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Orgil Z, Karthic A, Bell NF, Heisterberg LM, Williams SE, Ding L, Kashikar-Zuck S, King CD, Olbrecht VA. Feasibility and Acceptability of Biofeedback-Based Virtual Reality System Use in Children and Adolescents Undergoing Surgery: Phase 1 of a Pilot Observational Study. JMIR Perioper Med 2024. [PMID: 38742940 DOI: 10.2196/48959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Biofeedback-based virtual reality (VR-BF) is a novel, nonpharmacologic method for teaching patients how to control their breathing, which in turn increases heart rate variability (HRV) and may reduce pain. Unlike traditional forms of biofeedback (BF), VR-BF is delivered through a gamified virtual reality environment, increasing the accessibility of BF. This is the first study to systematically integrate VR-BF use in the pediatric perioperative setting, with the ultimate goal of evaluating the efficacy of VR-BF to reduce pain, anxiety, and opioid consumption once feasibility and acceptability has been established. OBJECTIVE The primary objective was to develop a clinical trial protocol for VR-BF use in the pediatric perioperative setting, including preoperative education/training and postoperative application of VR-BF in children undergoing surgery. A secondary objective was to evaluate the patient/parent experience with VR-BF. METHODS A total of 23 patients (12-18 years of age) scheduled for surgery at Nationwide Children's Hospital were recruited using purposive sampling. Following training, participants independently completed a daily, 10-minute VR-BF session for seven days before surgery and during their inpatient stay. Participants could use VR-BF up to two weeks after hospital discharge. Patient and session-level data of VR-BF usage and achievement of target HRV parameters were measured to identify the optimal frequency and duration of sessions before and after surgery for this population. Standardized questionnaires and semi-structured interviews were conducted to obtain qualitative information about patients' experiences with VR-BF. RESULTS Patient-level data indicated that the highest odds of achieving 1 session under target HRV parameters was after 4 sessions (OR 4 vs. 3 sessions=5.1, 95% CI 1.3-20.6; OR 3 vs. 2 sessions=16.6, 95% CI 1.2-217.0). Session-level data showed that a session duration of 9 to 10 minutes provided the greatest odds of achieving 1 session under target HRV parameters (OR 9 vs. 8 minutes=1.3, 95% CI 1.1-1.7; OR 8 vs. 7 minutes=1.4, 95% CI 1.1-1.8; OR 10 vs. 9 minutes=1.0, 95% CI 0.9-1.2). Qualitative data revealed patient satisfaction with the VR-BF technology, particularly in managing perioperative stress (n=17, 85%). Few patients reported VR-BF as beneficial for pain (n=8, 40%). CONCLUSIONS Children and adolescents undergoing surgery successfully learned behavioral strategies with VR-BF with once-daily 10-minute sessions for 5 days. To integrate VR-BF as a therapeutic intervention in a subsequent clinical trial, patients will be instructed to complete three 10-minute sessions a day for 7 days after surgery. CLINICALTRIAL ClinicalTrials.gov; NCT04943874; https://clinicaltrials.gov/ct2/show/NCT04943874.
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Affiliation(s)
- Zandantsetseg Orgil
- Department of Clinical Research Services, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, US
| | - Anitra Karthic
- The Ohio State University College of Medicine, Columbus, US
| | - Nora F Bell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, US
| | | | - Sara E Williams
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, US
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, US
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | - Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, US
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, US
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, US
| | - Vanessa A Olbrecht
- Department of Anesthesiology & Perioperative Medicine, Nemours Children's Health, Delaware Valley, 1600 Rockland Road, Wilmington, US
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Haroutounian S, Holzer KJ. Peri-operative mental health and pain after surgery: cause, consequence or coincidence? Anaesthesia 2024; 79:339-343. [PMID: 38177068 DOI: 10.1111/anae.16225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Affiliation(s)
- S Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
- Division of Clinical and Translational Research, Washington University School of Medicine, St. Louis, MO, USA
| | - K J Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
