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Nanbancha A, Mawhinney C, Sinsurin K. The effect of motor imagery and action observation in the rehabilitation of lower limb injuries: A scoping review. Clin Rehabil 2022; 37:145-161. [PMID: 36050928 DOI: 10.1177/02692155221123546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To synthesize research literature, which has investigated the application of motor imagery and action observation in rehabilitation protocols. Specifically, we aimed to review the implementation of motor imagery and action observation in the rehabilitation of lower limb injuries. METHODS This scoping review followed Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews checklist. The Medline (PubMed), Cochrane Library, Scopus, and Web of Science databases were searched for controlled clinical trials published between 2010 and 2021 using key search terms. Primary articles were screened for inclusion based upon applying motor imagery and action observation as a rehabilitation protocol (independently or in combination) after sustaining an injury or undergoing surgery. Data were charted by extracting the exercise duration, frequency, and the number of weeks from the rehabilitative intervention protocols, and the measured clinical outcomes (pain, range of motion, muscle activity, and functional outcomes). RESULTS The initial database search resulted in 1367 articles, with 1352 excluded after screening, resulting in a total of 15 articles eligible for inclusion in the review. Six of the included articles included an action observation intervention, eight studies a motor imagery intervention, and a single study included combined motor imagery and action observation approach. The motor imagery and action observation techniques were able to improve clinical outcomes, including daily activity, functional movement, rage of motion, pain, and muscle strength. CONCLUSION Motor imagery and action observation interventions may be effective to improve rehabilitative outcomes of lower limb injuries, thus its application should be considered alongside standard treatment protocols.
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Affiliation(s)
- Ampika Nanbancha
- College of Sports Science and Technology, 26685Mahidol University, Salaya, Thailand
| | - Chistopher Mawhinney
- College of Sports Science and Technology, 26685Mahidol University, Salaya, Thailand
| | - Komsak Sinsurin
- Biomechanics and Sports Research Unit, Faculty of Physical Therapy, 26685Mahidol University, Salaya, Thailand
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Lee TH, Liu CH, Chen PC, Liou TH, Escorpizo R, Chen HC. Effectiveness of mental simulation practices after total knee arthroplasty in patients with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0269296. [PMID: 35657803 PMCID: PMC9165806 DOI: 10.1371/journal.pone.0269296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023] Open
Abstract
Mental simulation practices, such as motor imagery, action observation, and guided imagery, have been an intervention of interest in neurological and musculoskeletal rehabilitation. Application of such practices to postoperative patients in orthopedics, particularly after total knee arthroplasty, has resulted in favorable physical function outcomes. In this systematic review and meta-analysis, we wish to determine the effectiveness of mental simulation practices with standard physical therapy compared to standard physical therapy alone in patients who underwent total knee arthroplasty in terms of postoperative pain, physical functions, and patient-reported outcome measures. We identified randomized controlled trials from inception to August 28, 2021, by using the PubMed, Cochrane Library, EMBASE, and Scopus databases. Data collection was completed on August 28, 2021. Finally, eight articles (249 patients) published between 2014 and 2020 were included. The meta-analysis revealed that mental simulation practices caused more favorable results in pain [standardized mean difference = -0.42, 95% confidence interval (CI) (-0.80 to -0.04), P = 0.03], range of motion [0.55, 95% CI (0.06-1.04), P = 0.03], maximal strength of quadriceps [1.21, 95% CI (0.31-2.12), P = 0.009], and 36-Item Short-Form Survey [0.53, 95% CI (0.14-0.92), P = 0.007]. Our data suggest that mental simulation practices may be considered adjunctive to standard physiotherapy after total knee arthroplasty in patients with knee osteoarthritis.
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Affiliation(s)
- Ting-Hsuan Lee
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Hung Liu
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pei-Chi Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, College of Nursing and Health Sciences, Burlington, VT, United States of America
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- * E-mail:
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Umberger W. Priorities in Complementary and Alternative Medicine Research for Pain Management: Advancing the State of the Science. Pain Manag Nurs 2022; 23:249-250. [DOI: 10.1016/j.pmn.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Li R, Du J, Yang K, Wang X, Wang W. Effectiveness of motor imagery for improving functional performance after total knee arthroplasty: a systematic review with meta-analysis. J Orthop Surg Res 2022; 17:65. [PMID: 35109909 PMCID: PMC8811995 DOI: 10.1186/s13018-022-02946-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/21/2022] [Indexed: 12/25/2022] Open
Abstract
Background The aim of this study was to appraise the effects of motor imagery on the functional performance improvement among total knee arthroplasty patients systematically. We hypothesized a relatively greater recovery in the motor imagery group. Methods Medline (Ovid), Embase and Cochrane Controlled Register of Trials (CENTRAL) were searched from inception to October 1st, 2021. We included randomized controlled trials evaluating the effects of motor imagery on the functional recovery among total knee arthroplasty patients. Measurements included range of motion, strength intensity, Visual Analogue Scale, Time Up and Go Test, Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, all of which were evaluated before and after intervention. Mean differences (MD) or standard mean differences (SMD) and 95% confidence intervals (CI) were calculated. The Cochrane risk of bias tool was used to assess the risk of bias. Results Six studies with 168 patients were included for the meta-analysis. The SMD of strength intensity was increased (SMD = 0.90, 95% CI = [0.47]–[1.32], P < 0.001). The SMD of Visual Analogue Scale was reduced (SMD = − 0.91; 95% CI = [− 1.29]–[− 0.52], P < 0.001). The SMD of Time Up and Go Test was reduced (SMD = − 0.56, 95% CI = [− 0.94]–[− 0.19], P = 0.003). The MD of Oxford Knee Score was slightly increased (MD = 0.79-point, 95% CI = [− 0.31]–[1.88], P = 0.159). The outcomes of range of motion, Western Ontario and McMaster Universities Osteoarthritis Index were described according to the original data. Conclusion Compared with control therapy, motor imagery in the intervention group achieved an effective treatment for strength enhancement, pain reduction and physical activities improvement. More large-scale, prospective researches are needed in the future. Trial registration: The PROSPERO trial registration number is CRD42021250996. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-02946-4.
