Association of Early Postoperative Pain Trajectories With Longer-term Pain Outcome After Primary Total Knee Arthroplasty

Singh, Jasvinder A; Lemay, Celeste A.; Nobel, Lisa; Yang, Wenyun; Weissman, Norman; Allison, Jeroan J.; Franklin, Patricia D.

doi:10.1001/jamanetworkopen.2019.15105

Cited by 35 publications

(35 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For approximately 30% of the patients, their pain increased from prior to surgery through 3 months after surgery, followed by only slight decreases over the remaining nine months. Consistent with our findings, one in three patients had slow decreases in pain intensity during the first 8 week following TKA (Singh, Lemay, et al, 2019) and had more severe pain 6 months following surgery compared to patients with fast decreases. Similarly, another study (Page et al, 2015) describes a constant high pain subgroup that was characterized by a neutral or positive pain slope with no improvement during the first 12 months following surgery.…”

Section: Discussionsupporting

confidence: 90%

Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty

Lindberg

Miaskowski

Rustøen

et al. 2020

European Journal of Pain

View full text Add to dashboard Cite

Background One in five patients experience chronic pain 12 months following total knee arthroplasty (TKA). This longitudinal study used a person‐centred approach to identify subgroups of patients with distinct chronic pain profiles following TKA and identified preoperative characteristics associated with these profiles. Methods On the day before surgery, 202 patients completed questionnaires that assessed pain, interference with functioning, fatigue, anxiety, depression and illness perceptions. Average and worst pain were assessed prior to surgery, on postoperative day 4, at 6 week and at 3 and 12 months following surgery. Using growth mixture modelling, two subgroups with distinct average and worst pain profiles were identified. Results Patients in the “lower average” and “lower worst” pain classes had moderate preoperative pain scores that decreased over the remaining 9 months following TKA. Patients in the “higher average” and “higher worst” pain classes had relatively higher preoperative pain scores that increased during the first three months and then decreased slightly over the remaining 9 months. Patients in the higher pain classes had higher interference with function scores; used opioids prior to surgery more often, were more likely to receive a continuous nerve block and ketamine; had higher preoperative fatigue severity and interference scores; and had worse perceptions of illness than patients in the lower pain classes. Conclusions These risk factors may be used to identify subgroups of patients at higher risk for more severe pain after TKA. Future studies should test whether modifying these risk factors can improve patients’ outcomes after TKA. Significance statement The present study provides a novel and original analysis of pain profiles following total knee arthroplasty that may contribute to our understanding of the transition from acute to chronic pain. Our results may be used to identify patients at higher risk for poorer outcomes based on preoperative risk factors.

show abstract

Section: Discussionsupporting

confidence: 90%

Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty

Lindberg

Miaskowski

Rustøen

et al. 2020

European Journal of Pain

View full text Add to dashboard Cite

show abstract

“…Our prior analyses of national data with outcomes at 12 months after TJR surgery documented wide variation in pain and function and the ability to predict discrete sub-groups of greater and lesser post-operative improvement [ 13 ]. These initial nomothetic models and subsequent FORCE-TJR analyses support that, in general, key pre-operative patient symptom and clinical variables are associated with greater or lesser pain relief and functional gain after surgery [ 17 – 19 ]. In addition, preliminary multivariable models developed in preparation for the A.S.K.…”

Section: Methodsmentioning

confidence: 90%

Translating clinical and patient-reported data to tailored shared decision reports with predictive analytics for knee and hip arthritis

