Effects of Mutual Goal Setting Program on Face Down Behavior and Clinical Outcomes in Patients after Gas-Filled Retinal Detachment Surgery

Abstract

The retina acts as a screen to receive images. When the vitreous humor adheres too tightly to the retina, it can cause traction, leading to retinal detachment. This condition affects the patient's quality of life and, if left untreated, may lead to vision loss. Vitrectomy is a common and effective treatment involving surgery inside the eyeball, where gas is injected to help the retina reattach. Patients must maintain a face-down position after surgery for successful reattachment.This requirement can hinder daily activities. Patients often experience discomfort, neck pain, and back pain, which makes it difficult to maintain the face-down position consistently. Setting shared goals regarding face-down positioning and following up on clinical outcomes in patients after retinal detachment surgery with gas tamponade involves active interaction between nurses and patients. Nurses educate patients using materials, videos, and explanations about retinal detachment and the importance of face-down positioning after surgery. Patients are trained in this positioning before surgery, using personalized strategies and shared goals to determine the number of required hours. This helps patients understand and manage self-care at home, improving surgical outcomes.This study aimed to compare the mean number of hours patients with gas tamponade retinal detachment spent in the face-down position over a 24-hour period between those who received a mutual goal-setting program and those who received standard nursing care. Additionally, it seeks to compare clinical outcomes, including visual acuity and retinal reattachment, between the two groups.

This study was a quasi-experimental research design using a two-group pretest-posttest design with an experimental and a control group. The participants were patients who underwent gas-filled retinal detachment surgery due to retinal holes or tears, traction caused by membranes or vitreous humor, or fluid leakage and accumulation under the retina. The study took place between May 1 and December 25, 2023. A total of 50 patients were purposively selected based on inclusion criteria: aged 18 years or older, undergoing their first retinal detachment surgery, receiving gas tamponade with Octafluoropropane (C3F8) or sulfur hexafluoride (SF6),scheduled for surgery in one eye only with the other eye not diagnosed with blindness, and able to be contacted via telephone or the LINE application. If post-surgery vision was impaired,communication via LINE could be facilitated by a relative. Moreover, those aged 60 and above were screened for cognitive impairment using the Thai version of the 6 Cognitive Impairment Test (6 CIT), with eligible participants scoring less than 8. The sample size was calculated using G*Power, with a power of 0.50, a significance level (α) of 0.05, and an effect size of 0.50,resulting in 23 participants per group, increased by 10% to 25 participants per group to account for incomplete data. The researchers purposively selected all participants for the experiment. Data were collected first from the control group and then from the experimental group using a mutual goal-setting program based on King’s Goal Attainment Theory, along with a demographic form,a 24-hour face-down behavior log, a visual acuity record, and a retinal reattachment record. Data analysis was performed using descriptive statistics and a two-factor repeated measures ANOVA.

The experimental group had a mean number of face-down positioning hours equal to or greater than 16 hours, which was higher than that of the control group. When comparing the mean hours of face-down positioning at different time points, the experimental group demonstrated significantly higher means on postoperative days 1-2, 6-7, and 13-14 (F = 93.39, p < .05).Within the experimental group, the mean hours of face-down positioning one month before surgery were significantly different from those on postoperative days 1-2 (t = .79, p < .05), 6-7(t = .94, p < .05), and 13-14 (t = .88, p < .05). Additionally, the mean hours on postoperative days 1-2 were significantly different from those on days 6-7 (t = .63, p < .05) and 13-14(t = .43, p < .05). However, there was no significant difference between days 6-7 and 13-14.The experimental group also showed significantly better visual acuity one month after surgery than at 6-7 days (t = 0.10, p < 0.05), but there was no significant difference between the experimental and control groups. Furthermore, the percentage of patients with successful retinal reattachment after surgery was higher in the experimental group than in the control group. This research recommends that nurses adopt a mutual goal-setting approach with patients before and after surgery, focusing on maintaining the face-down posture after gas-injection retinal detachment surgery to improve outcomes. Follow-up care should be extended to 3-6 months, including studies on patients' post-surgery quality of life. A program to set behavioral goals for face-down posture in patients with silicone oil injections is suggested to reduce reoperation rates. Future research should investigate factors such as body weight, retinal detachment location, and diabetes that may influence face-down posture.

Keywords: Clinical outcomes, Face-down positioning, Mutual goal setting, Retinal detachment,Retinal detachment surgery with gas tamponade