Patient Comprehension of Trigger Finger Concepts Based on Distribution Format: A Randomized Controlled Trial of Handout Versus Video

Abstract

Background:

Patient comprehension is an essential part of optimizing medical outcomes. It is unknown which format is most effective in delivering this information. In addition to a face-to-face conversation, a paper handout is often given as an educational supplement at the conclusion of a visit. Secondary to advances in technology and the ubiquity of the Internet, medical videos have gained popularity. The purpose of this randomized controlled trial was to determine whether the educational material format (paper handout vs video) resulted in a difference in either comprehension of the condition or satisfaction with the delivery of the information.

Methods:

Patients aged ≥18 years with a diagnosis of trigger finger were prospectively enrolled and randomized to receive either a paper handout or video link with information regarding the pathophysiology, diagnosis, and treatment of trigger finger. Survey assessments were then distributed, consisting of 7 questions related to trigger finger and 1 question related to patient satisfaction. Continuous data were compared using 2-sample t tests, and categorical data were compared with χ² tests. Alpha was 0.05.

Results:

Seventy-one patients were enrolled, and 60 completed their survey (response rate: 85%). The video group had significantly higher comprehension scores (82% vs 71%, P = .04) and significantly higher satisfaction scores (9.4 vs 8.6, P = .02).

Conclusions:

Those who received their educational material in a video format had greater comprehension of their condition and higher satisfaction compared with those receiving a paper handout. Medical providers should consider using video formats to provide supplemental educational materials to their patients.

Introduction

Current trends in clinical practice are encouraging patients to take responsibility for their care. In the context of rising healthcare costs, the need for patient education and self-management has grown to efficiently and affordably optimize health. ¹ Healthcare personnel can teach patients and subsequently enhance self-efficacy and positive behavioral change. Furthermore, improvements in patient education and self-management allow patients to participate in shared and informed decision-making. ² With a more informed understanding of their healthcare conditions, patients will likely, in turn, be more satisfied with their care.^2,3 Hence, there is a collective benefit for all parties involved, including orthopedic surgeons and patients, in finding effective ways to promote patient education and patient autonomy.

The positive impact of the video format on patient comprehension of medical terminology, informed consent, and surgical procedures has been well established. A prostate cancer study demonstrated significant improvements in prostate terminology comprehension after using videos in the low-literacy (mean literacy level of 7th to 8th grade) population. ⁴ In 2 randomized studies by Rossi et al,^5,6 video informed consent improved patient comprehension compared with verbal informed consent in both the ≤12th-grade educational and >12th-grade education level subgroups. Furthermore, a randomized controlled trial by Yin et al ⁷ found that patients in a Web-based tutorial group had better preoperative and postoperative knowledge recall than the standard preoperative counseling. Prior literature has focused on patients undergoing operative procedures rather than patients who present with a subacute problem, such as trigger finger.

Patient education is an essential component to optimizing patient outcomes, and it is critical to determine which educational formats most effectively promote patient comprehension. The purpose of this study was to evaluate the differences in patient comprehension after distributing educational information on trigger finger in handout and video formats. The secondary outcome was patient satisfaction based on the way the information was presented. We hypothesized that patients would demonstrate improved comprehension of trigger finger concepts and improved satisfaction when the information was presented in video format.

Materials and Methods

Data Collection and Study Design

After institutional review board approval, patients were prospectively enrolled in the study at orthopedic hand clinics. Exclusion criteria included patients less than 18 years of age, patients without a diagnosis of trigger finger, and those unable to read or write in English. Upon enrollment, patients were randomized to either the physical handout group (control) or the video group. Patients randomized to the handout group were given a handout at the end of their clinic appointment (Figure 1). Patients randomized to the video group were emailed or text messaged a link to a 3-minute video hosted on YouTube (San Bruno, California) (link: https://www.youtube.com/watch?v=AKWx3ix2GSk). The information presented in the handout and the video was identical. Patients received an online questionnaire through REDCap (Nashville, Tennessee) 1 week after enrollment, which asked their age (in years), sex (male or female), whether they obtained information from other sources (friend/family, Web site, another physician, magazine, or book), their satisfaction with the information presentation (1 to 10), and 7 comprehension questions (detailed in Table 1). Comprehension scores were calculated from these comprehension questions.