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Gordon AM, Magruder ML, Schwartz J, Ng MK, Erez O, Mont MA. Preoperative Depression Screening for Primary Total Knee Arthroplasty: An Evaluation of Its Modifiability on Outcomes in Patients Who Have Depression. J Arthroplasty 2024:S0883-5403(24)00133-5. [PMID: 38382629 DOI: 10.1016/j.arth.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Few studies have evaluated preoperative depression screenings in patients who have depression. We studied whether depression screenings before total knee arthroplasty (TKA) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations and readmissions; 3) implant complications; and 4) costs. METHODS A nationwide sample from January 1, 2010, to April 30, 2021, was collected using an insurance database. Depression patients were 1:1 propensity-score matched based on those who had (n = 29,009) and did not have (n = 29,009) preoperative depression screenings or psychotherapy visits within 3 months of TKA. A case-matched population who did not have depression was compared (n = 144,994). A 90-day period was used to compare complications and health-care utilization and 2-year follow-up for periprosthetic joint infections (PJIs) and implant survivorship. Costs were 90-day reimbursements. Logistic regression models computed odds ratios (ORs) of depression screening on dependent variables. P values less than .001 were significant. RESULTS Patients who did not receive preoperative screening were associated with higher medical complications (18.7 versus 5.2%, OR: 4.15, P < .0001) and ED utilizations (11.5 versus 3.2%, OR: 3.93, P < .0001) than depressed patients who received screening. Patients who had screening had lower medical complications (5.2 versus 5.9%, OR: 0.88, P < .0001) and ED utilizations compared to patients who did not have depression (3.2 versus 3.8%, OR: 0.87, P = .0001). Two-year PJI incidences (3.0 versus 1.3%, OR: 2.63, P < .0001) and TKA revisions (4.3 versus 2.1%, OR: 2.46, P < .0001) were greater in depression patients who were not screened preoperatively versus screened patients. Depression patients who had screening had lower PJIs (1.3 versus 1.8%, OR: 0.74, P < .0001) compared to nondepressed patients. Reimbursements ($13,949 versus $11,982; P < .0001) were higher in depression patients who did not have screening. CONCLUSIONS Preoperative screening was associated with improved outcomes in depression patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York; Questrom School of Business, Boston University, Boston, Massachusetts
| | - Matthew L Magruder
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Jake Schwartz
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Mitchell K Ng
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Orry Erez
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Michael A Mont
- Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Olsen U, Sellevold VB, Gay CL, Aamodt A, Lerdal A, Hagen M, Dihle A, Lindberg MF. Factors associated with pain and functional impairment five years after total knee arthroplasty: a prospective observational study. BMC Musculoskelet Disord 2024; 25:22. [PMID: 38167008 PMCID: PMC10759478 DOI: 10.1186/s12891-023-07125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Few studies have evaluated the associations between preoperative factors and pain and physical function outcomes after total knee arthroplasty (TKA) from a mid-term perspective. Identification of such factors is important for optimizing outcomes following surgery. Thus, we examined the associations between selected preoperative factors and moderate to severe pain and pain-related functional impairment as measured using the Brief Pain Inventory (BPI), five years after TKA in patients with knee osteoarthritis. METHODS In this prospective observational study, all patients scheduled for primary unilateral TKA for osteoarthritis were consecutively recruited. Preoperative factors identified from previous meta-analyses were included to assess their associations with pain severity and pain-related functional impairment five years after TKA. Pain severity was the primary outcome, while pain-related functional impairment was the secondary outcome. The BPI was used to evaluate outcomes five years post-TKA. Statistically significant factors from univariate regressions were entered into a multiple logistic regression model to identify those with the strongest associations with pain severity or pain-related functional impairment five years after TKA. RESULTS A total of 136 patients were included, with a mean age of 67.7 years (SD 9.2) and a majority being female (68%). More severe preoperative pain (OR = 1.34, 95% CI [1.03 to 1.74]), more painful sites (OR = 1.28., 95% CI [1.01 to 1.63]), and more severe anxiety symptoms (OR = 1.14., 95% CI [1.01 to 1.28]) were associated with increased likelihood of moderate to severe pain five years after TKA surgery, while more severe osteoarthritis (OR = 0.13, 95% CI [0.03 to 0.61]) was associated with reduced likelihood of moderate to severe pain five years after TKA. More severe anxiety symptoms (OR = 1.25, 95% CI [1.08 to 1.46]) were also associated with increased likelihood of moderate to severe pain-related functional impairment five years after surgery, while male sex (OR = 0.23, 95% CI [0.05 to 0.98]) was associated with reduced likelihood of pain-related functional impairment five years after surgery. CONCLUSION The identified preoperative factors should be included in larger prognostic studies evaluating the associations between preoperative factors and mid-term pain severity and physical function outcomes after TKA surgery.
