The Effectiveness of evidence-based nursing intervention for nasal irrigation after endoscopic sinus surgery in patients with chronic sinusitis：a randomized controlled trial

doi:10.21203/rs.3.rs-3337137/v1

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Research Article

The Effectiveness of evidence-based nursing intervention for nasal irrigation after endoscopic sinus surgery in patients with chronic sinusitis：a randomized controlled trial

https://doi.org/10.21203/rs.3.rs-3337137/v1

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Objective

To evaluate its effect of an evidence-based nursing program for nasal irrigation after endoscopic sinus surgery in patients with chronic sinusitis.

Methods

A total of 66 patients with chronic sinusitis who were randomly divided into two groups, the experimental group received evidence-based nasal irrigation nursing, and the control group received conventional nursing. Differences in VAS, SNOT-20, CT, LKES and overall efficacy were assessed between the two groups.

Results

2, 4 and 12 weeks after the intervention, the scores of VAS, SNOT-20, CT and LKES in the two groups were significantly lower than those before the surgery (P < 0.05). Compared with the control group, the scores were significantly lower in the experimental group (P < 0.05). 12 weeks after the intervention, the overall effective rate of treatment in the experimental group was 90.91%, while the control group was 72.73%, but the difference was not statistically significant in treatment effect(P > 0.05).

Conclusion

The implementation of nasal irrigation evidence-based nursing program for patients with chronic sinusitis after endoscopic sinus surgery can promote postoperative nasal mucosal recovery, improve treatment efficiency, and help improve patient comfort, quality of life and other subjective feelings.

Trial registration

The study was registered retrospectively with reference number ChiCTR2300075484 on 06/09/2023.

Chronic sinusitis

Nasal endoscopy

Surgery

Evidence-based nursing

Interventional research

Chronic rhinosinusitis (CRS) is a common disease in the Department of Otorhinolaryngology Head and Neck Surgery(ENT), and its incidence has been gradually increasing in recent years. Epidemiological surveys show that the overall prevalence of CRS in the Chinese population is 8%, which is higher than that in São Paulo, Brazil (5.51%), South Korea (6.93%) and Canada (5.7% in women and 3.4% in men) ^[1]. CRS mainly manifests as nasal congestion, runny nose, headache and loss of smell, and is often combined with lower respiratory tract diseases such as asthma, which affects patients in many ways, including physiologically and psychologically. Functional Endoscopic Sinus Surgery (FESS) is considered a minimally invasive standard surgical method for the treatment of chronic rhinosinusitis, which plays an important role in accelerating the improvement and restoration of the physiological function and morphology of the nasal sinus mucosa^[2]. Nasal irrigation can discharge nasal secretions, remove foreign bodies attached to the mucosal surface, improve the transmission function of nasal cilia, reduce the inflammatory response of nasal mucosa and relieve mucosal edema through mechanical physical flushing^[3]. There were many international guidelines that pointed out nasal irrigation was an important treatment after FESS^{[1, 4]}, however, there was much debate in clinical about the choice of temperature, dose, frequency and method of nasal irrigation, and there was no standard protocol for nasal irrigation care^{[5, 6]}. In this study, we used an evidence-based nasal rinsing care program to verify its effectiveness through clinical practice application, which is reported as follows.

Formation implementation team

A team of 10 members was formed to implement the nasal irrigation care program by the director of nursing, the chief nurse, the ENT physician, the responsible ENT nurse, and the graduate nursing student. One director of the nursing department and one chief nurse were responsible for team management, process development, quality control and coordination. 2 otolaryngologists were responsible for patient treatment and monitoring physiological indicators. 4 nurses were responsible for program implementation and monitoring records and 2 graduate nursing students were responsible for education and training as well as data collection. All members of the team have been systematically trained in the physiopathology of chronic sinusitis, functional nasal endoscopic sinus surgery, nasal irrigation and other specialized theoretical knowledge and clinical skills.

Study design and sample size calculation

The study is a parallel, single-blind, randomized controlled trial. Calculate the sample size by comparing two sets of Lund-Mackay CT Scores. According to the sample size calculation formula n₁ = n₂ = (Z_α+ Z_β)²×2σ² / δ2, hypothesis α = 0.05, Z_α=1.96; β = 0.2, Z_β=0.84; further reference to the literature σ = 2.30, δ = 1.76^[7]. Considering the shedding rate of 20%, the number of sample cases in each group is 33 through bilateral inspection, and the total sample size is 66.