Figure 1.

Trigger finger education handout.

Table 1.

Trigger Finger Comprehension Survey.

Question	Answer choices	Correct answer
What is the role of the tendon involved in trigger finger?	(a) Running alongside the bone to allow the finger to bend (b) Provide blood flow to the finger (c) Carry nerves to and from the finger (d) Connecting 2 bones together	(a) Running alongside the bone to allow the finger to bend
What causes trigger finger?	(a) Minor infection in the finger (b) Loss of blood flow to the finger (c) Thickening of the tendon or pulley (d) Disruption of the tendon in the finger	(c) Thickening of the tendon or pulley
What type of imaging test is most commonly done for patients who might have trigger finger?	(a) X-ray (b) CT scan (c) MRI (d) Imaging is not routinely needed	(d) Imaging is not routinely needed
Which of the following is NOT a treatment of trigger finger?	(a) Applying a hard cast temporarily (b) Avoid aggravating activities (c) Steroid injection (d) Splinting	(a) Applying a hard cast temporarily
What happens during trigger finger surgery?	(a) The tendon is thinned out (b) The tendon is reinforced with suture (c) The pulley holding the tendon is released (d) A new pulley is created using suture	(c) The pulley holding the tendon is released
After surgery, when can range of motion exercises begin?	(a) 10 days (b) Almost immediately (c) 6-8 weeks (d) 1 month	(b) Almost immediately
How long does the full recovery from trigger finger surgery typically take?	(a) 4-6 weeks (b) 6 months (c) 10 days (d) 48 hours	(a) 4-6 weeks

Statistical Analysis

Patients were separated into 2 groups for statistical analysis: those who received information in the video format (video) and those who received a physical handout (handout). Descriptive statistics, including mean and standard deviation, were reported for all variables. Continuous data between groups were compared with independent 2-sample t tests. Pearson χ² tests were used to compare categorical data between groups. A P value less than .05 was considered statistically significant. All analyses were performed in R Studio Version 4.0.2 (Boston, Massachusetts). A power analysis determined that a sample of 60 patients would be required for a power of 0.80.

Results

A total of 71 patients were enrolled in the study. Thirty-two patients were randomized to the handout group, whereas 39 patients were randomized to the video group. The overall response rate was 85%, and there was no difference in response rate between groups (handout: 87.5% vs video: 82.1%, P = .528). There were no significant differences in age (handout: 63.3 years vs video: 64.8 years, P = .530) or sex (handout: 75% women vs video: 65.6% women, P = .429) between groups. The video group had significantly higher comprehension scores (82% vs 71%, P = .043) and satisfaction scores (9.4 vs 8.6, P = .024). There were no differences in the proportion of participants who obtained information from other sources (Table 2).

Table 2.

Patient Survey Responses Based on Handout or Video Format.

Variable	Handout group (N = 28)	Video group (N = 32)	P value
Age, y	63.3 (10.0)	64.8 (8.54)	.530
Sex			.429
Male	7 (25.0%)	11 (34.4%)
Female	21 (75.0%)	21 (65.6%)
Comprehension score	71.4 (22.7)	81.7 (15.5)	.043 *
Satisfaction (1-10)	8.57 (1.57)	9.38 (1.10)	.024 *
Other resources
Friend/family	3 (10.7%)	4 (12.5%)	.830
Web site	6 (21.4%)	14 (43.8%)	.067
Another Physician	6 (21.4%)	4 (12.5%)	.355
Magazine	0 (0.00%)	0 (0.00%)	—
Textbook	0 (0.00%)	0 (0.00%)	—

^*Bolded, statistical significance (P < .05).

Discussion

The benefits of patient education, ranging from compliance, satisfaction, and outcomes, have been demonstrated in prior studies.^8,9 Orthopedic literature has stressed the importance of valuing patient self-efficacy and autonomy during the shared decision-making process. ¹⁰ Thus, determining the most effective form of delivering information is critical to optimizing patient comprehension in orthopedic patients. We hypothesized that patients might exhibit improved comprehension of orthopedic conditions with the information presented in video format rather than as a standard written handout. We selected trigger finger as the topic of investigation in this study to limit heterogeneity within the patient cohort. Our goal was to determine the ideal method of information distribution to be applied to and validated for other orthopedic conditions. Our findings supported our hypothesis of video-format superiority, as the video group had significantly improved both comprehension and satisfaction. Furthermore, there were no differences in patient demographics, such as age or sex, between groups.