Franklin

Zheng

Bond³

et al. 2020

Qual Life Res

Self Cite

View full text Add to dashboard Cite

Introduction New informatics tools can transform evidence-based information to individualized predictive reports to serve shared decisions in clinic. We developed a web-based system to collect patient-reported outcomes (PROs) and medical risk factors and to compare responses to national registry data. The system generates predicted outcomes for individual patients and a report for use in clinic to support decisions. We present the report development, presentation, and early experience implementing this PRO-based, shared decision report for knee and hip arthritis patients seeking orthopedic evaluation. Methods Iterative patient and clinician interviews defined report content and visual display. The web-system supports: (a) collection of PROs and risk data at home or in office, (b) automated statistical processing of responses compared to national data, (c) individualized estimates of likely pain relief and functional gain if surgery is elected, and (d) graphical reports to support shared decisions. The system was implemented at 12 sites with 26 surgeons in an ongoing cluster randomized trial. Results Clinicians and patients recommended that pain and function as well as clinical risk factors (e.g., BMI, smoking) be presented to frame the discussion. Color and graphics support patient understanding. To date, 7891 patients completed the assessment before the visit and 56% consented to study participation. Reports were generated for 98% of patients and 68% of patients recalled reviewing the report with their surgeon. Conclusions Informatics solutions can generate timely, tailored office reports including PROs and predictive analytics. Patients successfully complete the pre-visit PRO assessments and clinicians and patients value the report to support shared surgical decisions.

show abstract

“…Investigating the effects on function and pain after orthopaedic surgery is important given one in three adults fail to achieve clinical improvement in these postoperative outcomes [ 51 – 54 ]. Further, the presence of postoperative pain and psychological distress, such as depression, influence the recovery trajectory following orthopaedic surgery [ 55 – 58 ]. Our findings of lack of benefit on these outcomes are consistent with a recent meta-analysis of wearable-based interventions in adults with rheumatic diseases such as osteoarthritis, and rheumatic inflammatory diseases [ 21 ].…”

Section: Resultsmentioning

confidence: 99%

Effects of physical activity interventions using wearables to improve objectively-measured and patient-reported outcomes in adults following orthopaedic surgical procedures: A systematic review

et al. 2022

View full text Add to dashboard Cite

Objective To synthesize evidence on physical activity interventions that used wearables, either alone or in combination with education or rehabilitation, in adults following orthopaedic surgical procedures. Methods PubMed, CINAHL, PsycINFO and EMBASE were searched for randomized controlled trials of wearable-based interventions from each database’s inception to August 2021 in patients undergoing orthopaedic surgery. Relevant outcomes included physical activity, physical function, pain, psychological distress, or general health. PEDro scale scoring ranges from 0 to 10 and was used to appraise studies as high (≥7), moderate (5–6), or poor (<5) quality. Results Of 335 articles identified, 6 articles met eligibility criteria. PEDro scores ranged from 2 to 6, with 3 studies of moderate quality and 3 of poor quality. Studies included patients undergoing total knee (number; n = 4) or total knee or hip (n = 1) arthroplasty and lumbar disc herniation surgery (n = 1). In addition to wearables, intervention components included step diary (n = 2), motivational interviewing (n = 1), goal setting (n = 2), tailored exercise program (n = 2), or financial incentives (n = 1). Interventions were delivered in-person (n = 2), remotely (n = 3) or in a hybrid format (n = 1). Intervention duration ranged from 6 weeks to 6 months. Compared to controls, 3 moderate quality studies reported greater improvement in steps/day; however, 1 moderate and 2 poor quality studies showed no between-group difference in physical function, pain, or quality of life. No serious adverse events related to the use of wearable were reported. Conclusions The effects of physical activity interventions using wearables, either delivered in-person or remotely, appear promising for increasing steps per day after joint arthroplasty; however, this finding should be viewed with caution since it is based on 3 moderate quality studies. Further research is needed to determine the therapeutic effects of using wearables as an intervention component in patients undergoing other orthopaedic surgical procedures. Trial registration PROSPERO Registration Number: CRD42020186103

show abstract

Association of Early Postoperative Pain Trajectories With Longer-term Pain Outcome After Primary Total Knee Arthroplasty

Abstract: This cohort study examines patterns of individual pain trajectories after total knee arthroplasty (TKA) and assesses their independent associations with longer-term pain outcome after surgery.

Cited by 35 publications

References 70 publications

Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty

Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty

Translating clinical and patient-reported data to tailored shared decision reports with predictive analytics for knee and hip arthritis

Effects of physical activity interventions using wearables to improve objectively-measured and patient-reported outcomes in adults following orthopaedic surgical procedures: A systematic review

Contact Info

Product

Resources

About