Posted 09.20.2019 | by AMRA

Total hip and knee replacements are among the highest volume elective surgical procedures performed today. The vast majority of joint replacement patients report significant post-operative reductions in pain and disability. Nonetheless, about 15% of patients report poor surgical outcomes marked by continuing pain, disability, and dissatisfaction.

Pre-surgical levels of distress related to depression and anxiety are the best predictors of which patients are likely to fare poorly after surgery.

Medical professionals are interested in psychological interventions that could improve post-surgical outcomes. Dowsey et al. [Complementary Therapies in Medicine] tested whether pre-surgical Mindfulness-Based Stress Reduction (MBSR) could improve physical and psychological wellbeing outcomes after joint replacement surgery.

The researchers randomly assigned 127 Australian arthritis patients (average age = 65 years; female = 72%) with moderate-to-severe psychological distress (based on a psychological assessment cut-off score) who were surgically approved for knee or hip replacement to either surgery and post-operative care as usual, or a standard 8-week MBSR program followed by surgery and post-operative care as usual. Out of this sample, 45 MBSR assignees and 56 treatment-as-usual assignees eventually underwent surgery. Surgical patients were seen by their treating surgeons during 12-month surgical follow-up appointments.

Patients completed a self-report osteoarthritis measure that included subscales assessing pain, stiffness, and functional disability, as well as a total overall score that can serve as a single measure of global symptom severity. They also completed measures of general physical and psychological wellbeing, pain-management self-efficacy, and mindfulness (using the Five Facet Mindfulness Questionnaire). Assessments were completed at baseline, 3 months, and 12 months.

MBSR participants reported significantly less pain at 12 months than controls. They also reported significantly greater improvement on the global measure of overall osteoarthritis pain, stiffness, and functional disability.

A significantly larger proportion of MBSR participants (91%) were rated as having made clinically meaningful improvements (≥10% improvement) in pain than controls (75%). Additionally, a significantly greater proportion of MBSR participants (91%) showed clinically meaningful improvement (≥9 % improvement) in functional disability than did controls (66%).

In an unexpected finding a greater proportion of MBSR patients (31%) than control patients (10%) never proceeded to surgery at all, many of them citing symptom improvement as their reason for not electing surgery.

The study shows that MBSR improves pain and functional outcomes for psychologically distressed arthritis patients undergoing joint replacement surgery.

The study is limited by the loss of follow-up information on patients who did not proceed with surgery, and the absence of a time-and-attention placebo control. Moreover, recruitment for the study proved difficult, with many patients declining to participate due to lack of interest, poor health, or logistical concerns.

Reference:

Dowsey, M., Castle, D., Knowles, S., Monshat, K., Salzberg, M., Nelson, E., . . . Choong, P. (2019). The effect of mindfulness training prior to total joint arthroplasty on post-operative pain and physical function: A randomised controlled trial. Complementary Therapies in Medicine.

[Link to study]