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Affiliation(s)
- Ran Li
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, 45# Chang Chun Street, Beijing, 100000, China.,Department of Rehabilitation Center, Fuxing Hospital, Capital Medical University, 20# Fu Xing Men Wai Street, Beijing, 100000, China
| | - Jubao Du
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, 45# Chang Chun Street, Beijing, 100000, China.
| | - Kun Yang
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, 45# Chang Chun Street, Beijing, 100000, China
| | - Xue Wang
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, 45# Chang Chun Street, Beijing, 100000, China
| | - Wenjiao Wang
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, 45# Chang Chun Street, Beijing, 100000, China
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Prossin A, Koch A, Campbell P, Laumet G, Stohler CS, Dantzer R, Zubieta JK. Effects of placebo administration on immune mechanisms and relationships with central endogenous opioid neurotransmission. Mol Psychiatry 2022; 27:831-839. [PMID: 34716408 PMCID: PMC9054677 DOI: 10.1038/s41380-021-01365-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
Behavioral conditioning and expectation can have profound impact on animal and human physiology. Placebo, administered under positive expectation in clinical trials, can have potent effects on disease pathology, obscuring active medications. Emerging evidence suggests placebo-responsive neurotransmitter systems (e.g., endogenous opioid) regulate immune function by manipulating inflammatory proteins including IL-18, a potent pro-inflammatory, nociceptive cytokine implicated in pathophysiology of various diseases. Validation that neuroimmune interactions involving brain μ-opioid receptor (MOR) activity and plasma IL-18 underlie placebo analgesic expectation could have widespread clinical applications. Unfortunately, current lack of mechanistic clarity obfuscates clinical translation. To elucidate neuroimmune interactions underlying placebo analgesia, we exposed 37 healthy human volunteers to a standardized pain challenge on each of 2 days within a Positron Emission Tomography (PET) neuroimaging paradigm using the MOR selective radiotracer, 11C-Carfentanil (CFN). Each day volunteers received an intervention (placebo under analgesic expectation or no treatment), completed PET scanning, and rated their pain experience. MOR BPND parametric maps were generated from PET scans using standard methods. Results showed placebo reduced plasma IL-18 during pain (W74 = -3.7, p < 0.001), the extent correlating with reduction in pain scores. Placebo reduction in IL-18 covaried with placebo-induced endogenous opioid release in the left nucleus accumbens (T148 = 3.33; puncorr < 0.001) and left amygdala (T148 = 3.30; puncorr < 0.001). These findings are consistent with a modulating effect of placebo (under analgesic expectation in humans) on a potent nociceptive, pro-inflammatory cytokine (IL-18) and underlying relationships with endogenous opioid activity, a neurotransmitter system critically involved in pain, stress, and mood regulation.
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Affiliation(s)
- Alan Prossin
- Department of Psychiatry and Behavioral Sciences, University of Texas McGovern Medical School, Houston, TX, USA. .,Translational Imaging Center, Houston Methodist Research Institute, Weill Cornell College of Medicine, Houston, TX, USA.
| | - Alisa Koch
- grid.214458.e0000000086837370Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, MI USA
| | - Phillip Campbell
- grid.214458.e0000000086837370Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, MI USA
| | - Geoffroy Laumet
- grid.17088.360000 0001 2150 1785Department of Physiology, Michigan State University, East Lansing, MI USA
| | - Christian S. Stohler
- grid.21729.3f0000000419368729College of Dental Medicine, Columbia University, New York, NY USA
| | - Robert Dantzer
- grid.240145.60000 0001 2291 4776Department of Symptom Research, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Jon-Kar Zubieta
- grid.416477.70000 0001 2168 3646Department of Psychiatry, John T Mather Memorial Hospital, Northwell Health, Port Jefferson, NY USA
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Kaplun A, Alperovitch-Najenson D, Kalichman L. Effect of Guided Imagery on Pain and Health-Related Quality of Life in Musculoskeletal Medicine: a Comprehensive Narrative Review. Curr Pain Headache Rep 2021; 25:76. [PMID: 34894311 DOI: 10.1007/s11916-021-00991-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Guided imagery (GI) is a non-pharmacological method used to reduce pain, stress, and anxiety. No comprehensive review has yet investigated the application of GI in musculoskeletal medicine, its various types, and potential mechanisms. The aim of this comprehensive narrative review was to examine the types of GI used in musculoskeletal medicine and GI effect on pain and health-related quality of life. RECENT FINDINGS A comprehensive narrative review of the English language scientific literature. PubMed, Google Scholar, ProQuest, and PEDro databases were searched from inception until August 2020 using keywords related to GI, musculoskeletal disorders, pain, and health-related quality of life. The search results generated 133 articles. After a critical analysis, 12 publications were included in this review. GI characteristics and protocols varied significantly between studies. Based on the reviewed studies, we advocate GI as a safe, non-invasive technique that can assist in managing pain, depression, stress, fatigue, anxiety, reducing medication use, improving general well-being, wellness, and quality of life in patients with musculoskeletal disorders. We recommend further investigations of GI mechanisms.
