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Patient activation intervention to facilitate participation in recovery after total knee replacement (MIME): a cluster randomised cross-over trial
  1. Jo McDonall1,
  2. Richard de Steiger2,
  3. John Reynolds3,
  4. Bernice Redley1,
  5. Patricia M Livingston4,
  6. Anastasia F Hutchinson5,
  7. Mari Botti5
  1. 1 Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Safety Research, Deakin University, Geelong, Victoria, Australia
  2. 2 Department of Surgery, Epworth Healthcare, The University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  4. 4 Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
  5. 5 Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Safety Research, Epworth Partnership, Deakin University, Geelong, Victoria, Australia
  1. Correspondence to Dr Jo McDonall, Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC 3220, Australia; jo.mcdonall{at}


Background Patient participation in care is a fundamental element of safe and high-quality healthcare with the potential to enhance health outcomes and improve patient satisfaction.

Objectives To test the efficacy of a clinician-facilitated, bedside multimedia (MyStay) intervention designed to support patient participation in their recovery after total knee replacement surgery. The primary outcome was patients’ reported worst pain intensity on postoperative day 3. Secondary outcomes were patient activation, length of hospital stay, knee function and satisfaction with care.

Methods Unmasked, cluster randomised, four-period cross-over trial with a simultaneous process evaluation within in a large private, not-for-profit, metropolitan teaching hospital. Statistical analyses used linear mixed models with random effects for wards, cohorts within wards and patients within cohorts and fixed effects for treatment and period.

Results 241 patients were recruited between March 2014 and June 2015. Patients were admitted to intervention (104) or control (137) clusters. Intervention group patients reported significantly lower mean pain intensity scores on postoperative day 3 (6.1 vs 7.1, 95% CI −1.94 to −0.08, p=0.04). The percentages of patients who reported severe pain (score ≥7) were 43.7% and 64.2% in the intervention and control groups, respectively (χ2 9.89, p=0.002; generalised linear mixed model Wald test, p=0.05). Intervention group patients on average stayed in hospital one less day (5.3 vs 6.3, 95% CI 0.05 to 1.94, p=0.04), reported higher activation (45.1% vs 27.1% at level 4 activation) (p=0.04) and higher overall satisfaction with care (9.3 vs 8.6, 95% CI 1.09 to 0.219, p=0.01), and were more likely to refer family or friends to the health service (9.3 vs 8.7, 95% CI 1.07 to 0.13, p=0.02).

Conclusion The clinician-facilitated, MyStay bedside multimedia intervention enhanced patients’ activation and participation in their care after surgery; pain intensity and length of stay in hospital were reduced and patients were more satisfied with their care.

Trial registration ACTRN12614000340639 (

  • patient-centred care
  • information technology
  • health services research
  • cluster trials

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors JM, RdS, BR, AFH, PML, JR and MB conceived the study and designed the trial. MB supervised the conduct of the trial and data collection. JM collected, analysed the data and drafted the manuscript. JR was responsible for secondary analysis of the data. All authors contributed substantially to manuscript revision. JM completed the final draft, submitted the manuscript and takes responsibility for the paper as a whole.

  • Funding The Norman Beischer Medical Research Foundation provided funding for the MyStay development.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Approval to conduct this research was received from the University Human Research and Ethics Committee (approval no. 2013-195) and the hospital where the data were collected (approval no. 598-13).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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