Target of study

The participants were recruited from the department of ENT of the First Hospital of Shanxi Medical University, from February 2023 to May 2023. 66 CRS patients were included in our study and randomly divided into an intervention group and a control group according to a random number table, with 33 cases each.

Inclusion criteria

Meeting the diagnostic criteria of chronic rhinosinusitis; 18–75 years old, regardless of gender; Voluntarily accepting comprehensive treatment such as nasal endoscopic surgery, postoperative nasal irrigation and regular postoperative review; Voluntarily signing the informed consent and submitting to the requirements of this study.

Exclusion criteria

Patients with other nasal sinus diseases such as benign nasal and sinus tumors, cases with abnormal nasal structures, allergic rhinitis, mycosis fungoides, odontogenic maxillary sinus infections, etc.; Patients during pregnancy or lactation; Patients in critical condition or combined with serious diseases of other systems such as heart, liver and kidney; Patients who could not cooperate with the treatment and could not understand the questionnaire correctly.

Methods

The program included 22 entries in 7 areas. Nasal rinse preparation, nasal rinse implementation process, adverse reaction prevention, rinse disposal, review, health education and follow-up(Table 1). To better achieve the purpose, the study team developed relevant nursing instruments according to the nasal rinse care program, such as nasal rinse care record sheets, education materials, and training for study members. After systematic education and training, the program was implemented by the implementation team at the ENT of a hospital in Taiyuan, Shanxi Province. The visual analog scale (VAS)^[8], Sino-Nasal Outcome Test − 20(SNOT-20)^{[9, 10]}, endoscopic Lund–Kennedy score (LKES)^[1] results, Lund-Mackay CT^[1] results and Overall efficacy^[1] were recorded for all patients. Members of the study team instructed all patients included in the study to fill out the general information form, VAS scale and SNOT-20 scale before surgery, and the physicians in team used LKES to assess the severity of the patients' disease. All patients underwent nasal endoscopy by the same senior physician, and nasal irrigation was started at 24-48h postoperatively when filling material was extracted and there was no active bleeding or discomfort. The control group was given the usual care and the experimental group was given care according to the evidence-based care program for nasal irrigation. All patients were asked to fill in the VAS scale, SNOT-20 scale at weeks 2, 4, and 12 of postoperative nasal irrigation, and the LKES was assessed by the group's attending physician again. A Overall outcome assessment of the patient was performed at week 12. All procedures performed in the current study were approved by the research ethics committee of our institution.

