The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Szeverényi, Csenge; Kekecs, Zoltán; Johnson, Alisa; Elkins, Gary; Csernátony, Zoltán; Varga, Katalin

doi:10.1016/j.jpain.2018.05.006

Cited by 52 publications

(61 citation statements)

References 126 publications

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“…It is noted that the effect size was small, and the meta‐analysis drawn from a small pool of patients from only two studies, which may have led to inconsistency of results observed, and so this result should be interpreted with caution. Unlike Szeverenyi et al ., we were unable to find sufficient evidence that these interventions reduce post‐operative pain scores. Their study included trials applying interventions post‐operatively, ostensibly when the pain is greatest, which potentially resulted in a larger, measurable effect.…”

Section: Discussioncontrasting

confidence: 93%

“…included 105 studies in their review of psychological preparation in patients undergoing surgery, and noted possible benefits in pain, behavioural recovery, negative effect and length of stay. Szeverenyi et al . performed a large meta‐analyses examining the impact of psychosocial interventions applied either pre‐ or post‐operatively in general orthopaedics, finding a significant improvement in pain and anxiety outcomes, but not in analgesia use or quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…Powell et al 12 included 105 studies in their review of psychological preparation in patients undergoing surgery, and noted possible benefits in pain, behavioural recovery, negative effect and length of stay. Szeverenyi et al 9 performed a large meta-analyses examining the impact of psychosocial interventions applied either pre-or post-operatively in general orthopaedics, finding a significant improvement in pain and anxiety outcomes, but not in analgesia use or quality of life. However, despite noting that electiveness was a significant moderating factor in outcomes, with larger effect sizes in studies examining acute trauma patients, their analyses pooled trauma and elective patient data.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review and meta‐analysis examined the effect of psychosocial interventions in orthopaedic patients; however, the timing of delivery was not specific to the preoperative period. In addition, data for studies examining trauma and elective orthopaedic populations were pooled for meta‐analysis, despite evidence from the literature that these groups have different psychological pre‐ and post‐operative factors that may influence psychological and functional scores .…”

Section: Introductionmentioning

confidence: 99%

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Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta‐analysis

Tong

Dannaway

Enke

et al. 2019

ANZ Journal of Surgery

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Background Orthopaedic surgery is largely successful; however, a proportion of patients are dissatisfied and report pain and poor function. Psychological factors have been shown to influence orthopaedic surgical outcomes. This systematic review and meta‐analysis investigates the types and effectiveness of preoperative psychological interventions in elective orthopaedic surgery. Methods A registered systematic review (PROSPERO CRD42017073833) was performed on literature (1960–January 2018) using eight databases. Prospective controlled clinical trials involving adult and adolescent elective orthopaedic surgery were included. Interventions examined included relaxation, cognitive behavioural therapy, hypnosis, emotional counselling and mixed psychotherapies; general procedural education was excluded. Outcomes extracted included pain, anxiety, quality of life and disability. Results A total of 19 studies met the inclusion criteria (n = 1893 patients). Meta‐analyses were performed for pain, anxiety and quality of life. Analysis did not find enough evidence to confirm reduction in post‐operative pain (seven studies, 666 patients; g = −0.15 (95% CI −0.42, 0.13), P = 0.305). Pooled data from six studies on acute post‐operative anxiety (589 patients) showed a moderate statistically significant benefit (g = −0.26 (−0.49, −0.03), P = 0.024). There was an improved quality of life (mental component) at longer term follow‐up (g = 0.25 (0.02, 0.49), P = 0.034). Conclusions These studies provide evidence that psychological interventions have a positive effect on anxiety in the acute post‐operative period, and on mental components of quality of life at longer term follow‐up.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta‐analysis

Tong

Dannaway

Enke

et al. 2019

ANZ Journal of Surgery

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“…Consideration of non-pharmacological strategies: whilst not the focus of this review, there is some evidence that use of psychosocial techniques, such as relaxation, behavioural instruction and patient education can be beneficial in reducing post-operative pain (82,83). The development of Enhanced Recovery After Surgery (ERAS) protocols using a multimodal approach to minimize impact of the surgical episode does incorporate optimising analgesia, but also uses early mobilization and other techniques which may indirectly improve pain outcomes (84).…”

Section: Current Options For Treating Tolerance and Oihmentioning

confidence: 99%

Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

2019

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Watching a movie or listening to music is effective in managing perioperative anxiety and pain: a randomised controlled trial

Demirci,

van der Storm,

Huizing

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Despite the use of perioperative anxiolytics and pain medication, surgery can be a stressful and painful experience. Providing patients with distractions using video and/or audio tools in addition to medication may be helpful. To date, no studies have compared different distraction modalities in a same-day surgical setting in adults. This study aims to determine whether audio-visual distraction with video glasses (AVD) is more effective in reducing anxiety and pain compared to audio distraction (AD) in conscious patients undergoing orthopaedic surgery. It was hypothesised that AVD, being the more immersive modality, would be more effective than AD on the outcome parameters. Methods Fifty patients undergoing orthopaedic surgery with local and/or regional anaesthesia in a clinical day-care setting were randomly assigned to receive either fixed-scenery AVD or patient-choice AD with music. Primary outcome was anxiety, as measured by the Dutch version of the Spielberger State–Trait Anxiety Inventory-6 (STAI-6) prior to and 15 min after the intervention. Secondary outcomes were pain (Numeric Rating Scale Pain [NRS-P]), systolic and diastolic blood pressure, heart rate and patient satisfaction. Results Within each group, there was a significant reduction in anxiety (p = 0.028 for AVD, p < 0.001 for AD). In contrast to our hypothesis, listening to music without watching a video (AD group) reduced anxiety significantly more than experiencing full AVD (p = 0.018). The mean pain score did not change significantly within either user group, nor did pain scores differ between user groups. Conclusion In conscious patients undergoing surgery, watching a movie (using video glasses and a headphone set) and listening to music (using only a headphone set) are able to significantly reduce anxiety. AVD, although believed to provide higher levels of distraction, did not prove to be superior to AD. The clinical relevance of this study highlights the potential benefits of AVD or AD modalities in improving the surgical experience for conscious patients. Further research is required to examine the influence of freedom of choice in content on the aforementioned outcomes. To estimate the true value of higher immersion levels, different distraction modalities (e.g. AVD versus virtual reality) featuring the exact same scenery or content need to be compared. Level of evidence Level I.

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The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 52 publications

References 126 publications

Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta‐analysis

Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta‐analysis

Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

Watching a movie or listening to music is effective in managing perioperative anxiety and pain: a randomised controlled trial

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