Effects of a telehealth program for wound healing promotion on the wound healing level in patients with diabetes undergoing coronary artery bypass graft surgery: A randomized controlled trial


wound healing
coronary artery bypass
patient discharge
diabetes mellitus
saphenous vein

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Sumrattana, S., Asdornwised, U., Wongkongkam, K., & Tantiwongkosri, K. (2023). Effects of a telehealth program for wound healing promotion on the wound healing level in patients with diabetes undergoing coronary artery bypass graft surgery: A randomized controlled trial. Belitung Nursing Journal, 9(5), 428–436. https://doi.org/10.33546/bnj.2775
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Accepted for publication: 2023-08-15
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Background: Patients with diabetes undergoing coronary artery bypass graft (CABG) are at risk of delayed wound healing. The telehealth program for wound healing promotion (TPWHP) was developed to improve wound healing in patients with diabetes undergoing CABG in a university hospital.

Objective: This study aimed to examine the effects of the TPWHP on the healing of the sternal wound and saphenous vein graft (SVG) donor site in patients with diabetes undergoing CABG.

Methods: In this randomized controlled trial, the participants were randomly assigned to the intervention (n = 30) and control (n = 30) groups. The control group received routine nursing care, whereas the intervention group received routine nursing care along with the TPWHP, which provides education and wound monitoring using multimedia and a surgical wound care booklet and monitors the wound through the LINE application on a smartphone after hospital discharge. Data were collected from June to November 2020 at two university hospitals in Bangkok, Thailand, using the demographic and health-related data form and the Thai wound assessment inventory (WAI). Data were analyzed using the Chi-squared, Fisher’s exact, and Mann–Whitney U tests.

Results: The intervention group had significantly lower mean scores—indicating favorable wound healing—for SVG donor site wound healing level than the control group on days 14–21 after surgery (p = 0.012, mean = 0.58 ± 0.54 and 1.08 ± 0.82, respectively). No significant intergroup difference was observed in terms of the sternal wound healing level (p = 0.126); however, the intervention group showed lower mean scores—indicating good wound healing—than the control group.

Conclusion: The TPWHP promotes effective wound healing of the SVG donor site; however, its efficacy on sternal wound healing was uncertain. Therefore, nurses should implement the TPWHP in collaboration with a multidisciplinary team to improve wound healing after hospital discharge.

Trial registration: Thai Clinical Trials Registry (TCTR20211112002)


Supporting Agencies

This study is part of the Master of Nursing Science Program in Adult and Gerontological Nursing, Faculty of Nursing, Mahidol University. The researcher (SS) received a scholarship from the Thai Red Cross Society.


Copyright (c) 2023 Siriporn Sumrattana, Usavadee Asdornwised, Kessiri Wongkongkam, Kriangkrai Tantiwongkosri

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, or publication of this article.


Thanks to the Thai Red Cross Society, Faculty of Nursing & Graduate Studies of Mahidol University, King Chulalongkorn Memorial Hospital, Siriraj Hospital, all advisers, participants, family, and colleagues, for supporting this research.

Authors’ Contributions

SS contributed to the study’s conceptualization, literature review, research design, data collection, data analysis, and conclusions, including manuscript writing. UA contributed to providing key concepts of the study, research methodology, sample selection, data analysis, and manuscript writing. KW and KT contributed to the sample selection and critical analysis of the study. All authors approved the final version to be published.

Data Availability

The datasets generated during and analyzed during the current study are not publicly available due to privacy and confidentiality concerns but are available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

Nothing to declare.


Ajibade, A., Younas, H., Pullan, M., & Harky, A. (2020). Telemedicine in cardiovascular surgery during COVID‐19 pandemic: A systematic review and our experience. Journal of Cardiac Surgery, 35(10), 2773-2784. https://doi.org/10.1111/jocs.14933

AlRiyami, F. M., Al-Rawajfah, O. M., Al Sabei, S., & Al Sabti, H. A. (2022). Incidence and risk factors of surgical site infections after coronary artery bypass grafting surgery in Oman. Journal of Infection Prevention, 23(6), 285-292. https://doi.org/10.1177/17571774221127553

Annesley, S. H. (2019). Current thinking on caring for patients with a wound: A practical approach. British Journal of Nursing, 28(5), 290-294. https://doi.org/10.12968/bjon.2019.28.5.290

Atinyagrika Adugbire, B., & Aziato, L. (2018). Surgical patients’ perspectives on nurses’ education on post-operative care and follow up in Northern Ghana. BMC Nursing, 17(1), 1-9. https://doi.org/10.1186/s12912-018-0299-6

Delmore, B., Cohen, J. M., O’Neill, D., Chu, A., Pham, V., & Chiu, E. (2017). Reducing postsurgical wound complications: A critical review. Advances in Skin & Wound Care, 30(6), 272-286. https://doi.org/10.1097/01.ASW.0000516426.62418.48