Table 1

Contents of entries in the nasal rinse evidence-based care protocol
Sports event	Content
Pre-flush preparation	1. Assessment: assess the patient's nasal condition before each rinse, and strictly prohibit rinsing in patients with acute inflammation of the upper respiratory tract and acute infection of the middle ear to prevent the spread of inflammation
Pre-flush preparation	2. Psychological care: before rinsing, the nurse should introduce the purpose, method and precautions of nasal rinsing to the patient and family members, and mobilize the patient to actively cooperate with the treatment; For patients of different ages and with different psychological problems, the nurse should do a good job of psychological guidance; when the patient performs nasal rinsing for the first time, the nurse should be on the side to guide the patient to master the correct rinsing method through on-site demonstration and explanation. Patients can also observe and learn from other patients who have mastered the correct rinsing method.
Flushing Implementation Process	3. Flushing fluid: saline is recommended
	4. Flushing method: high volume low positive pressure flushing is recommended for adults; spray or nebulization is recommended for children
	5. Start rinsing time: 24–48 hours after removal of nasal stuffing, when there is no active bleeding and discomfort, start nasal rinsing
	6. Rinse position: lean forward, head down
	7. Rinse solution temperature: 35–38℃, not to exceed the basal body temperature to avoid damage to the nasal mucosa
	8. Dosage: large volume (> 200 mL) nasal saline rinses are recommended as an adjunct to other medications, depending on the condition of the patient's nasal mucosa
	9. Order: flush the side with severe nasal congestion first, then the other side to prevent the flushing fluid from flowing into the middle ear due to the resistance of the more severely blocked nasal cavity
	10. Flushing time: 5–10 minutes is the most appropriate, adjust the flushing speed according to the patient's comfort, and prevent irritation caused by too fast a flow rate and too high a water pressure
	11. Frequency: sequential flushing i.e. 2 times/day in weeks 1–2, 1 time/day in weeks 3–10 and 3 times/week after week10
	12. Duration of rinsing: The nasal mucosa after nasal endoscopic surgery has to go through 3 stages, i.e. 1–2 weeks postoperative cavity cleaning stage, 3–10 weeks postoperative mucosal transformation stage, and 10 weeks postoperative epithelialization completion stage, so 10 weeks of continuous nasal rinsing after nasal endoscopic surgery may be the best time period, the specific duration depends on the condition Adherence
	13. Condition observation: when the patient is undergoing nasal rinsing the nurse should observe whether the patient's rinsing method is accurate, teach the patient to master the correct nasal rinsing method; and observe whether there is blood, scabs and purulent secretions in the rinsing fluid to observe the effectiveness and effect of rinsing
Adverse reaction prevention	14. Open mouth breathing is required during the rinsing process, don't inhale through the nose, and do not swallow or blow the nose to avoid choking and coughing; if coughing, sneezing or vomiting and ear pain occur during the rinsing process, stop immediately
	15. Prevention of nasal irritation: Don't apply too much pressure during rinsing to avoid excessive pressure, which may cause middle ear infection by flowing into the eustachian tube or choking and coughing by entering the trachea, and adjust slowly according to the patient's comfort level
	16. Prevention of nasal bleeding: educate before rinsing, instruct patients not to pick their nose and blow it hard, and control complication and their blood pressure in elderly patients with comorbidities
	17. After rinsing, instruct the patient to tilt the head forward so that the residual fluid in the nasal cavity is discharged, and then blow the nose gently on one side and one side respectively; do not blow the nose too sharply or violently or pinch both nostrils at the same time
Flusher treatment	18. To prevent secondary infection caused by corrosion or bacterial residue of the rinse device, instruct the patient to rinse and disinfect the rinse device after the nasal rinse is completed, and microwave disinfection is recommended
Flusher treatment	19. To prevent the growth of bacteria and fungi, the douche should be replaced in 2–3 weeks
Reexamination Health education	20. review weekly in month 1, every 2 weeks in month 2, and monthly from month 3–6 until nasal mucosal epithelialization
Reexamination Health education	21. Before discharge, patients were taught the correct use of nasal irrigator; instructed to actively strengthen physical exercise, eat more fresh fruits and vegetables, and prevent colds; instructed not to dig their noses with fingers and blow their noses hard for 3 months; to keep the nasal mucosa moist at all times; and to avoid contact with allergens, and the above contents were compiled into a health education manual for health promotion and pushed to patients through the WeChat platform
follow up visits	22. Improve the follow-up system, establish a complete patient information file, do a good job of educating patients about self-care after discharge, issue a follow-up plan sheet, and record in detail each review of the patient

Visual Analogue Scale (VAS)

Patients score their feelings on a simulated scale of 0 to 10 according to how they feel. 0 is no discomfort; 1 to 3 is mild discomfort that is tolerable; 4 to 6 is significant discomfort that is also tolerable and may interfere with sleep; and 7 to 10 is severe discomfort that should be avoided at all costs. Among them, a score of 4 or more is considered that the patient is in an uncomfortable state. The method is easy to use and more commonly applied, but it can only roughly assess the comfort level of patients and has not been scientifically and effectively validated.

Sino-Nasal Outcome Test-20 (SNOT-20)

This questionnaire consists of 20 entries and 3 classification levels, covering 3 areas including physical problems, sleep function, and psychological problems. Respondents were asked to rate the 20 symptoms according to their own sinusitis symptoms, with a score of 0 representing no distress to the respondent; 1 representing mild distress to the respondent; 2 representing moderate distress to the respondent; and 3 representing severe distress to the respondent. Finally, patients were asked to choose the 5 most important symptoms for themselves from the 20 symptoms. the higher the total score of the 20 symptoms, the worse the quality of life of the respondents.

Endoscopic Lund–Kennedy Score (LKES)

Polyps, edema, nasal leaks, scarring and crusting were scored according to the patient's mucosal morphology on endoscopic video, and each item was scored according to its condition and assessed separately on the left and right. Polyps: 0 for no polyps, 1 for polyps in the middle nasal tract only, 2 for polyps beyond the middle nasal tract; nasal leaks: 0 for no nasal leaks, 1 for clear thin nasal leaks, 2 for mucopurulent nasal leaks; edema, scarring, and crusting: 0 for none, 1 for mild, 2 for severe; 0 to 10 points per side, 0 to 20 points total.