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Affiliation(s)
- Anat Kaplun
- Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer Sheva, Israel
| | - Deborah Alperovitch-Najenson
- Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer Sheva, Israel.
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The Impact of Guided Imagery on Pain and Anxiety in Hospitalized Adults. Pain Manag Nurs 2021; 22:465-469. [PMID: 33771469 DOI: 10.1016/j.pmn.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use and impact of guided imagery in the acute care setting is limited. AIMS The purpose of this quality improvement project was to evaluate the feasibility of a guided imagery intervention to change pain scores, anxiety scores, and opioid analgesia usage among hospitalized adults in an acute care setting. DESIGN Quality improvement project using three measurements (baseline, 24 hours, and 48 hours). SETTINGS Acute care hospital. PARTICIPANTS/SUBJECTS Adult inpatients referred to an APRN-led pain management service. METHODS The intervention was the use of a 30-minute guided imagery recording delivered via MP3 player which patients used twice daily. RESULTS Limited changes were seen in pain scores, with no statistically significant results (p = .449). Statistically significant reductions were found in both anxiety scores (p < .001) and opioid analgesia usage (p = .043). CONCLUSIONS Findings from this quality improvement project support the impact of guided imagery on anxiety and opioid analgesia use. Changes in pain scores were not demonstrated in this project. Additional research with a rigorous design is needed to determine cause and effect conclusions. CLINICAL IMPLICATIONS The use of guided imagery as an adjunctive intervention for pain control may engage and empower the patient in self-care activities, which may have an impact on how care is perceived. Guided imagery is a low-cost, easily implemented approach that can be incorporated into patient care to reduce anxiety and, potentially, opioid analgesia use.
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Paravlic AH, Maffulli N, Kovač S, Pisot R. Home-based motor imagery intervention improves functional performance following total knee arthroplasty in the short term: a randomized controlled trial. J Orthop Surg Res 2020; 15:451. [PMID: 33008432 PMCID: PMC7531130 DOI: 10.1186/s13018-020-01964-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/14/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Motor imagery (MI) is effective in improving motor performance in the healthy asymptomatic adult population. However, its possible effects among older orthopaedic patients are still poorly investigated. Therefore, this study explored whether the addition of motor imagery to routine physical therapy reduces the deterioration of quadriceps muscle strength and voluntary activation (VA) as well as other variables related to motor performance in patients after total knee arthroplasty (TKA). METHODS Twenty-six patients scheduled for TKA were randomized to either MI practice combined with routine physical therapy group (MIp) or to a control group receiving physical therapy alone (CON). MIp consisted of maximal voluntary isometric contraction (MViC) task: 15 min/day in the hospital, then 5 times/week in their homes for 4 weeks. MViC and VA of quadriceps muscle, knee flexion and extension range of motion, pain level, along with a Timed Up-and-Go Test (TUG) and self-reported measure of physical function (assessed using the Oxford Knee Score questionnaire [OKS]) were evaluated before (PRE) and 1 month after surgery (POST). RESULTS Significantly better rehabilitation outcomes were evident on the operated leg for the MIp group compared to CON: at POST, the MIp showed lower strength decrease (p = 0.012, η2 = 0.237) and unaltered VA, significantly greater than CON (p = 0.014, η2 = 0.227). There were no significant differences in knee flexion and extension range of motion and pain level (p > 0.05). Further, MIp patients performed better in TUG (p < 0.001, η2 = 0.471) and reported better OKS scores (p = 0.005, η2 = 0.280). The non-operated leg showed no significant differences in any outcomes at POST (all p > 0.05). In addition, multiple linear regression analysis showed that failure of voluntary activation explained 47% of the quadriceps muscle strength loss, with no significant difference in perceived level of pain. CONCLUSION MI practice, when added to physical therapy, improves both objective and subjective measures of patients' physical function after TKA, and facilitates transfer of MI strength task on functional mobility. TRIAL REGISTRATION Retrospectively registered on ClinicalTrials.gov NCT03684148.
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Affiliation(s)
- Armin H Paravlic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
- Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK.
| | - Simon Kovač
- Orthopaedic Hospital Valdoltra, Ankaran, Slovenia
| | - Rado Pisot
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
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The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty. Rheumatol Int 2020; 40:1961-1986. [PMID: 32728837 PMCID: PMC7591436 DOI: 10.1007/s00296-020-04644-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022]
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.
