Pre-TJA mind/body therapy improved postoperative patient-reported outcomes
DALLAS — Patients who underwent preoperative mindfulness training prior to total joint arthroplasty as part of a three-arm randomized trial involving different behavioral pain management techniques showed a clinically and statistically significant improvement in patient-reported function outcome scores at 6 weeks postoperatively, according to a speaker at the American Association of Hip and Knee Surgeons Annual Meeting.
At the meeting, study co-author Jeremy M. Gililland, MD, said, “A single 15-minute preoperative mindfulness intervention in these patients helped improve their anxiety and pain intensity right after the intervention. It also increased the self-reported physical function score at 6 weeks postop. So, the hope is that, potentially, this may help with coping, physical pain and the emotional stress of surgery.”
Gililland and his colleagues, including members of The Center on Mindfulness and Integrative Health Intervention Development, an on-campus center at University of Utah in Salt Lake City, collected preoperative patient-reported outcomes measurement information system (PROMIS) physical function (PF) scores at the time patients signed up for an arthroplasty class and at 6 weeks after TJA. In all, patients who participated in the study underwent 183 total knee arthroplasties and 102 hip arthroplasties from January 2018 to January 2019. They were categorized so that 106 patients were trained in mindfulness/meditation, 90 patients were trained in hypnosis and 89 patients were trained in cognitive behavior therapy (CBT).
The trainings occurred during a portion of a regular preoperative TJA education class in which patients are given information to prepare them for their upcoming joint replacement, according to Gililland.
In addition, during the classes, all patients were scored for the intensity and unpleasantness of their current pain, their pain medication desire and their anxiety just before they underwent their respective behavioral pain management strategy intervention and at 15 minutes after the intervention.
“We followed all these patients out 6 weeks postop and looked at their 6-week postop scores in terms of their physical function,” Gililland told Healio/Orthopedics.
After adjusting for age, BMI and comorbidities, results showed preoperative pain intensity was reduced significantly by the mindfulness (24%) and hypnosis (26%) interventions. Patients who underwent these same two interventions also experienced significantly reduced preoperative pain unpleasantness and anxiety, based on the results.
Additionally, patients who underwent a preoperative mindfulness intervention also had significant changes in their 6-week PROMIS PF scores.
“Both statistically significantly, as well as, more importantly, clinically significant, meaning they were above the [minimally clinically important difference] MCID for the PROMIS physical function score, ” said Gililland, who noted this finding was completely unexpected.
The results showed no significant changes from preoperative to 6 weeks postoperative in PROMIS PF scores for patients in the hypnosis and CBT groups.
When asked if the investigators had push-back from any patients randomized to receive the hypnosis training, Gililland said, “Actually, nearly everybody was willing to participate in the mind-body therapy that they were assigned.” – by Susan M. Rapp
Hanley A, et al. Abstract 4. Presented at: American Hip and Knee Surgeons Annual Meeting; Nov. 7-10, 2019; Dallas.
Disclosure: Gililland reports no relevant financial disclosures.