Lund-Mackay CT Score

The Lund-Mackay CT score of the sinuses including the presence or absence of turbidity in the maxillary sinus, anterior group septal sinus, posterior group septal sinus, pterygoid sinus, and frontal sinus and presence or absence of obstruction in the sinonasal tract complex, assessed separately on the left and right. A score of 0 indicates no abnormality in the sinuses, 1 indicates partial turbidity, and 2 indicates total turbidity; sinonasal tract complex: 0 indicates no obstruction and 2 indicates obstruction; 0 to 12 points per side, total score 0 to 24.

Overall efficacy

Complete control of disease: complete disappearance of symptoms, VAS score 0, Lund-Kennedy score < 1, no edema of the mucosa of the nasal sinuses, no mucous or mucopurulent discharge, good opening of the sinus orifice, good epithelialization.

Partial control: obvious improvement of symptoms but not complete disappearance (total score of unilateral postoperative cavity assessment less than 3 is considered as an obvious improvement), VAS score is less than before at least 3 points reduction, LKES > 1, congestion and edema of mucosa in some areas of nasal sinuses, a small amount of mucous or mucopurulent discharge, mucosal hypertrophy or granulation.

Not controlled: no significant improvement in symptoms or no improvement at all. There was no significant reduction in VAS score and LKES compared with before treatment. Congestion and swelling of the mucosa of the nasal sinuses, accumulation of mucous or mucopurulent secretions, hyperplasia of connective tissue or even polyp formation, extensive adhesions of the mucosa of the operative cavity, and narrowing or atresia of the sinus opening.

Treatment efficiency = (n1 + n2)/N. n1: number of patients with complete control, n2:number of patients with partial control, N: number of all patients.

Statistical analysis

The statistical analysis was processed by with SPSS Statistics version 26.0. Demographic and clinical data are expressed as the means, SDs and frequency. The t-test, χ2 test, ANOVA were adopted to compare groups. P < 0.05 was defined statistically significant.

Demographic and clinical data

No differences were observed between the groups regarding gender, marital status, education level, occupation, mode of payment, disease subtype, history of nasal surgery, and presence of comorbidities. (Table 2)

Table 2

Comparison of Demographic and clinical data between the two groups
Subjects		Experimental	Control	T/χ²	P
Subjects		(n = 33)	(n = 33)	T/χ²	P
Age(‾x ± s, years )		47.42 ± 16.68	48.03 ± 15.41	T=-0.153	0.879
Sex	Male	23	20	X² = 0.601	0.438
Sex	Woman	10	13	X² = 0.601	0.438
Marital status	Unmarried	5	4	X² = 0.129	0.720
Marital status	Married	28	29	X² = 0.129	0.720
Educational level	Secondary and below	14	15	X² = 0.520	0.914
	Sigh school	2	3
	Specialized subject	9	9
	Undergraduate	8	6
Profession	Workers	9	9	X² = 0.650	0.885
	Cadres	9	7
	Peasants	4	6
	Freelance and nonemployed	11	11
Payment method	Self-financed	4	6	X² = 0.733	0.865
	Municipal health insurance	13	12
	Provincial health insurance	12	10
	New Agricultura Cooperation	4	5
Duration of illness years(‾x ± s )		2.42 ± 3.62	2.49 ± 4.03	T=-0.072	0.943
Disease typing	Chronic sinusitis with nasal polyps	20	22	X² = 0.262	0.609
Disease typing	Chronic sinusitis without nasal polyps	13	11	X² = 0.262	0.609
Any history of nasal surgery	Yes	3	5	X² = 0.569	0.451
Any history of nasal surgery	Not	30	28	X² = 0.569	0.451
Comorbidities or lack	Yes	15	13	X² = 0.248	0.618
Comorbidities or lack	Not	18	20	X² = 0.248	0.618
Note: n: number of participants. T: t-test. χ²: χ²-test

VAS, SNOT-20, CT and LKES at each time point

Scores for VAS, SNOT-20, CT and LKES between the two groups showed no significant difference before intervention (P > 0.05). Scores for VAS, SNOT-20, CT and LKES were significantly lower in the experimental group than in the control group at all times points after nasal rinsing (P < 0.05). (Table 3).