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Belford K, Gallagher N, Dempster M, Wolfenden M, Hill J, Blaney J, O'Brien S, Smit AM, Botha P, Molloy D, Beverland D. Psychosocial predictors of outcomes up to one year following total knee arthroplasty. Knee 2020; 27:1028-1034. [PMID: 32299757 DOI: 10.1016/j.knee.2020.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/06/2020] [Accepted: 03/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) aims to relieve pain and improve physical functioning of the knee, however, some patients continue to experience pain and impaired function following TKA which cannot be explained by surgical and implant factors. Psychological factors may influence the outcomes of TKA. The aim of this prospective study was to examine the psychosocial factors that predicted pain, stiffness and physical functioning up to one year following TKA. METHODS One hundred and two patients completed pre-operative and one-year questionnaires which assessed a wide range of psychosocial and sociodemographic factors prior to surgery. The Oxford Knee Score (OKS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Stiffness and Physical Functioning subscales were used as outcome measures. Pearson correlation analysis and multiple linear regression were conducted to examine relationships between predictor and outcome variables. RESULTS Regression analysis showed that regarding variance in WOMAC outcome measures post TKA, our model predicted 31% for physical functioning, 25% for pain and 29% for stiffness at one year. Regarding variance in OKS post TKA, the model predicted 36% at one year. Greater levels of depressive symptoms and neuroticism and worse pre-operative scores significantly predicted poorer outcomes. CONCLUSIONS The findings indicate that pre-operative psychosocial factors are important in understanding outcomes of TKA. Psychosocial factors could be considered during pre-operative assessment. Further research conducted on psychological interventions is needed within this population to determine whether early and one-year outcomes can be improved.
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Affiliation(s)
- Kathryn Belford
- School of Behavioural Sciences, Queens University Belfast, David Keir Building, 18-30 Malone Road, Belfast BT9 5BN, Northern Ireland.
| | - Nicola Gallagher
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast BT9 7JB, Northern Ireland.
| | - Martin Dempster
- School of Behavioural Sciences, Queens University Belfast, David Keir Building, 18-30 Malone Road, Belfast BT9 5BN, Northern Ireland.
| | - Melanie Wolfenden
- Clinical Health Psychology Department, 4(th) Floor Bostock House, Royal Victoria Hospital, Belfast Health and Social Care trust, Grosvenor Road, Belfast BT12 6BA, Northern Ireland.
| | - Janet Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast BT9 7JB, Northern Ireland.
| | - Janine Blaney
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast BT9 7JB, Northern Ireland.
| | - Seamus O'Brien
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast BT9 7JB, Northern Ireland.
| | - Anne-Marie Smit
- Pinehaven Orthopaedic & Arthroplasty Institute, Netcare Pinehaven Hospital, Consulting Rooms, Floor 1 Suite 1, 1 Gateway Road, Pinehaven Country Estate, Krugersdorp, South Africa.
| | - Pieter Botha
- Pinehaven Orthopaedic & Arthroplasty Institute, Netcare Pinehaven Hospital, Consulting Rooms, Floor 1 Suite 1, 1 Gateway Road, Pinehaven Country Estate, Krugersdorp, South Africa
| | - Dennis Molloy
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast BT9 7JB, Northern Ireland.
| | - David Beverland
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast BT9 7JB, Northern Ireland.
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Paravlic AH, Tod D, Milanovic Z. Mental Simulation Practice Has Beneficial Effects on Patients' Physical Function Following Lower Limb Arthroplasty: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:1447-1461. [PMID: 32437689 DOI: 10.1016/j.apmr.2020.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the effectiveness of mental simulation practice (MSP) on measures of physical function recovery in patients who have undergone a joint replacement surgery of lower limbs. DATA SOURCES A systematic review was conducted using CINAHL, PubMed/MEDLINE, Embase, SPORTDiscus, PEDro, Cochrane Register of Controlled Trials, and Google Scholar from the earliest record until August 16, 2019. STUDY SELECTION The following inclusion criteria were used to determine eligibility for studies: (1) randomized and matched controlled trials recruiting men and women who underwent primary unilateral joint arthroplasty; (2) the study examined the effects of MSP intervention on measures of physical function recovery (both performance-based and patient self-reported); and (3) measures of interest were compared between MSP and control groups. A total of 8 papers (7 studies) met the inclusion criteria and were included. DATA EXTRACTION Data were extracted by 1 reviewer and checked by a second reviewer, independently. DATA SYNTHESIS When compared with standard physical therapy (SPT), MSP showed an effect on physical function in general (effect size [ES], 0.67; 95% confidence interval [CI], 0.38-0.96; n=7), maximal voluntary strength of knee extensor muscles of the affected leg (ES, 1.41; 95% CI, 0.64-2.18; n=2), brisk walking speed (ES, 1.20; 95% CI, 0.58-1.83; n=2), brisk walking speed with dual task (ES, 1.02; 95% CI, 0.41-1.63; n=2), timed up-to go test (ES, 0.96; 95% CI, 0.15-1.77; n=3), and active flexion of the affected leg (ES, 0.70; 95% CI, 0.29-1.11; n=4). Finally, meta-regression analysis revealed that the effects of MSP were significantly predicted only by total number of training sessions per study. CONCLUSIONS The present meta-analysis demonstrated that MSP intervention has multiple positive effects on measures of physical function recovery in patients who have undergone total knee or hip replacement surgery in comparison with SPT. Thus, MSP can be applied as an effective complementary therapy to SPT in physical rehabilitation of this specific population, especially in the early postacute and acute phase.