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Affiliation(s)
- Unni Olsen
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, PB 4970 Nydalen, Oslo, 0440, Norway.
| | - Vibeke Bull Sellevold
- Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, USA
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, PB 4970 Nydalen, Oslo, 0440, Norway
| | - Anners Lerdal
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Milada Hagen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Alfhild Dihle
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Maren Falch Lindberg
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, PB 4970 Nydalen, Oslo, 0440, Norway
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Kaynar AM, Lin C, Sanchez AG, Lavage DR, Monroe A, Zharichenko N, Strassburger M, Saucier K, Groff YJ, Klatt BA, O'Malley MJ, Szigethy E, Wasan AD, Chelly JE. SuRxgWell: study protocol for a randomized controlled trial of telemedicine-based digital cognitive behavioral intervention for high anxiety and depression among patients undergoing elective hip and knee arthroplasty surgery. Trials 2023; 24:715. [PMID: 37946291 PMCID: PMC10634062 DOI: 10.1186/s13063-023-07634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/08/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Mood disorders (anxiety, depression), sleep disorders, and catastrophizing lead to increased post-operative pain perception, increase in postoperative opioid consumption, decreased engagement with physical activity, and increased resource utilization in surgical patients. Psychosocial disorders significantly affect postoperative outcome. Unfortunately, studies focused on perioperative psychological assessment and treatment are scarce. We propose to test whether digital cognitive behavioral intervention (dCBI) can help surgical patients. dCBI such as RxWell™ is a proven treatment for mood disorders in medical patients such as reducing depression in patients with inflammatory bowel disease. We hypothesize that RxWell™ will also be effective in surgical patients. This study aims to test whether RxWell™ can improve preoperative mood disorders and subsequently reduce postoperative pain and opioid requirement in patients scheduled for primary total hip and knee arthroplasty (THA, TKA). We named the trial as the SuRxgWell trial. METHODS This is a randomized, controlled trial that will enroll primary and unilateral THA or TKA patients with anxiety and/or depression symptoms before surgery to receive the SuRxgWell dCBI program and investigate its impact on postoperative outcomes including postoperative pain, anxiety, depression, sleep disorder, and catastrophizing. After signing an informed consent, subjects will be screened using the PROMIS questionnaires, and subjects with a T-score of ≥ 60 on the short Patient-Reported Outcomes Measurement Information System (PROMIS) 4a Anxiety and/or short PROMIS 4a Depression questionnaires will be randomized to either usual care (control group) or the cognitive behavioral intervention, RxWell™, plus usual care (intervention group). The control group will receive information on how to locate tools to address anxiety and depression, whereas the intervention group will have access to SuRxgWell 1 month prior to surgery and up to 3 months after surgery. The allocation will be 3:1 (intervention to control). Investigators will be blinded, but research coordinators approaching patients and research subjects will not. The primary outcome will be day of surgery anxiety or depression symptoms measured with the PROMIS Short Form v1.0 -Anxiety 4a/Depression and Generalized Anxiety Disorder Measure (GAD-7) and Patient Health Questionnaire (PHQ-8). Secondary end points include measuring other health-related quality of life outcomes including sleep disturbance, fatigue, ability to participate in social roles, pain interference, cognitive function, pain catastrophizing, and physical function. Other secondary outcomes include collecting data about preoperative and postoperative pain scores, and pain medication usage, and orthopedic functional recovery at baseline, day of surgery, and 1, 2, and 3 months after the surgery with the Pain Catastrophizing Scale, the Knee injury and Osteoarthritis Outcome Score (KOOS), and Hip injury and Osteoarthritis Outcome Score (HOOS). In addition, subjects will be asked to complete a GAD-7 and PHQ-8 questionnaires bi-weekly (via the RxWell™ app for the interventional group or REDCAP for the control group). Data about postsurgical complications, and resource utilization will also be recorded. We will also receive monthly reports measuring the usage and engagement of RxWell use for each participant randomized to that arm. The primary hypotheses will be assessed with intention-to-treat estimates, and differences in primary outcome will be tested using independent two sample t-tests. This trial is registered to the ClinicalTrials.gov database (NCT05658796) and supported by the DAPM, UPMC Health Plan, and the NIH. DISCUSSION Our trial will evaluate the feasibility of digital cognitive behavioral intervention as a perioperative tool to improve anxiety and depression before and after major orthopedic surgery in comparison to education. If digital cognitive behavioral intervention proves to be effective, this might have important clinical implications, reducing the incidence of chronic postsurgical pain and improving outcomes.