Duggan, E. W., Carlson, K., & Umpierrez, G. E. (2017). Perioperative hyperglycemia management: An update. Anesthesiology, 126(3), 547-560. https://doi.org/10.1097/ALN.0000000000001515

Dumfarth, J., Zimpfer, D., Vögele-Kadletz, M., Holfeld, J., Sihorsch, F., Schaden, W., Czerny, M., Aharinejad, S., Wolner, E., & Grimm, M. (2008). Prophylactic low-energy shock wave therapy improves wound healing after vein harvesting for coronary artery bypass graft surgery: A prospective, randomized trial. The Annals of Thoracic Surgery, 86(6), 1909-1913. https://doi.org/10.1016/j.athoracsur.2008.07.117

Goh, L. J., & Zhu, X. (2017). Effectiveness of telemedicine for distant wound care advice towards patient outcomes: Systematic review and meta-analysis. International Archives of Nursing and Health Care, 3(2), 1-9. https://doi.org/10.23937/2469-5823/1510070

Gull, S., Hussain, I., Farogh, A., Afshan, S., & Iqbal, M. (2018). Incidence and predictor of post-operative wound Infection in patients under-went coronary artery bypass grafting. Journal of Clinical Trials in Cardiology, 5(1), 1-5.

Gunter, R. L., Fernandes-Taylor, S., Rahman, S., Awoyinka, L., Bennett, K. M., Weber, S. M., Greenberg, C. C., & Kent, K. C. (2018). Feasibility of an image-based mobile health protocol for postoperative wound monitoring. Journal of the American College of Surgeons, 226(3), 277-286. https://doi.org/10.1016/j.jamcollsurg.2017.12.013

Holden lund, C. (1988). Effects of relaxation with guided imagery on surgical stress and wound healing. Research in Nursing & Health, 11(4), 235-244. https://doi.org/10.1002/nur.4770110405

Jimenez, A. R., Gleghorn, K., & Wagner, R. (2021). The implementation of educational videos in Mohs micrographic surgery for improved patient satisfaction and comprehension: A review of literature. SKIN The Journal of Cutaneous Medicine, 5(3), 233-239. https://doi.org/10.25251/skin.5.3.4

Lie, I., Bunch, E. H., Smeby, N. A., Arnesen, H., & Hamilton, G. (2012). Patients’ experiences with symptoms and needs in the early rehabilitation phase after coronary artery bypass grafting. European Journal of Cardiovascular Nursing, 11(1), 14-24. https://doi.org/10.1016/j.ejcnurse.2010.09.004

Logan, S., Quinn, D., Brault, D., Vandal, V., Paré, B., & Clarke, S. (2016). Risk factors and best practices for the prevention of post-cardiac surgery surgical site infections in a tertiary. Canadian Journal of Cardiovascular Nursing, 26(4), 19-26.

McLean, K. A., Mountain, K. E., Shaw, C. A., Drake, T. M., Pius, R., Knight, S. R., Fairfield, C. J., Sgrò, A., Bouamrane, M., & Cambridge, W. A. (2021). Remote diagnosis of surgical-site infection using a mobile digital intervention: A randomised controlled trial in emergency surgery patients. NPJ Digital Medicine, 4(1), 160. https://doi.org/10.1038/s41746-021-00526-0

Mousa, A. Y., Broce, M., Monnett, S., Davis, E., McKee, B., & Lucas, B. D. (2019). Results of telehealth electronic monitoring for post discharge complications and surgical site infections following arterial revascularization with groin incision. Annals of Vascular Surgery, 57, 160-169. https://doi.org/10.1016/j.avsg.2018.09.023

Musa, A. F., Dillion, J., Taib, M. E. M., Yunos, A. M., Baie, S., & Nordin, R. B. (2018). A study on the effect of Haruan fish extract (Channa striatus) on wound healing and quality of life of coronary artery bypass grafting (CABG) patients: A prospective, double-blind, randomized, controlled trial. F1000 Research, 7, 469. https://doi.org/10.12688/f1000research.13372.1

Nabngarm, W., Asdornwised, U., Pinyopasakul, W., & Thongcharoen, P. (2015). Relationship between blood glucose level, body mass index, and nutritional status for sternal wound healing in patients with post coronary artery bypass grafting. Nursing Science Journal of Thailand, 33(4), 40-50.

Navaratnarajah, M., Rea, R., Evans, R., Gibson, F., Antoniades, C., Keiralla, A., Demosthenous, M., Kassimis, G., & Krasopoulos, G. (2018). Effect of glycaemic control on complications following cardiac surgery: Literature review. Journal of Cardiothoracic Surgery, 13(1), 1-8. https://doi.org/10.1186/s13019-018-0700-2

Neuman, B., & Fawcett, J. (2011). The Neuman Systems Model (5th ed.). Boston: Pearson.

