Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions

Abstract

Purpose: To summarize evidence on preoperative and postoperative psychologically informed physical therapy (PIPT) for improving outcomes after degenerative spine, hip, or knee surgery. Methods: Four electronic databases were searched.Randomized trials were included if they examined the efficacy of a preoperative or postoperative intervention involving the delivery of psychologically based strategies by a physical therapist for improving function/disability, pain, quality of life, or psychological factors. Outcomes at 12 months or longer were considered long-term.Results: Twelve articles representing 10 unique studies (total N = 1,127 patients, 636 (56.4%) females) in lumbar (n = 7) or cervical spine surgery (n = 1), total knee arthroplasty (n = 1), and total knee/hip arthroplasty (n = 1) were included. The most common PIPT components were coping skills training, psychoeducation, and positive reinforcement. Greater improvements following PIPT were reported in 5 (56%) studies for function/disability, 6 (60%) for pain, 5 (71%) for quality of life, and 7 (70%) for psychological factors. Of these, greater long-term benefit was reported

Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials

“…Prior systematic reviews have summarized evidence on efficacy of graded activity 46 , 51 , 80 and PIPT. 1 , 17 , 33 , 75 , 90 Overall, our results are largely consistent with these reviews, which show promising effects for PIPT, namely in-person cognitive-behavioral-based physical therapy. Prior reviews have differed in their focus for condition (ie, postoperative pain, 17 general musculoskeletal pain, 1 , 75 low back pain, 33 and chronic pain 90 ) and comparators.…”

“… 1 , 17 , 33 , 75 , 90 Overall, our results are largely consistent with these reviews, which show promising effects for PIPT, namely in-person cognitive-behavioral-based physical therapy. Prior reviews have differed in their focus for condition (ie, postoperative pain, 17 general musculoskeletal pain, 1 , 75 low back pain, 33 and chronic pain 90 ) and comparators. We intended a broad condition focus that would include both nonoperative and postoperative patients, but did not find any postoperative studies that directly compared PIPT to standard physical therapy.…”

“…To date, there have been several systematic reviews around the topic of PIPT. 1 , 17 , 33 , 75 , 90 These prior reviews have summarized studies focused on different pain conditions (ie, postoperative pain, general musculoskeletal pain, and low back pain) and using a range of PIPT delivery modes (ie, in-person, group-based, and remotely delivered) and control groups (ie, no/minimal treatment, attention control, education, and usual care). Most of the prior studies reviewed have included a PIPT intervention based on cognitive-behavioral approaches.…”

Role of psychosocial factors on the effect of physical activity on physical function in patients after lumbar spine surgery

“…The variability in the chosen psychosocial factors was minimal, and the overall analytical sample represented a low to medium risk psychosocial profile. Evidence suggests that patients at high-risk for poor outcomes should be targeted for a biopsychosocial management approach [ 81 , 82 ]; our findings may not be generalizable for those at highest psychosocial risk. Approximately, 50% of the physical activity and patient-reported outcomes were missing at the 24-month time-point.…”

An exploration of physiotherapists' perceived benefits and barriers towards using psychosocial strategies in their practice

“…The benefits of psychosocial approaches have been recognized in physiotherapy literature, with regard to patient outcomes. From a patient perspective, reported benefits include: reduced pain and disability (Coronado, Patel, McKernan, Wegener, & Archer, 2019; Guerrero, Maujean, Campbell, & Sterling, 2018; Richmond et al, 2015; van Erp, Huijnen, Jakobs, Kleijnen, & Smeets, 2019), improved functional outcomes and quality of life (Coronado, Patel, McKernan, Wegener, & Archer, ; Richmond et al, 2015; Wilson & Cramp, ), increased adherence to rehabilitation programmes (Skolasky, Maggard, Li, Riley, & Wegener, 2015), enhanced psychosocial wellbeing (Guerrero, Maujean, Campbell, & Sterling, ; Sullivan & Adams, ), reduced use of health care system and improved return to work outcomes (Sullivan & Adams, ), less reliance on pain medication (Sullivan & Adams, ) and greater therapeutic alliance (Wilson, Chaloner, Osborn, & Gauntlett‐Gilbert, 2017). Likewise, from a physiotherapist perspective, the use of psychosocial approaches is perceived to be extremely beneficial for patients' rehabilitation outcomes and adherence (Cowell et al, ; Driver, Lovell, et al, 2019).…”