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Affiliation(s)
- Armin H Paravlic
- Science and Research Centre, Institute for Kinesiology Research, Koper, Slovenia.
| | - David Tod
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Zoran Milanovic
- Science and Research Centre, Institute for Kinesiology Research, Koper, Slovenia; Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
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Garza JR, Campbell RE, Tjoumakaris FP, Freedman KB, Miller LS, Santa Maria D, Tucker BS. Clinical Efficacy of Intra-articular Mesenchymal Stromal Cells for the Treatment of Knee Osteoarthritis: A Double-Blinded Prospective Randomized Controlled Clinical Trial. Am J Sports Med 2020; 48:588-598. [PMID: 32109160 DOI: 10.1177/0363546519899923] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently, there are limited nonoperative treatment options available for knee osteoarthritis (OA). Cell-based therapies have emerged as promising treatments for knee OA. Autologous stromal vascular fraction (SVF) has been identified as an efficient medium for intra-articular administration of progenitor cells and mesenchymal stem cells derived from adipose tissue. HYPOTHESIS Patients receiving intra-articular SVF would show significantly greater improvement than patients receiving placebo injections, and this improvement would be dose dependent. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a multisite prospective double-blinded randomized placebo-controlled clinical trial. Adult patients with symptomatic knee OA were eligible. Thirty-nine patients were randomized to high-dose SVF, low-dose SVF, or placebo (1:1:1). SVF was obtained via liposuction, processed to create the cellular implant, and injected during the same clinical visit. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and magnetic resonance images were obtained preoperatively and at 6 and 12 months after injection. The Wilcoxon rank sum nonparametric test was utilized to assess statistical significance, and the Hodges-Lehmann location shift was used to assess superiority. RESULTS The median percentage change in WOMAC score at 6 months after injection for the high-dose, low-dose, and placebo groups was 83.9%, 51.5%, and 25.0%, respectively. The high- and low-dose groups had statistically significant changes in WOMAC scores when compared with the placebo group (high dose, P = .04; low dose, P = .02). The improvements were dose dependent. The median percentage change in WOMAC score from baseline to 1 year after injection for the high-dose, low-dose, and placebo groups was 89.5%, 68.2%, and 0%, respectively. The high- and low-dose groups displayed a greater percentage change at 12 months when compared with the placebo group (high dose, P = .006; low dose, P = .009). Magnetic resonance image review revealed no changes in cartilage thickness after treatment. No serious adverse events were reported. CONCLUSION Intra-articular SVF injections can significantly decrease knee OA symptoms and pain for at least 12 months. The efficacy and safety demonstrated in this placebo-controlled trial support its implementation as a treatment option for symptomatic knee OA. REGISTRATION NCT02726945 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jaime R Garza
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
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Whale K, Wylde V, Beswick A, Rathbone J, Vedhara K, Gooberman-Hill R. Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement: a systematic review. BMJ Open 2019; 9:e029742. [PMID: 31806606 PMCID: PMC6924731 DOI: 10.1136/bmjopen-2019-029742] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess the effectiveness and reporting standards of psychological interventions for improving outcomes after total knee replacement (TKR). DESIGN Medline, Embase, and PsycINFO were searched from inception to up to 9 May 2019 with no language restrictions applied. Randomised controlled trials (RCTs) assessing the effectiveness of psychological interventions for short-term and long-term postoperative pain after TKR were included. Screening, data extraction, and assessment of methodological quality were performed in duplicate by two reviewers. The primary effectiveness outcome was postoperative pain severity and the primary harm outcome was serious adverse events. Secondary outcomes included function, quality of life, and psychological well-being. Reporting standards were assessed using the Template for Intervention Description and Replication (TIDieR) checklist for intervention reporting. RESULTS 12 RCTs were included, with a total of 1299 participants. Psychological interventions comprised music therapy (five studies), guided imagery and music (one study), hypnosis (one study), progressive muscle relaxation with biofeedback (one study), pain coping skills programme (one study), cognitive-behavioural therapy (two studies), and a postoperative management programme (one study). Due to the high heterogeneity of interventions and poor reporting of harms data, it was not possible to make any definitive statements about the overall effectiveness or safety of psychology interventions for pain outcomes after TKR. CONCLUSION Further evidence about the effectiveness of psychological interventions for improving pain outcomes after TKR is needed. The reporting of harm outcomes and intervention fidelity is currently poor and could be improved. Future work exploring the impact of intervention timing on effectiveness and whether different psychological approaches are needed to address acute postoperative pain and chronic postoperative pain would be of benefit. PROSPERO REGISTRATION NUMBER CRD42018095100.
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Affiliation(s)
- Katie Whale
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vikki Wylde
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Rathbone
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Kavita Vedhara
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachael Gooberman-Hill
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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15
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Nicholson V, Watts N, Chani Y, Keogh JW. Motor imagery training improves balance and mobility outcomes in older adults: a systematic review. J Physiother 2019; 65:200-207. [PMID: 31521556 DOI: 10.1016/j.jphys.2019.08.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 01/20/2023] Open
Abstract
QUESTION Does motor imagery training improve measures of balance, mobility and falls in older adults without a neurological condition? DESIGN Systematic review and meta-analysis of randomised controlled trials. PARTICIPANTS Adults aged at least 60 years and without a neurological condition. INTERVENTION Three or more sessions of motor imagery training. OUTCOME MEASURES The primary outcomes were balance measures (such as single leg stance and Berg Balance scale) and mobility measures (such as gait speed and the Timed Up and Go test). Falls were a secondary outcome measure. Risk of bias was evaluated using the PEDro Scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach. RESULTS Twelve trials including 356 participants were included in the systematic review and 10 trials (316 participants) were included in the meta-analyses. All trials included either apparently healthy participants or older adults after orthopaedic surgery. There was evidence that motor imagery training can significantly improve balance (SMD 1.03, 95% CI 0.25 to 1.82), gait speed (MD 0.13 m/s, 95% CI 0.04 to 0.22) and Timed Up and Go (MD 1.64 seconds, 95% CI 0.79 to 2.49) in older adults; however, the quality of evidence was very low to low. No data regarding falls were identified. CONCLUSION Motor imagery training improves balance and mobility in older adults who do not have a neurological condition. These results suggest that motor imagery training could be an adjunct to standard physiotherapy care in older adults, although it is unclear whether or not the effects are clinically worthwhile. TRIAL REGISTRATION PROSPERO CRD42017069954.
