A Randomized Controlled Trial of Psychological Intervention to Improve Satisfaction for Patients with Depression Undergoing TKA

Abstract

Background: The overall satisfaction of patients after total knee arthroplasty (TKA) is approximately 80%, and current studies have demonstrated that patients with depression may have lower patient satisfaction. The purpose of this study was to determine whether perioperative psychological intervention in patients with depression improves the clinical outcomes and patient satisfaction in patients undergoing TKA. Methods: Six hundred patients who underwent primary TKA from May 2016 to January 2018 were prospectively screened for eligibility. A preoperative psychological evaluation was conducted by a psychiatrist to evaluate each patient’s psychological status. Patients who were diagnosed with depression were randomly divided into 2 groups: the intervention group (patients received psychological interventions that were administered by a psychiatrist at the first visit before surgery and from then on) and the control group (patients received routine TKA care without psychological interventions). The primary outcome was patient satisfaction at 6 months postoperatively. The secondary outcomes were patient satisfaction at 2 years postoperatively as well as the Hospital for Special Surgery (HSS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and range of motion at 6 months and 2 years postoperatively. Results: Fifty-three patients with depression were identified. Fifty-one patients were enrolled in the randomized controlled trial. Two patients were lost to follow-up at 6 months after surgery. Therefore, 49 patients (25 in the intervention group and 24 in the control group) remained in the final analysis. At 6 months postoperatively, statistical differences in patient satisfaction were identified between the 2 groups (88.0% in the intervention group compared with 62.5% in the control group; odds ratio = 4.40; 95% confidence interval, 1.02 to 18.99). There was a significant improvement in the Self-Rating Depression Scale (SDS) score (the reduction rate was 51.97% in the intervention group compared with 17.35% in the control group) and the Symptom Checklist 90 Revised (SCL-90-R) subscore for depression (the reduction rate was 44.66% in the intervention group compared with 15.73% in the control group). The clinical outcomes, including the WOMAC scores, the HSS scores, and maximal range of motion, in the intervention group had improved significantly more compared with those in the control group. Conclusions: Psychological interventions during the perioperative period can improve patient satisfaction in patients with depression who undergo TKA. Therefore, psychological intervention and management may be beneficial for patients with depression who are planning to undergo TKA. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Does psychological distress influence postoperative satisfaction and outcomes in patients undergoing total knee arthroplasty? A prospective cohort study

“…In China, the prevalence of depressive disorders is reportedly 6.8% and that of an anxiety disorder is 7.6% [ 19 ]. In Chinese patients with severe osteoarthritis scheduled for TKA, Geng et al reported that the prevalence of depression was 8.83% [ 20 ]. However, mental disorders were diagnosed by psychiatrists after a clinical interview in the abovementioned two studies.…”

Development and internal validation of machine learning algorithms to predict patient satisfaction after total hip arthroplasty

“…Recent studies have also suggested the possibility of mental health optimization, with Geng et al showing that psychological intervention in patients with depression could improve post-TKA satisfaction [31].…”

“…This information could be used by surgeons to enhance preoperative counselling and manage patient expectations regarding THA, as prior studies have reported that interventions encouraging realistic expectations could improve satisfaction after joint arthroplasty [ 30 ]. Identification of at-risk patients may also allow for early intervention and optimization of their physical and mental health prior to THA, with prior studies showing that some predictors of satisfaction may be fully or partially modifiable [ 7 , 31 ].…”

“…On the other hand, it is widely recognized that poor mental health influences a patient’s perception of disability and sensitivity to pain which may contribute to poorer satisfaction [ 33 ]. Recent studies have also suggested the possibility of mental health optimization, with Geng et al showing that psychological intervention in patients with depression could improve post-TKA satisfaction [ 31 ].…”

The effectiveness of exercise therapy and education plus cognitive behavioral therapy, alone or in combination with total knee arthroplasty in patients with knee osteoarthritis – study protocol for the MultiKnee trial

“…CBT has shown promising results for OA patients in terms of reduced pain intensity [ 22 , 23 ], improved function [ 22 – 24 ] and reduced health care costs [ 24 ]. Geng et al also showed that perioperative psychotherapy, including CBT and medication, improved patient’s satisfaction 6 months after TKA among patients diagnosed with depression [ 25 ]. Despite these promising prior findings, no studies have tested the effectiveness of a combination of internet-delivered CBT (iCBT) and exercise therapy, either as a substitute for or as a supplement to TKA among patients with painful knee OA.…”