Oshvandi, K., Pakrad, F., Mohamadi Saleh , R., Seif Rabiei , M. A., & Shams , A. (2020). Post-operative symptoms and complications in patients having undergone coronary artery bypass graft in Hamadan: A descriptive cross-sectional study. Jundishapur Journal of Chronic Disease Care, 9(4), e104180. https://doi.org/10.5812/jjcdc.104180

Patel, S., Srivastava, S., Singh, M. R., & Singh, D. (2019). Mechanistic insight into diabetic wounds: Pathogenesis, molecular targets and treatment strategies to pace wound healing. Biomedicine & Pharmacotherapy, 112, 108615. https://doi.org/10.1016/j.biopha.2019.108615

Rochon, M., Jenkinson, S., Ramroop, R., Deakin, A., Rai, P., Healy, K., Lukban, R., Soppa, A., Bhugun, K., & Lavack, C. (2018). Retrospective analysis of the photo at discharge scheme and readmission for surgical site infection following coronary artery bypass graft surgery. Journal of Infection Prevention, 19(6), 270-276. https://doi.org/10.1177/1757177418780986

Ruttanamontree, S., Asdornwised, U., Wongkongkam, K., & Chuthapisith, S. (2020). The effectiveness of a telehealth program on the anxiety levels among women with core needle biopsy for suspected breast cancer. Journal of Perioperative Nursing, 33(2), 15-21.

Sanger, P. C., Hartzler, A., Han, S. M., Armstrong, C. A. L., Stewart, M. R., Lordon, R. J., Lober, W. B., & Evans, H. L. (2014). Patient perspectives on post-discharge surgical site infections: Towards a patient-centered mobile health solution. PloS One, 9(12), e114016. https://doi.org/10.1371/journal.pone.0114016

Sanonoi, N., Asdornwised, U., Wongkongkam, K., & Tocharoenchok, T. (2021). Effects of a telehealth program on the functional status and rehospitalization rates of patients after coronary artery bypass grafts. Chulalongkorn Medical Journal, 65(2), 179-186. https://doi.org/10.14456/clmj.2021.24

Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. BMC Medicine, 8, 18. https://doi.org/10.1186/1741-7015-8-18

Si, D., Rajmokan, M., Lakhan, P., Marquess, J., Coulter, C., & Paterson, D. (2014). Surgical site infections following coronary artery bypass graft procedures: 10 years of surveillance data. BMC Infectious Diseases, 14(1), 1-9. https://doi.org/10.1186/1471-2334-14-318

Somsiri, V., Asdornwised, U., O’Connor, M., Suwanugsorn, S., & Chansatitporn, N. (2021). Effects of a transitional telehealth program on functional status, rehospitalization, and satisfaction with care in Thai patients with heart failure. Home Health Care Management & Practice, 33(2), 72-80. https://doi.org/10.1177/1084822320969400

Sreedharan, S., Nemeth, L. S., Hirsch, J., & Evans, H. L. (2022). Patient and provider preferences for monitoring surgical wounds using an mhealth app: A formative qualitative analysis. Surgical Infections, 23(2), 168-173. https://doi.org/10.1089/sur.2021.240

Tanner, J., Padley, W., Davey, S., Murphy, K., & Brown, B. (2012). Patients’ experiences of surgical site infection. Journal of Infection Prevention, 13(5), 164-168. https://doi.org/10.1177/1757177412452677

Tocharoenchok, T., Ruangchira-urai, R., Sriyoschati, S., Subtaweesin, T., & Tantiwongkosri, K. (2017). Minimally invasive direct vision versus conventional open saphenous vein harvesting. Journal of the Medical Association of Thailand, 100(2), S1-S9.

Totty, J. P., Harwood, A. E., Wallace, T., Smith, G. E., & Chetter, I. C. (2018). Use of photograph-based telemedicine in postoperative wound assessment to diagnose or exclude surgical site infection. Journal of Wound Care, 27(3), 128-135. https://doi.org/10.12968/jowc.2018.27.3.128

Tu, S.-L., Lin, Y.-D., Chiu, I. C., & Lin, Y.-J. (2012). A performance study of multimedia patient education: A case of surgical wound care. 2012 International Symposium on Computer, Consumer and Control, Taichung, Taiwan.

Yuroong, A., Asdornwised, U., Pinyopasakul, W., Wongkornrat, W., & Chansatitporn, N. (2021). The effectiveness of the transitional care program among people awaiting coronary artery bypass graft surgery: A randomized control trial. Journal of Nursing Scholarship, 53(5), 585-594. https://doi.org/10.1111/jnu.12673

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