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Objective To assess whether brief mindfulness-based cognitive behavioral therapy (MBCBT) could enhance the benefits of total knee arthroplasty (TKA) in improving pain and pain-related disability. Specifically, to determine (1) whether patients who received MBCBT differed from matched controls who received treatment as usual (TAU) on post-surgical pain outcomes, and (2) whether changes in pain catastrophizing, depression, and/or anxiety explained the potential effects of MBCBT on pain outcomes. Design Pilot clinical trial. Subjects Sample of 44 patients undergoing TKA. Patients who completed a brief MBCBT intervention (n = 22) were compared with age-, race-, and sex-matched controls who received TAU (n = 22). Methods The MBCBT intervention included 4, 60-minute sessions delivered by a pain psychologist in-person and via telephone during the perioperative period. Participants were assessed at baseline, 6 weeks, 3 months, and 6 months post-surgery. Results Compared to matched controls, patients who received MBCBT had lower pain severity and pain interference at 6-week post-surgery. Group differences in outcomes were mediated by changes in pain catastrophizing, but not by changes in depression or anxiety. The MBCBT group had similar reductions in pain severity and interference as the control group at 3- and 6-month post-surgery. Conclusions This work offers evidence for a safe and flexibly delivered nonpharmacological treatment (MBCBT) to promote faster recovery from TKA and identifies change in pain catastrophizing as a mechanism by which this intervention may lead to enhanced pain-related outcomes. Clinical Trial Registration ClinicalTrials.gov (NCT04328701) https://clinicaltrials.gov/ct2/show/NCT04328701?term=NCT04328701&draw=2&rank=1
Objective To assess whether brief mindfulness-based cognitive behavioral therapy (MBCBT) could enhance the benefits of total knee arthroplasty (TKA) in improving pain and pain-related disability. Specifically, to determine (1) whether patients who received MBCBT differed from matched controls who received treatment as usual (TAU) on post-surgical pain outcomes, and (2) whether changes in pain catastrophizing, depression, and/or anxiety explained the potential effects of MBCBT on pain outcomes. Design Pilot clinical trial. Subjects Sample of 44 patients undergoing TKA. Patients who completed a brief MBCBT intervention (n = 22) were compared with age-, race-, and sex-matched controls who received TAU (n = 22). Methods The MBCBT intervention included 4, 60-minute sessions delivered by a pain psychologist in-person and via telephone during the perioperative period. Participants were assessed at baseline, 6 weeks, 3 months, and 6 months post-surgery. Results Compared to matched controls, patients who received MBCBT had lower pain severity and pain interference at 6-week post-surgery. Group differences in outcomes were mediated by changes in pain catastrophizing, but not by changes in depression or anxiety. The MBCBT group had similar reductions in pain severity and interference as the control group at 3- and 6-month post-surgery. Conclusions This work offers evidence for a safe and flexibly delivered nonpharmacological treatment (MBCBT) to promote faster recovery from TKA and identifies change in pain catastrophizing as a mechanism by which this intervention may lead to enhanced pain-related outcomes. Clinical Trial Registration ClinicalTrials.gov (NCT04328701) https://clinicaltrials.gov/ct2/show/NCT04328701?term=NCT04328701&draw=2&rank=1
Background Patients with cancer receiving neoadjuvant treatment prior to surgery are in a very stressful situation. Chemotherapy and radiation therapy put a strain on the quality of life and the pending surgery poses a relevant burden for many patients. Preparation of these patients for the intervention in terms of prehabilitation has great potential to reduce the burden of postoperative complications and may improve the clinical outcome. A prehabilitation approach also yields the possibility to address unmet patients’ needs and to help them modify their lifestyle in a maintainable way. Therefore, a multimodal approach is mandatory during this critical period. Objective The aim of this study is to assess the feasibility of prehabilitation in an integrative medicine day clinic (PRIME-DC) prior to cancer surgery at a major university clinic. PRIME-DC is considered feasible if 80% of enrolled patients are willing and able to complete at least 6 out of the 8 weekly meetings, each lasting 6.5 hours, at such a clinic. Secondary end points aim to evaluate this multimodal program. Methods The PRIME-DC intervention combines mind-body medicine, exercise therapy, nutrition therapy, naturopathic counseling, and the application of a yarrow liver compress. Adult patients with cancer, with a primary tumor in the abdomen (including intraperitoneal cancer, stomach cancer, and extraperitoneal cancers such as pancreatic, bladder, rectal, esophageal, endometrial, ovarian, and cervical cancer) or the breast requiring a neoadjuvant oncological treatment setting are eligible to participate. The addressed cancer entities imply either an extensive surgical intervention with an expected need for prehabilitation (eg, abdominal surgery) or a neoadjuvant treatment of several months with a high burden of treatment-associated side effects (breast cancer). Adherence to the day clinic program is the primary end point being defined as presence during the day clinic session. Secondary end points are physical assessment and quality of life, together with a structured assessment of neoadjuvant treatment-associated side effects. Furthermore, to collect qualitative data voluntary participants of the day clinic will be interviewed in a semistructured way after completion of the day clinic program on each component of the study (mind-body intervention, exercise, nutrition, naturopathic counseling, and a yarrow liver compress). Results The procedures used in this study adhere to the tenets of the Declaration of Helsinki. As of February 2023, we enrolled 23 patients; the dominant cancer entity is breast cancer (18 enrolled patients). Conclusions The presented protocol combines prehabilitation, lifestyle modification, naturopathic counseling, dietary assistance, and naturopathic treatment in an innovative and integrative way. Trial Registration Deutsches Register Klinischer Studien German Clinical Trials Register DRKS00028126; https://drks.de/search/de/trial/DRKS00028126 International Registered Report Identifier (IRRID) DERR1-10.2196/46765
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