Combined Digital Interventions for Pain Reduction in Patients Undergoing Knee Replacement

Abstract

ImportanceDigital technology represents an opportunity to improve outcomes following total knee replacement (TKR). Digitally delivered interventions have been shown to be similar to face-to-face interventions and to increase participation levels in people with osteoarthritis.ObjectiveTo assess the effect of a digital technology package in reducing pain compared with usual care following TKR.Design, Setting, and ParticipantsThis randomized clinical trial recruited 102 adults after they received TKR in 3 rehabilitation hospitals in Sydney, Australia, between June 2020 and July 2021.InterventionsAll participants underwent usual care. In addition to usual care, 51 participants received a digital technology package consisting of an exercise app, fitness tracker, and online health coaching. In the usual care group, 51 participants received a fitness tracker but with all notifications turned off and goals for step count, sleep, and active hours removed. Participants were followed up for 12 months (June 2021 to July 2022).Main Outcome and MeasuresThe primary outcome was mean knee pain during the past week assessed using a numerical rating scale (range, 0-10, with 10 indicating worst possible pain) at 3 months. In unadjusted analyses, considered primary and based on multiple imputations, independent t tests were used to compare means between groups. Secondary outcomes, including measures of function, activity participation, and quality of life, were analyzed using a generalized estimating equation model that accounted for repeated measurements.ResultsOf 102 participants (mean [SD] age, 67.9 [7.2] years; 68 [67%] female; and 92 [90%] White) randomly assigned to intervention or usual care groups, 47 (92%) in each group completed the 3-month follow up. At 3 months, participants in the intervention group demonstrated small but not clinically meaningful improvements in pain compared with the usual care group in the unadjusted intention-to-treat analysis (mean difference, −0.84; 95% CI, −1.59 to −0.10; P = .03). Secondary outcomes indicated a statistically significant reduction in pain intensity, (mean difference, −0.94; 95% CI, −1.82 to −0.06), pain disability (mean difference, −5.42; 95% CI, −10.00 to −0.83), and sedentary behavior (mean difference, −9.76; 95% CI, −19.17 to −0.34) favoring the intervention from baseline to 3, 6, and 12 months.Conclusions and RelevanceIn this randomized clinical trial, a combined digital technology program provided small but not clinically meaningful improvements in pain at 3 months and other longer-term favorable outcomes following TKR compared with usual care. Future studies should tailor digital interventions based on participants’ abilities and preferences to ensure that the intervention is appropriate and fosters long-term self-management.Trial RegistrationAnzctr.org.au Identifier: ACTRN12618001448235

Exercise and Pain Neuroscience Education for Patients With Chronic Pain After Total Knee Arthroplasty

“…Studies evaluating the effect of treatments introduced in the early postoperative period 32 , 33 , 34 , 35 , 36 , 37 have not considered that patients who undergo TKA often experience spontaneous improvements in pain between 3 and 9 months after surgery. 38 Hence, the observed treatment effects could have been influenced by the natural course of improvement after TKA and are therefore not generalizable to patients with chronic pain more than 1 year after TKA.…”