Several studies on the use of video and multimedia interventions have shown promising results. In a study of knee arthroscopy, 61 patients were randomized to multimedia, verbal consent, or pamphlet group for informed consent 3 to 6 weeks before surgery. ⁹ The multimedia module included a mix of voice, text, pictures, and 3-dimensional animation, with the script being the same as the verbal and pamphlet groups. Patient comprehension was then determined by questionnaire after the initial consent process, at the time of surgery, and 6 weeks after surgery. The multimedia group performed significantly better with 98% ± 5% correct responses in the questionnaire at the time of consent than the verbal group (88% ± 14%) and pamphlet group (76% ± 28%). The multimedia group also performed better than the verbal and pamphlet groups when assessed at the time of surgery and 6 weeks postoperatively. In addition, patient satisfaction was significantly higher in the multimedia group than the pamphlet group. ⁹ Although our study did not have diagrams or 3-dimensional models within the video group, we demonstrated similar improvements in patient comprehension and satisfaction using a video format.

In addition, a randomized controlled trial of 40 patients undergoing informed consent for shoulder arthroscopy found significantly improved information recall in the video group compared with the verbal consent group. ¹¹ Finally, 2 randomized studies from Rossi et al^5,6 investigated informed consent for ankle fracture surgery and knee arthroscopy, and both found improved comprehension in the video group compared with the verbal informed consent group regardless of the education level. Our study had similar findings to the 4 previously mentioned randomized controlled trials, as the video group demonstrated significantly improved comprehension compared with the control group. However, our methods were slightly different from the previously referenced studies. First, these studies investigated patient comprehension before and after surgery, whereas our study investigated patients diagnosed with a subacute condition seeking routine care. Second, the control group in our study was physical handout rather than verbal communication. The authors decided to use physical handouts as the control group due to handouts being the standard format for patient educational materials in healthcare clinics. Both groups received verbal communication during the encounter. Third, the studies mentioned above assessed patient comprehension of risks, benefits, instructions, and treatment alternatives before surgery, whereas our study assessed patient comprehension of the pathophysiology, diagnosis, and treatment options for trigger finger.

The relationship between patient education and patient satisfaction is thoroughly studied in the literature. A study by McGaughey ³ on perioperative informed consent explored the effect of lack of information on patient satisfaction, and they found that patients’ perceived lack of information was correlated with decreased patient satisfaction. Our study found that patients in the video group had increased satisfaction. However, we cannot determine whether their satisfaction was a result of increased comprehension, preference for the video format, or a combination of both. Furthermore, the literature is mixed on patient satisfaction using more advanced distribution techniques. Corniou et al ⁹ and Yin et al ⁷ found increased satisfaction in their treatment groups (multimedia and Web-based tutorial, respectively) compared with control, but these increases in satisfaction were not observed in the studies of Rossi et al ⁶ or Hoppe et al, ¹¹ despite all studies reporting an increase in patient comprehension.

There are a few limitations to this study. First, the authors developed the questionnaire on trigger finger for this study, and it is not a previously validated questionnaire. Furthermore, we cannot determine which components of the questionnaire are essential to patients in understanding their condition and which components may be unimportant and unnecessary. However, both the handout and video provided identical information, and the same follow-up assessment was given to each patient. Despite the potential for unimportant information included within the distributed information or the survey assessments, patients in the video group still reported significantly higher satisfaction rates. Patient education level was not accounted for, but patients were randomized to limit differences in patient demographics, and there were no differences in age or sex between groups. Finally, there were no significant differences in patients seeking information from other sources, but patients in the video group may have been more likely to use Internet resources after watching the video. Although not significantly different, we feel this may be a beneficial byproduct of the video distribution method.

Conclusions

In conclusion, the video format outperformed the handout format for the distribution of trigger finger information. The video group had not only better comprehension but also higher satisfaction. These findings may be applied to or validated in other orthopedic conditions and subspecialties. Healthcare providers and their patients may benefit from providing patient educational materials in more modern formats, such as video, to improve patient comprehension and satisfaction.