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Affiliation(s)
- Vaughan Nicholson
- School of Allied Health, Australian Catholic University, Brisbane, Australia.
| | - Naomi Watts
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Yannick Chani
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Justin Wl Keogh
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia; Human Potential Centre, AUT University, Auckland, New Zealand; Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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16
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Strunce J, Spoonemore S, Golding J, Randall T, Krok M, Lee S, Bordt D, Walker-Ferrell W, Cordel D. Physical rehabilitation therapists' perspective of the opioid crisis with evidence-based recommendations. Pain Manag 2019; 9:483-495. [PMID: 31452447 DOI: 10.2217/pmt-2019-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In 2017, the Secretary of Health and Human Services and Office of the Surgeon General declared the opioid crisis of our nation to be a public health emergency. In response to the Office of the Assistant Secretary of Health and Office of the Surgeon General's 'Call to Action', the Therapist category of the US Public Health Service commissioned a nine-member task force consisting of pain science subject matter experts to study the Therapists' role in effectively reducing chronic pain and opioid abuse. This article addresses the opioid epidemic, how patients with chronic pain have been managed inappropriately, and five key, evidence-based recommendations from this task force.
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Affiliation(s)
- Joseph Strunce
- Rehabilitation Department, Four Corners Regional Health Center, Red Mesa, AZ 86514, USA
| | - Stephen Spoonemore
- Rehabilitation Department, Physical Therapy & Exercise Southcentral Foundation, Anchorage, AK 99508, USA
| | - Joseph Golding
- Rehabilitation Department, Parker Indian Health Center, Parker, AZ 85344, USA
| | - Tarri Randall
- Rehabilitation Department, Whiteriver Indian Hospital, Whiteriver, AZ 85941, USA
| | - Michael Krok
- Rehabilitation Department, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Steven Lee
- Rehabilitation Department, Valley Native Primary Care Center, Wasilla, AK 99654, USA
| | - Daniel Bordt
- Rehabilitation Department, Federal Medical Center Rochester, Rochester, MN 55904, USA
| | - Wendy Walker-Ferrell
- Rehabilitation Department, Chinle Comprehensive Health Care Facility, Chinle, AZ 86503, USA
| | - Douglas Cordel
- Rehabilitation Department, Four Corners Regional Health Center, Red Mesa, AZ 86514, USA
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Paravlic AH, Pisot R, Marusic U. Specific and general adaptations following motor imagery practice focused on muscle strength in total knee arthroplasty rehabilitation: A randomized controlled trial. PLoS One 2019; 14:e0221089. [PMID: 31412056 PMCID: PMC6693761 DOI: 10.1371/journal.pone.0221089] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Motor imagery (MI) has been a widely used strategy in the past two decades to enhance physical capabilities among orthopaedic patients. However, its effectiveness is still questioned, since the demonstrated effects were likely task-dependent, with little evidence of transfer to tasks not specifically trained with MI. OBJECTIVE The aim of this study was to investigate whether an MI practice focused on maximal isometric knee extension strength, causes additional specific and general adaptations upon neuromuscular and functional variables when compared to conventional rehabilitation only, in patients submitted to total knee arthroplasty (TKA). DESIGN Parallel group randomized controlled clinical trial. PARTICIPANTS Thirty-four patients (56% man) submitted to TKA. PROGRAM Patients were randomly assigned to an MI practice group (MIp: 15 minutes per day/5 days per week in addition to routine physical therapy) or control group (CON) that performed routine physical therapy alone for four weeks. OUTCOME MEASURES The maximal isometric knee extension strength of the operated leg was defined as the primary outcome. Secondary outcomes were spatial and temporal gait parameters, 30-second chair sit-to-stand performance, a self-reported physical function assessed by the Lower Extremity Functional Scale (LEFS) questionnaire, and an MI ability score. All measurements were conducted before and one month after TKA. RESULTS Significant differences in treatment effects were observed for the MIp group compared to CON: the MIp showed less strength decrease (ES = 1.15, 95% CI: 0.32, 1.99, p = 0.022); faster self-selected speed under single (ES = 2.12, 95% CI: 1.16, 3.08, p = 0.001) and dual task (ES = 1.59, large, 95% CI: 0.67, 2.50, p = 0.002) conditions; brisk-pace gait speed during single (ES = 1.32, 95% CI: 0.47, 2.17, p = 0.020) and dual task conditions (ES = 1.31, large, 95% CI: 0.38, 2.23, p = 0.013); improved chair sit-to-stand (ES = 1.45, large, 95% CI: 0.58, 2.31, p = 0.004) performance; and a higher score on MI ability questionnaires for kinaesthetic imagery (KI) (ES = 0.55, 95% CI: -0.23, 1.34, p = 0.010) and internal visual imagery (EVI) (ES = 0.99, 95% CI: 0.18, 1.80, p = 0.039) scales, respectively. In addition, only MIp showed unaltered single and double support periods, as well as stride length and cadence during single task self-selected gait condition. Finally, analysis showed that the improved MI ability score achieved at the end of MI training was significantly correlated with the changes in the strength of the operated leg (kinaesthetic imagery: r = 0.741, p = 0.004; and internal visual imagery: r = 0.623, p = 0.023). CONCLUSIONS MI training, when added in a corollary to routine physical therapy, led to improvements in both specific and general adaptations that were related to patients' physical capabilities. While future studies must also evaluate the long-term effects, conducting MI training during acute and post-acute rehabilitation phases is advised, especially when the extent and range of physical exercise is limited or made impossible. TRIAL REGISTRATION ClinicalTrials.gov NCT03684148.
