Biofeedback Relaxation for Pain Associated With Continuous Passive Motion in Taiwanese Patients After Total Knee Arthroplasty

Wang, Tsae Jyy; Chang, Ching Fen; Lou, Meei‐Fang; Ao, Man Kuan; Liu, Chiung Chen; Shen, Liang; Shu, Wu; Tung, Heng Hsing

doi:10.1002/nur.21633

Cited by 24 publications

(23 citation statements)

References 41 publications

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“…Searches identified 4898 articles, and 781 full-text articles were assessed for eligibility. Twelve RCTs with a total of 1299 participants were eligible for inclusion 35–46. A PRISMA flow diagram is provided in figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…One single-centre RCT evaluated the effectiveness of progressive muscle relaxation with biofeedback on pain during continuous passive motion therapy 46. The study had unclear risk of bias for five domains and high risk of bias for blinding of outcome assessment.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, it was not possible to make any conclusive statements about the overall effectiveness of psychological interventions for pain outcomes after TKR. However, some promising areas for future research were identified including the use of CBT to reduce kinesiophobia39 and the use of progressive muscle relaxation during continuous passive motion therapy 46. Use of the TIDieR checklist as a framework highlighted a need for improvements in the reporting of interventions, particularly in relation to fidelity/adherence.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement: a systematic review

et al. 2019

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ObjectivesTo assess the effectiveness and reporting standards of psychological interventions for improving outcomes after total knee replacement (TKR).DesignMedline, Embase, and PsycINFO were searched from inception to up to 9 May 2019 with no language restrictions applied. Randomised controlled trials (RCTs) assessing the effectiveness of psychological interventions for short-term and long-term postoperative pain after TKR were included. Screening, data extraction, and assessment of methodological quality were performed in duplicate by two reviewers. The primary effectiveness outcome was postoperative pain severity and the primary harm outcome was serious adverse events. Secondary outcomes included function, quality of life, and psychological well-being. Reporting standards were assessed using the Template for Intervention Description and Replication (TIDieR) checklist for intervention reporting.Results12 RCTs were included, with a total of 1299 participants. Psychological interventions comprised music therapy (five studies), guided imagery and music (one study), hypnosis (one study), progressive muscle relaxation with biofeedback (one study), pain coping skills programme (one study), cognitive–behavioural therapy (two studies), and a postoperative management programme (one study). Due to the high heterogeneity of interventions and poor reporting of harms data, it was not possible to make any definitive statements about the overall effectiveness or safety of psychology interventions for pain outcomes after TKR.ConclusionFurther evidence about the effectiveness of psychological interventions for improving pain outcomes after TKR is needed. The reporting of harm outcomes and intervention fidelity is currently poor and could be improved. Future work exploring the impact of intervention timing on effectiveness and whether different psychological approaches are needed to address acute postoperative pain and chronic postoperative pain would be of benefit.PROSPERO registration numberCRD42018095100.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement: a systematic review

et al. 2019

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“…Second, due to the current lack of RCTs on one specific type of intervention focused on psychological distress (for example only pain coping skills training) applied to patients undergoing TKA, we have decided to also include a wider range of study designs to create a complete overview of the perioperative interventions focused on psychological distress that have been used to decrease pain and improve function and/or QoL after surgery. Besides, ten studies [ 32 , 34 , 37 , 39 , 48 , 54 , 55 , 66 , 70 , 71 ] in our systematic review evaluated the degree of postoperative pain not only by measuring pain scores, but also by assessing postoperative prescription of opioids or other types of pain medication. Investigating alternative nonpharmacologic methods to reduce postoperative pain and opioid use may help prevent further expansion of opioid misuse and addiction, which is currently a rapidly evolving public health crisis [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

et al. 2020

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Our aim was to assess the effect of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty (TKA). We searched studies on the effect of perioperative interventions focused on psychological distress used in conjunction with TKA on pain, function, and quality of life (QoL) on PubMed, Embase.com, PsycINFO/OVID, CENTRAL, the Cochrane Database of Systematic Reviews, Scopus, and Web of Science. We included 40 studies (22 RCTs, ten cohort studies, and eight quasi-experimental studies) with a total of 3846 patients. We graded the quality of evidence as low for pain and function and as moderate for QoL. Patients receiving music, education, cognitive behavioural therapy, guided imagery, pain coping skills training, Reiki, occupational therapy with self-monitoring, and biofeedback-assisted progressive muscles relaxing training had lower pain scores or declined opioid prescriptions after TKA. Pain coping skills training, audio recording-guided imagery scripts, video promoting self-confidence, psychological therapies by video, Reiki, music, occupational therapy with self-monitoring, education, and psychotherapy improved postoperative functional outcome. Education through an app improved QoL after TKA. The studies in our systematic review show that perioperative interventions targeting psychological distress for patients receiving TKA seem to have a positive effect on postoperative pain, function, and QoL. RCTs with strict methodological safeguards are still needed to determine if perioperative interventions focused on psychological distress should be used in conjunction with TKA. These studies should also assess which type of intervention will be most effective in improving patient-reported outcome measures and declining opioid prescriptions.

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“…As a knee loading apparatus for human use, the application of FDA-approved continuous passive motion devices after knee surgery can be considered. 32 These devices are used for rehabilitation to enhance joint mobility. Besides loading to the skeletal system, weight-bearing physical activity induces varying responses in the cardiovascular system, immune system, and neurological systems, 33,34 and other systems may also be involved in the observed dynamic shift in cholesterol and calcitriol in the urine.…”

Section: Discussionmentioning

confidence: 99%

Mechanical stimulations can inhibit local and remote tumor progression by downregulating WISP1

Liu

Sun

et al. 2020

FASEB j.

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Mechanical stimulations can prevent bone loss, but their effects on the tumor‐invaded bone or solid tumors are elusive. Here, we evaluated the effect of knee loading, dynamic loads applied to the knee, on metastasized bone and mammary tumors. In a mouse model, tumor cells were inoculated to the mammary fat pad or the proximal tibia. Daily knee loading was then applied and metabolic changes were monitored mainly through urine. Urine samples were also collected from human subjects before and after step aerobics. The result showed that knee loading inhibited tumor progression in the loaded tibia. Notably, it also reduced remotely the growth of mammary tumors. In the urine, an altered level of cholesterol was observed with an increase in calcitriol, which is synthesized from a cholesterol derivative. In urinary proteins, knee loading in mice and step aerobics in humans markedly reduced WNT1‐inducible signaling pathway protein 1, WISP1, which leads to poor survival among patients with breast cancer. In the ex vivo breast cancer tissue assay, WISP1 promoted the growth of cancer fragments and upregulated tumor‐promoting genes, such as Runx2, MMP9, and Snail. Collectively, the present preclinical and human study demonstrated that mechanical stimulations, such as knee loading and step aerobics, altered urinary metabolism and downregulated WISP1. The study supports the benefit of mechanical stimulations for locally and remotely suppressing tumor progression. It also indicated the role of WISP1 downregulation as a potential mechanism of loading‐driven tumor suppression.

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Biofeedback Relaxation for Pain Associated With Continuous Passive Motion in Taiwanese Patients After Total Knee Arthroplasty

Cited by 24 publications

References 41 publications

Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement: a systematic review

Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement: a systematic review

The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

Mechanical stimulations can inhibit local and remote tumor progression by downregulating WISP1

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