along with the requirement for medications or switching from injectable to oral analgesic duration, hospital stay and user satisfaction via various methods, which are described under the following heads:

i. Postoperative pain Intensity prioritising self-report and sensory pain: The pain Visual Analogue Scale (VAS) will be employed on conscious patients which is a continuous, single item scale which may be a horizontal or a vertical line, usually 10 cm (100 mm) in size, with two graphical or verbal indicators at each end relating to the severity of pain, ranging from ‘No pain felt’ to “Worst pain imaginable’ (7).

• The patients will be asked to report on their current pain or intensity over the last 24 hours.
• Using a ruler, the score will be determined by measuring the distance (mm) on the scale between the two anchors having been allocated scores of’0’ and ‘100’.
• A higher score indicates a greater intensity and from previous studies, the following cut-points are recommended: no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), and severe pain (75-100 mm) (8).

ii. Behavioural Recovery relating to physical mobility and restoration of performance: The RAND 36 item Health Survey (version 1.0) or Short Form health Survey (SF-36) developed by the RAND Corporation as part of the Medical Outcomes Study (MOS) is a set of generic, easy to understand and easy to administer quality of life measures. The survey utilises self-reporting as a measure to tap into concepts such as physical functioning, bodily pain, limitation in roles due to physical/emotional problems, social and emotional well-being, energy, and general perceptions about health (9).

• Scoring is a two-step process that involves recording the numerical value assigned to a particular answer, subsequently averaging certain specific items to create scales (physical functioning, role limitation and so on...) and finally calculating for measures of central tendency and variability in the scales.

iii. Length of Hospital Stay (in days): Including the day of discharge, will be analysed for outcomes of recovery.
iv. Switchover from injectable to oral analgesic time (in days): will be obtained from patient records.
v. User satisfaction: The short form of Patient Satisfaction Questionnaire III (PSQ-18) instrument (10) developed by the RAND Corporation deals with the development of psychometric properties and taps into dimensions of medical care satisfaction such as general satisfaction, technical quality, communication, accessibility, convenience, etc… and is analysed in the same manner as the SF-36 instrument via a two-step process of recording pre-assigned values and calculating averages of the scales created.

vi Preoperative and postoperative negative affects/mood: The Spielberger State-Trait Anxiety Inventory (STAI) is a psychological inventory that relies on a 4-point Likert scale and consists of questions answered on a self-reported basis (11). The STAI measures state anxiety (event-related) and trait anxiety (personality related). Form Y1 and form Y2, the current revisions of the same will be employed to find correlations of outcomes to levels on anxiety.

• The value of possible scores for form Y of the STAI ranges from a minimum score of 20 to a maximum score of 80 on both the STAI-T and STAI-S subscales. STAI scores are commonly classified as “no or low anxiety” (20-37), “moderate anxiety” (38-44), and “high anxiety” (45-80).

Statistical Analysis

Analysis will be conducted with the help of Statistical Package for Social Sciences (SPSS) version 28.0, IBM Corporation and Excel 2019, Microsoft Corporation. Effects of the intervention on recovery outcomes will be compared via Chi-square test, Mann Whitney U test for comparison of qualitative data between the two groups and the Student’s Unpaired t-test for comparison of quantitative data between the groups. Wilcoxon’s Signed Rank test and the Student’s paired t-test will be used for analysing qualitative and quantitative input between prepreoperative and postoperative states.

Discussion

The investigator expects that the application of behavioural sensitisation techniques will indicate enhanced recovery outcomes in patients over standard care practices. Improvements in ratings of postoperative pain intensity, behavioural recovery and patient satisfaction with their medical care are surmised from the intervention group compared to the control. The study will presumably also correlate effects of preoperative psychological preparation to reduced duration of hospital stay and a reduction in time of switchover from injectable to oral analgesics. Postoperative levels of state and trait anxiety evaluated against preoperative levels are foreseen to show a modest decline in the intervention group in contrast to the control group. The results will be utilised to further research newer modalities in behavioural preparedness to influence patient healthcare and adoption of said methods in routine practice.

Evidence is mounting that psychological variables influence surgical results in both the short and long-term. Preoperative anxiety, hopelessness, and low self-efficacy have all been linked to worse physiological surgical outcomes and postoperative quality of life (12). The study seeks to establish the benefits of psychological preparedness as a cost-effective method in improving outcomes and postoperative recovery, along with creating awareness amongst patients and doctors, aspiring to improve healthcare delivery services. Although ignorance might be bliss for some patients, an accurate grasp of future expectations in the form of an ability to accept is even better.

References

1.
Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne-Davis LMT, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database of Systematic Reviews. 2016;5. Art. No.: CD008646. DOI: 10.1002/14651858.CD008646.pub2. [crossref] [PubMed]
2.
Johnson JE, Rice VH, Fuller SS, Endress MP. Sensory information, instruction in a coping strategy, and recovery from surgery. Research in Nursing and Health. 1978;1(1):4-17. [crossref] [PubMed]
3.
Johnson JE, Christman NJ, Stitt C. Personal control interventions: short- and long-term effects on surgical patients. Research in Nursing and Health. 1985;8:131-45. [crossref] [PubMed]
4.
Aglio LS, Mezzalira E, Mendez-Pino L, Corey SM, Fields KG, Abbakar R, et al. Surgical prehabilitation: Strategies and psychological intervention to reduce postoperative pain and opioid use. Anaesthesia & Analgesia. 2022;134(5):1106-11. [crossref] [PubMed]
5.
Levett DZ, Grimmett C. Psychological factors, prehabilitation and surgical outcomes: Evidence and future directions. Anaesthesia. 2019;74:36-42. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2023/59853.17262

Date of Submission: Aug 25, 2022
Date of Peer Review: Sep 26, 2022
Date of Acceptance: Oct 15, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 30, 2022
• Manual Googling: Oct 11, 2022
• iThenticate Software: Oct 14, 2022 (10%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
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  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
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  • Popline (reproductive health literature)
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