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Affiliation(s)
- Armin H. Paravlic
- Science and Research Centre, Institute for Kinesiology Research, Garibaldijeva 1, Slovenia
| | - Rado Pisot
- Science and Research Centre, Institute for Kinesiology Research, Garibaldijeva 1, Slovenia
- Faculty of Sport, University of Ljubljana, Slovenia
| | - Uros Marusic
- Science and Research Centre, Institute for Kinesiology Research, Garibaldijeva 1, Slovenia
- Department of Health Sciences, Alma Mater Europaea-ECM, Maribor, Slovenia
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Tong F, Dannaway J, Enke O, Eslick G. Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta-analysis. ANZ J Surg 2019; 90:230-236. [PMID: 31334592 DOI: 10.1111/ans.15332] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/09/2019] [Accepted: 05/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Orthopaedic surgery is largely successful; however, a proportion of patients are dissatisfied and report pain and poor function. Psychological factors have been shown to influence orthopaedic surgical outcomes. This systematic review and meta-analysis investigates the types and effectiveness of preoperative psychological interventions in elective orthopaedic surgery. METHODS A registered systematic review (PROSPERO CRD42017073833) was performed on literature (1960-January 2018) using eight databases. Prospective controlled clinical trials involving adult and adolescent elective orthopaedic surgery were included. Interventions examined included relaxation, cognitive behavioural therapy, hypnosis, emotional counselling and mixed psychotherapies; general procedural education was excluded. Outcomes extracted included pain, anxiety, quality of life and disability. RESULTS A total of 19 studies met the inclusion criteria (n = 1893 patients). Meta-analyses were performed for pain, anxiety and quality of life. Analysis did not find enough evidence to confirm reduction in post-operative pain (seven studies, 666 patients; g = -0.15 (95% CI -0.42, 0.13), P = 0.305). Pooled data from six studies on acute post-operative anxiety (589 patients) showed a moderate statistically significant benefit (g = -0.26 (-0.49, -0.03), P = 0.024). There was an improved quality of life (mental component) at longer term follow-up (g = 0.25 (0.02, 0.49), P = 0.034). CONCLUSIONS These studies provide evidence that psychological interventions have a positive effect on anxiety in the acute post-operative period, and on mental components of quality of life at longer term follow-up.
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Affiliation(s)
- Felice Tong
- Nepean Clinical School, Sydney Medical Program, The University of Sydney, Sydney, New South Wales, Australia
| | - Jasan Dannaway
- Department of Orthopaedic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Oliver Enke
- Department of Orthopaedic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Guy Eslick
- Nepean Clinical School, Sydney Medical Program, The University of Sydney, Sydney, New South Wales, Australia
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Umberger W, Draucker CB, Jacobson A. Guided Imagery for Total Knee Replacement: Responses to an Audiobook Placebo Treatment. West J Nurs Res 2019; 42:210-219. [PMID: 31161926 DOI: 10.1177/0193945919852964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of a placebo is the gold standard for establishing the efficacy of new treatments in randomized controlled trials (RCTs). Placebo treatments are inert; this allows specific effects of the experimental treatment to be separated from nonspecific physiological, psychological, and social effects. The aim of this study was to scrutinize the workings of an audiobook (AB) placebo treatment, which was used in a placebo-controlled, investigator-blinded, RCT of the effect of guided imagery (GI) to improve pain and function in persons undergoing total knee replacement. A secondary analysis of quantitative and narrative data collected during the RCT was performed. The AB treatment provided attention control. Participants in the AB group identified benefits-pleasant get-away, new knowledge, quiet time-out, and inspiration; however, there was also evidence of resentful demoralization, especially in the postoperative period. The use of ABs as a placebo treatment in GI RCTs should be executed with caution.