Table 3

VAS, SNOT-20, CT and LKES of the two groups at each time point(‾x ± s )
Sargets	Point of time	Experimental group	Control group	T	P
VAS	Pre-operative	6.55 ± 1.69	6.52 ± 1.39	0.079	0.937
	2 weeks post intervention	5.06 ± 1.52	6.06 ± 1.48	-2.710	0.009*
	4 weeks post-intervention	4.24 ± 1.37	5.06 ± 1.22	-2.559	0.013*
	12 weeks post-intervention	212 ± 1.08	3.55 ± 1.37	-4.682	< 0.001**
SNOT-20	Pre-operative	35.55 ± 6.84	37.85 ± 5.59	-1.498	0.139
	2 weeks post-intervention	21.30 ± 4.36	34.27 ± 4.75	-11.559	< 0.001**
	4 weeks post-intervention	14.94 ± 3.47	30.39 ± 4.16	-16.383	< 0.001**
	12 weeks post-intervention	10.12 ± 3.35	23.18 ± 4.21	-13.738	< 0.001**
CT	Pre-operative	8.39 ± 3.36	8.55 ± 2.97	-0.194	0.847
	2 weeks post-intervention	5.73 ± 2.55	7.03 ± 2.33	-2.168	0.034*
	4 weeks post-intervention	3.76 ± 2.74	5.82 ± 1.83	-3.595	0.001*
	12 weeks post-intervention	2.79 ± 2.81	4.55 ± 2.19	-2.836	0.006*
LKES	Pre-operative	10.64 ± 2.33	10.55 ± 2.24	0.162	0.872
	2 weeks post-intervention	8.15 ± 2.48	9.24 ± 2.05	-1.951	0.045*
	4 weeks post-intervention	5.55 ± 2.12	8.00 ± 1.71	-5.168	< 0.001**
	12 weeks post-intervention	3.33 ± 2.89	5.82 ± 3.55	-3.119	0.003*
Note: VAS: Visual Analogue Scale. SNOT-20: 20-item Sino-Nasal Outcome Test. CT: Lund-Mackay CT Score. LKES: Endoscopic Lund–Kennedy Score. T: t-test.
*p < 0.05
**p < 0.001

Scores for every group in different time points

The scores of VAS, SNOT-20, CT and LKES tended to decrease with time (P < 0.05), the interaction of time and group was statistically significant (P < 0.05), and the scores of the two groups changed differently with time. The experimental group had a greater decrease than the control group, and the experimental group were lower than those in the control group at each time after intervention (P < 0.05). (Table 4)

Table 4

Different time points for VAS, SNOT-20, CT and LKES in both study groups (± s)
	Intra-group factors		Intergroup factors		Interaction
	F	P	F	P	F	P
VAS	208.752	< 0.001**	7.245	0.009*	8.856	< 0.001**
SNOT-20	471.036	< 0.001**	105.943	< 0.001**	77.93	< 0.001**
CT	115.409	< 0.001**	4.754	0.033*	6.16	0.001**
LKES	343.043	< 0.001**	7.035	0.010*	32.201	< 0.001**
Note: VAS: Visual Analogue Scale. SNOT-20: 20-item Sino-Nasal Outcome Test. CT: Lund-Mackay CT Score. LKES: Endoscopic Lund–Kennedy Score. F: ANOVA
*p < 0.05
**p < 0.001

Overall efficacy at 12 weeks after intervention

There were no significant differences in treatment efficiency between the two groups(P > 0.05). But at 12 weeks after intervention, 17 patients in the experimental group had control of the disease completely, 13 partially control and 3 had no control, the overall effective rate was 90.91%.

In the control group, patients that completed control were 13, partially control were 12 and 8 patients had no control, the overall effective rate was 75.76%. The treatment efficiency of the experimental group was 15.15% higher than the control group. The reason is thought to be related to that only the immediate efficacy was evaluated in this study and the long-term effects were not observed.

Trends at different points in time

A comparison of the changes’ trends in VAS, SNOT-20,CT and LKES for the study subjects is shown in Figs. 1–1, 1–2, 1–3, and 1–4. The scores in the experimental group were basically the same as those of the control group before surgery, but the scores of the experimental group were lower than the control group at 2, 4, and 12 weeks after the intervention.

Standardized care is an important element of postoperative patients’ management with nasal diseases and is one of the keys to successful surgery. Nasal rinsing after FESS has been widely used and recognized as a safe and effective nasal management method, which can reduce mucosal inflammation, cellular edema, and promote recovery of mucosal function^{[11, 12]}. A survey by the AAO-HNS showed that more than 90% of otolaryngologists recommend nasal saline rinses as apart of routine postoperative care after nasal endoscopy^[13]. But there was no clinical consensus on the rinsing method.

With the development of the biopsychosocial model of medicine, more and more researchers are recognizing that the impact of disease on health and life should be assessed more from the patient's perspective, and medical research on health-related quality of survival is receiving increasing attention. Improving patient comfort becomes an urgent issue in the field of nursing^[4].

