Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial

Abstract

Objective:To determine the feasibility of conducting a trial of a pre-surgical psychological intervention on pain, function, and mood in people with knee osteoarthritis listed for total knee arthroplasty.Design:Multi-centre, mixed-methods feasibility randomized controlled trial of intervention plus usual care versus usual care.Setting:Participants’ homes or hospital.Participants:Patients with knee osteoarthritis listed for total knee arthroplasty and score >7 on either subscales of Hospital Anxiety and Depression Scale.Intervention:Up-to 10 sessions of psychological intervention (based on cognitive behavioural therapy).Main measures:Feasibility outcomes (recruitment and retention rates, acceptability of trial procedures and intervention, completion of outcome measures), and standardized questionnaires assessing pain, function, and mood at baseline, and four and six months post-randomisation.Results:Of 222 people screened, 81 did not meet inclusion criteria, 64 did not wish to participate, 26 were excluded for other reasons, and 51 were randomized. A total of 30 completed 4-month outcomes and 25 completed 6-month outcomes. Modal number of intervention sessions completed was three (range 2–8). At 6-month follow-up, mood, pain, and physical function scores were consistent with clinically important benefits from intervention, with effect sizes ranging from small (d = 0.005) to moderate (d = 0.74), and significant differences in physical function between intervention and usual care groups (d = 1.16). Feedback interviews suggested that participants understood the rationale for the study, found the information provided adequate, the measures comprehensive, and the intervention acceptable.Conclusion:A definitive trial is feasible, with a total sample size of 444 people. Pain is a suitable primary outcome, but best assessed 6 and 12 months post-surgery.

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

“…As shown in Table 3 , function was significantly improved by perioperative interventions in 18 studies. Pain coping skills training [ 62 ], audiorecording guided imagery scripts [ 61 ], video promoting self-confidence and psychological support [ 64 ], music [ 35 , 36 ], occupational therapy in combination with self-monitoring using a diary [ 68 ], various types of education [ 41 , 43 , 45 , 47 , 51 – 53 ], weight-bearing biofeedback training [ 67 ], and psychological therapies (behavioural change intervention [ 60 ] and cognitive behavioural therapy [ 57 – 59 ]) positively affected any, but not all, of the functional outcome measures after TKA. In the most recent study by Riddle et al [ 63 ], patients receiving pain coping skills training did not have significantly better scores on WOMAC function and the short physical performance battery.…”

“…Perioperative music [33,36,[38][39][40], education [41,49,[51][52][53]55], cognitive behavioural therapy [57,58], pain coping skills training [62], guided imagery [61], perioperative Reiki therapy [66,70], occupational therapy in combination with self-monitoring using a diary [68], and biofeedback-assisted progressive muscle relaxing training [71] seem to improve postoperative pain or to decline opioid prescriptions after TKA. For function, pain coping skills training [62], audiorecording guided imagery scripts [61], video promoting self-confidence and psychological support [64], music [35,36], occupational therapy in combination with self-monitoring using a diary [68], various types of education [41,43,45,47,[51][52][53], weight-bearing biofeedback training [67], psychological therapies (behavioural change intervention [60] and cognitive behavioural therapy [57][58][59]) seem to significantly improve at least one postoperative functional outcome measure. Day-to-day education after TKA using an app might improve postoperative QoL.…”

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

“…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.…”

“…Two RCTs (one pilot and one feasibility) with 150 participants evaluated the effectiveness of CBT-based programmes 39 41. Both studies were at low risk of bias for four domains, with one having unclear risk of bias for selective outcome reporting and other bias,39 and one with high risk of bias for blinding of participants and personnel, blinding of outcome assessment, and incomplete outcome data 41. One 2-arm pilot RCT with 100 participants evaluated use of CBT that aimed to reduce kinesiophobia (fear of movement) postsurgery when compared with standard care 39.…”

“…Between group difference was found with reduction in pain NRS scores of 5.63 (SD 0.73) in the intervention group compared with 6.27 (SD 0.86) in the standard care group demonstrated at 6-month follow-up (p=0.003). One 2-arm feasibility RCT with 50 participants compared the use of a CBT-based programme of up to 10 1 hour sessions for reducing anxiety and depression to standard care 41. No between group differences in pain measured using the WOMAC pain score were found at 4-month or 6-month follow-up, and no between group difference in mood was found at 4-month or 12-monthfollow-up measured using the Beck Anxiety Inventory and Depression Inventory.…”