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20
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Felix MMDS, Ferreira MBG, da Cruz LF, Barbosa MH. Relaxation Therapy with Guided Imagery for Postoperative Pain Management: An Integrative Review. Pain Manag Nurs 2019; 20:3-9. [DOI: 10.1016/j.pmn.2017.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 12/29/2022]
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21
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Szeverenyi C, Kekecs Z, Johnson A, Elkins G, Csernatony Z, Varga K. The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. THE JOURNAL OF PAIN 2018; 19:1231-1252. [DOI: 10.1016/j.jpain.2018.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 04/15/2018] [Accepted: 05/14/2018] [Indexed: 01/03/2023]
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22
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Bay S, Kuster L, McLean N, Byrnes M, Kuster MS. A systematic review of psychological interventions in total hip and knee arthroplasty. BMC Musculoskelet Disord 2018; 19:201. [PMID: 30037341 PMCID: PMC6055334 DOI: 10.1186/s12891-018-2121-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality, anxiety, depression and negative thinking styles can influence outcomes and recovery from surgery. The objective of this paper was to review the effectiveness of psychological interventions used in conjunction with total hip (THA) and knee arthroplasty (TKA), in improving patient reported joint outcomes. METHODS An extensive literature search was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Search terms included psychology, interventions, and orthopaedics. Articles were included if they were randomised controlled trials (RCTs) of psychological interventions involving active patient participation measured with patient reported joint outcomes in patients undergoing hip or knee arthroplasty. RESULTS A total of 19,489 titles were screened. Seven studies met the inclusion criteria and were included. Five of seven studies did not show improvements in patient reported outcomes after surgery. Specifically, psycho-education alone was not effective at improving patient reported joint outcomes in two out of two studies. CONCLUSION The current literature does not support routine psychological interventions for TKA and THA. However, it should be noted that the literature for psychological interventions in conjunction with TKA and THA is still in its infancy. This gap in the literature is surprising, considering the importance of the role of psychological factors in recovery. Further RCTs with long term follow ups, multidisciplinary involvement, and more comprehensive and focused interventions that go beyond educating patients are needed. Future studies should account for the demand effect, include measures of psychological variables to determine whether psychological interventions are more beneficial for some patients compared to others, and compare the different modes of delivery and timing of interventions to determine the optimal nature and duration of psychological interventions for TKA and THA.
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MESH Headings
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Hip/trends
- Arthroplasty, Replacement, Knee/psychology
- Arthroplasty, Replacement, Knee/trends
- Cognitive Behavioral Therapy/methods
- Humans
- Osteoarthritis, Hip/psychology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/psychology
- Osteoarthritis, Knee/surgery
- Patient Education as Topic/methods
- Patient Participation/methods
- Patient Participation/psychology
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Affiliation(s)
- Samantha Bay
- M304, School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009 Australia
| | - Lukas Kuster
- Sir Charles Gairdner Hospital, Hospital Ave, Perth, Western Australia 6009 Australia
| | - Neil McLean
- M304, School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009 Australia
| | - Michelle Byrnes
- Perron Institute for Neurological and Translational Science, The University of Western Australia, RR Block, QEII Medical Centre, 8 Verdun Street, Perth, Western Australia 6009 Australia
| | - Markus Stefan Kuster
- Sir Charles Gairdner Hospital, Hospital Ave, Perth, Western Australia 6009 Australia
- Medical School, The University of Western Australia, 35 Stirling Hwy, Perth, Western Australia 6009 Australia
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Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, Ratner E, Lemmon RL, Wayne P, Zador V. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore (NY) 2018; 14:177-211. [PMID: 29735382 DOI: 10.1016/j.explore.2018.02.001] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.
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Affiliation(s)
- Heather Tick
- Departments of Family Medicine, Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kenneth R Pelletier
- Department of Medicine, University of California School of Medicine, San Francisco, CA
| | - Robert Bonakdar
- Department of Pain Management, Scripps Center for Integrative Medicine, La Jolla, CA
| | | | - Ronald Glick
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Emily Ratner
- MedStar Health, Institute for Innovation, Integrative Medicine Initiatives, MedStar Montgomery Medical Center, Washington, DC
| | - Russell L Lemmon
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Veronica Zador
- Beaumont Hospital Integrative Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
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Chad-Friedman E, Talaei-Khoei M, Ring D, Vranceanu AM. First Use of a Brief 60-second Mindfulness Exercise in an Orthopedic Surgical Practice; Results from a Pilot Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2017; 5:400-405. [PMID: 29299495 PMCID: PMC5736889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Mindfulness based interventions may be useful for patients with musculoskeletal conditions in orthopedic surgical practices as adjuncts to medical procedures or alternatives to pain medications. However, typical mindfulness programs are lengthy and impractical in busy surgical practices. We tested the feasibility, acceptability and preliminary effect of a brief, 60-second mindfulness video in reducing pain and negative emotions in patients presenting to an orthopedics surgical practice. METHODS This was an open pilot study. Twenty participants completed the Numerical Rating Scale to assess pain intensity, the State Anxiety subscale of the State Trait Anxiety Scale to assess state anxiety, and emotional thermometers to assess distress, anxiety, anger and depression immediately prior to and following the mindfulness video exercise. At the end of the exercise patients also answered three questions assessing satisfaction with the mindfulness video. RESULTS Feasibility of the mindfulness video was high (100%). Usefulness, satisfaction and usability were also high. Participants showed improvements in state anxiety, pain intensity, distress, anxiety, depression and anger after watching the video. These changes were both statistically significant and clinically meaningful, when such information was available. CONCLUSION People with musculoskeletal pain seeking orthopedic care seem receptive and interested in brief mindfulness exercises that enhance comfort and calm.
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Affiliation(s)
- Emma Chad-Friedman
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Mojtaba Talaei-Khoei
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - David Ring
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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25
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Billquist EJ, Michelfelder A, Brincat C, Brubaker L, Fitzgerald CM, Mueller ER. Pre-operative guided imagery in female pelvic medicine and reconstructive surgery: a randomized trial. Int Urogynecol J 2017; 29:1117-1122. [DOI: 10.1007/s00192-017-3443-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
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