In this study, we used a Evidence-based nasal rinsing program for CRS patients after FESS. The evidence-based care program includes seven aspects: Per-rinsing preparation, rinsing implementation process, adverse reaction prevention, rinser handling, review, health education and follow-up. The specific implementation process of nasal rinsing was refined to standardize the rinsing solution, rinsing method, posture, temperature, dose, and frequency, providing nurses with entry-based checklists and enhancing the execution.

The results of this study showed that there were no significant differences in VAS and SNOT-20 scores before intervention between the two groups (P > 0.05), and the scores of the experimental group were significantly lower than those of the control group at 2, 4, and 12 weeks after intervention (P < 0.05). indicating that the implementation of the evidence-based nasal rinsing program was more conducive to improving patients' subjective perceptions, which is consistent with the results of related studies^{[14, 15]}. The CT scores and LKES of the experimental and control groups were both significantly improved postoperative compared to the preoperative scores. And the scores in the experimental group were lower than those of control group at all times after the intervention. Both surgery and comprehensive treatment had definite efficacy in removing lesions and improving patients' symptoms. However the implementation of the evidence-based nasal rinsing program significantly reduced the patients' trauma edema, promoted the recovery of nasal mucosal morphology, reduced nasal inflammatory secretions, promoted the rehabilitation of sinus function, and improved the efficacy compared with conventional care, which agreement with the research findings of Yan ^[16].

The evidence-based nasal rinsing program recommend the use of saline rinses that are physiologically and physicochemically compatible with the human body and less irritating, and recommend different rinsing methods with individualization according to different groups. Appropriate rinsing temperature, dosage, posture, frequency and time optimize the distribution of rinsing fluid in the nasal cavity and bring the rinsing fluid into full contact with the mucous membrane of the nasal cavity and sinuses^[17], which can promote blood circulation in the mucous membrane of the operative cavity, improve local anti-inflammatory effects, eliminate inflammation and oedema, promote the recovery of mucosal morphology and the ciliary system function, effectively shorten the epithelialization time, improve the cure rate^{[18, 19]}and patients' compliance with rinsing by urging them to clock in daily at the WeChat.

Limitations

This study included a small sample and the observation period was relatively short, which may have affected the results to some extent. A large sample, multi-centre RCT with long-term follow-up observations could be conducted in the future to further explore the effects and improve the protocol.

The evidence-based nursing plan for nasal irrigation constructed in this study has a significant effect in promoting the recovery of nasal mucosa, improving the treatment effect, improving the comfort and quality of life of patients, and is scientific and practical.

CRS：Chronic rhinosinusitis

ENT：Otorhinolaryngology Head and Neck Surgery

FESS：Functional Endoscopic Sinus Surgery

VAS：visual analogue scale

SNOT-20：Sino-Nasal Outcome Test-20

LKES：Endoscopic Lund–Kennedy Score

Ethics approval and consent to participate:

This study conforms to the principles of the Declaration of Helsinki and has been approved by the Medical Ethics Committee of Shanxi Medical University (No. 2023008). In addition, participants have signed informed consent and have the right to withdraw from the study at any time.

Consent for publication:

Not applicable.

Availability of data and materials:

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests:

No conflict of interest exists in the submission of this manuscript

Funding:

Not applicable

Authors' contributions:

Study Design: LW, XWC.

Data Collection: JW, MYW,XWC.

Data Analysis: JWY,YRL.

Manuscript Writing: LW, YRL.

Critical revision of the article: CMZ

All authors read and approved the final manuscript.

Authorship statement:

All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors and all authors agree with the manuscript.

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No competing interests reported.

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The Effectiveness of evidence-based nursing intervention for nasal irrigation after endoscopic sinus surgery in patients with chronic sinusitis：a randomized controlled trial

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Abstract

Objective

Methods

Results

Conclusion

Trial registration

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Introduction

Materials and Methods

Formation implementation team

Study design and sample size calculation

Target of study

Inclusion criteria

Exclusion criteria

Methods

Visual Analogue Scale (VAS)

Sino-Nasal Outcome Test-20 (SNOT-20)

Endoscopic Lund–Kennedy Score (LKES)

Lund-Mackay CT Score

Overall efficacy

Statistical analysis

Results

Demographic and clinical data

VAS, SNOT-20, CT and LKES at each time point

Scores for every group in different time points

Overall efficacy at 12 weeks after intervention

Trends at different points in time

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1