Examining the effects of total knee arthroplasty enhanced with a brief mindfulness-based cognitive behavioral therapy on pain and pain-related outcomes following surgery: a pilot study
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Résumé
BACKGROUND: Total knee arthroplasty (TKA) is one of the most common surgical treatments for patients with end-stage knee osteoarthritis (KOA). Although most patients benefit from this treatment, approximately 10-34% report poor postoperative outcomes, including persistent pain. Studies have shown that psychological distress (e.g., depression and anxiety) and pain catastrophizing (PC) contribute to worse pain-related outcomes in participants undergoing TKA. To address this, recent efforts have focused on optimizing TKA by incorporating psychological intervention into the perioperative period. Prior research indicates that cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) may improve postoperative pain and pain-related outcomes following TKA. More work is needed to understand the effects of these types of non-pharmacological interventions on various postsurgical outcomes. OBJECTIVE: The current study examined whether participants experienced changes in pain, physical functioning, psychosocial, and psychophysical outcomes after undergoing TKA enhanced with a brief perioperative mindfulness-based CBT (MBCBT). DESIGN: Uncontrolled quasi-experimental design with follow-up 3 months after surgery. METHODS: Participants (N = 22) with KOA undergoing TKA completed a baseline assessment 1-4 weeks prior to surgery, then attended a total of 4 sessions of MBCBT pre- and postoperatively. Participants were reassessed approximately 3 months after surgery. Self-reported pain and physical functioning were assessed using the Brief Pain Inventory (BPI) scale and the Western Ontario and McMaster University of Osteoarthritis (WOMAC)-index scale including 3 subscales (i.e., pain, physical function, and stiffness). Psychological distress was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales, and PC was measured using the Pain Catastrophizing Scale (PCS). Objective measures of physical performance were assessed using the 6-minute walk test (6MWT) and stair climbing task (SCT). Lastly, pain sensitization was measured using a battery of quantitative sensory testing (QST) including pressure pain thresholds (PPThs) using mechanical stimuli, temporal summation of pain (TSP) using mechanical stimuli, and conditioned pain modulation (CPM) using a mechanical and temperature stimulus. Paired sample t-tests were used to assess changes in outcome measures from baseline to 3-month post-surgery. RESULTS: Analyses showed that participants who received TKA enhanced with perioperative MBCBT (TKA+MBCBT) reported a significant reduction in BPI pain severity scores, BPI pain interference scores, total WOMAC scores, WOMAC pain scores, WOMAC function scores, and PCS scores at 3 months after surgery. CONCLUSION: The results from our study suggest that TKA enhanced with a brief psychosocial intervention targeting postoperative pain prevention may improve pain, self-reported functioning, and pain catastrophizing following surgery. Nevertheless, without the control comparison group, it is impossible to determine how much of these improvements can be attributed to the MBCBT intervention alone. It is possible that participants may have achieved similar gains without such intervention. Thus, larger studies with an appropriate comparator arm are needed to discern the isolated effects of MBCBT in improving postoperative outcomes following surgery.
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
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