The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty

Abstract

Our aim was to assess the effect of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty (TKA). We searched studies on the effect of perioperative interventions focused on psychological distress used in conjunction with TKA on pain, function, and quality of life (QoL) on PubMed, Embase.com, PsycINFO/OVID, CENTRAL, the Cochrane Database of Systematic Reviews, Scopus, and Web of Science. We included 40 studies (22 RCTs, ten cohort studies, and eight quasi-experimental studies) with a total of 3846 patients. We graded the quality of evidence as low for pain and function and as moderate for QoL. Patients receiving music, education, cognitive behavioural therapy, guided imagery, pain coping skills training, Reiki, occupational therapy with self-monitoring, and biofeedback-assisted progressive muscles relaxing training had lower pain scores or declined opioid prescriptions after TKA. Pain coping skills training, audio recording-guided imagery scripts, video promoting self-confidence, psychological therapies by video, Reiki, music, occupational therapy with self-monitoring, education, and psychotherapy improved postoperative functional outcome. Education through an app improved QoL after TKA. The studies in our systematic review show that perioperative interventions targeting psychological distress for patients receiving TKA seem to have a positive effect on postoperative pain, function, and QoL. RCTs with strict methodological safeguards are still needed to determine if perioperative interventions focused on psychological distress should be used in conjunction with TKA. These studies should also assess which type of intervention will be most effective in improving patient-reported outcome measures and declining opioid prescriptions.

Short-term functional outcome after fast-track primary total knee arthroplasty: analysis of 623 patients

“…Other studies are less distinct and did not find a relationship between anxiety and suboptimal outcomes (Wood et al 2021). Nevertheless, previous studies showed that psychological support might lead to lower incidence of pain, anxiety/depression, and improve faster recovery (Tristaino et al 2016, Sorel et al 2020. Preoperative analysis of the presence of these factors and concomitant treatment might be an effective way to improve the satisfaction rate of TKA.…”

“…This might be feasible with the Pain Catastrophizing Scale (PCS) or Hospital Anxiety and Depression Scale (HADS) (Mercurio et al 2020). The recently published systematic review by Sorel et al is promising and described various interventions with good effect on postoperative pain, quality of life, and function for psychological distress in TKA patients (Sorel et al 2020). Therefore further studies are needed to identify these patients preoperatively and to examine in which way adequate therapy can be provided in this setting.…”

Acute pain after total hip and knee arthroplasty does not affect chronic pain during the first postoperative year: observational cohort study of 389 patients

“…Several modifiable risk factors have been reported that could reduce pain before surgery: losing weight, healthier dietary choices, levels of physical activity, use of assistive devices (i.e. insoles), decrease the number of medical comorbidities, pain catastrophizing and coping, and psychological factors, such as anxiety, distress and depression might also affect postoperative pain [ 5 , 32 , 41 , 42 ]. Sorel et al [ 42 ] showed that perioperative interventions targeting psychological distress resulted in improved pain scores or decreased opioid or other types of pain medication prescriptions after TKA.…”

Depression in Osteoarthritis: Current Understanding

“… 92 Although not all of the evidence included in the meta-analysis was for psychotherapy, the results suggest that interventions targeting psychological distress in patients with TKA are very attractive directions for treatment. 92 …”

“… 91 A more recent meta-analysis included 40 studies. 92 It concluded that perioperative interventions targeting psychological distress had a positive effect on postoperative pain, function, and QoL for patients who underwent TKA. 92 Although not all of the evidence included in the meta-analysis was for psychotherapy, the results suggest that interventions targeting psychological distress in patients with TKA are very attractive directions for treatment.…”