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Affiliation(s)
- A Murat Kaynar
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Charles Lin
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea Gomez Sanchez
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Danielle R Lavage
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Monroe
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicole Zharichenko
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Katheryn Saucier
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yram J Groff
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian A Klatt
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J O'Malley
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ajay D Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Jacques E Chelly
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- The Center for Innovation in Pain Care (CIPC), University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Kaynar AM, Zharichenko N, Wasan AD, Chelly JE. Telemedicine-Based Digital Cognitive Behavioral Intervention for Perioperative Anxiety and Depression for Total Knee Arthroplasty. JOURNAL OF PAIN & RELIEF 2023; 12:1000005. [PMID: 37886028 PMCID: PMC10601399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Introduction Preoperative anxiety and depression have been shown to increase postoperative pain and opioid consumption by up to 50% in patients undergoing primary unilateral Total Knee Arthroplasty (TKA). We hypothesized that the use of a telemedicine-based digital Cognitive Behavioral Intervention program (RxWell®) started one month prior to surgery would control anxiety and depression prior to surgery. Materials and methods This was a randomized, controlled trial that enrolled patients undergoing primary unilateral TKA. At least a month prior to surgery, patients who gave consent to participate were asked to complete PROMIS® (Patient-Reported Outcomes Measurement Information System) emotional anxiety short form 8a and PROMIS® emotional depression short form-8a questionnaires. Patients with T-scores of ≥ 57 were randomized to either a no intervention (control group) or a RxWell® program (treatment group) for a month prior to surgery. The primary outcome of this proof-of-concept study was the ability of the RxWell® to normalize patients' PROMIS anxiety T scores. Results T scores for anxiety and depression among patients randomized to the RxWell® group significantly decreased from 64.3 ± 3.0 at the time of randomization to 58.5 ± 2.6 prior to surgery (n=5, p=0.006), whereas no changes in T scores were recorded in the control group (59.4 ± 4.2 at the time of randomization vs. 57.7 ± 6.2; n=6, p=0.559). Conclusion These preliminary data suggest that the use of a RxWell® program represents an effective approach to control anxiety and depression prior to surgery. In contrast, it seems that in the absence of treatment, anxiety level remains similar over a month prior to surgery.
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Affiliation(s)
- Ata Murat Kaynar
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA
- Department of Anesthesiology and Perioperative Medicine, Center for Innovation in Pain Care (CIPC), Pennsylvania, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Pennsylvania, USA
| | - Nicole Zharichenko
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA
- Department of Anesthesiology and Perioperative Medicine, Center for Innovation in Pain Care (CIPC), Pennsylvania, USA
| | - Ajay D Wasan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA
- Department of Anesthesiology and Perioperative Medicine, Center for Innovation in Pain Care (CIPC), Pennsylvania, USA
| | - Jacques E Chelly
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pennsylvania, USA
- Department of Anesthesiology and Perioperative Medicine, Center for Innovation in Pain Care (CIPC), Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pennsylvania, USA
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Bolarinwa OA, Holt N. Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review. BMC Health Serv Res 2023; 23:390. [PMID: 37087506 PMCID: PMC10122823 DOI: 10.1186/s12913-023-09410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Cancer is currently the leading cause of mortality globally, with new cancer cases estimated at 19.3 million and almost 10 million deaths in 2020. Specifically, breast and cervical cancer incidence and mortality prevalence among women of the minority group or marginalised populations in Europe have continued to be a public health concern due to the low uptake of cancer screening. Thus, this study utilised a mixed-method systematic review to identify barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom. METHODS Databases including PubMed, CINAHL, British Nursing Index, Web of Science, EMBASE, and Scopus databases, were systematically searched for studies on barriers to breast and cervical screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom published in English between January 2010 to July 2022. This mixed-method systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in reporting the included studies' results. The cluster mapping approach was used to identify and classify the barriers into themes. RESULTS Thirteen eligible studies were included in this current review. Seven of the thirteen studies used quantitative cross-sectional research design, while six used qualitative cross-sectional research design. These studies were conducted across the United Kingdom. Five themes were developed from the cluster mapping, and thirty-four sub-theme barriers to the uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom were identified. The developed themes in relation to the barriers include; socio-demographic characteristics, health service delivery, cultural, religious & language, the gap in knowledge & awareness, and emotional, sexual & family support. CONCLUSION The study concluded that barriers in socio-demographic characteristics, health service delivery, cultural, religious and language, the gap in knowledge & awareness, and emotional, sexual & family support were identified as non-uptake of breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom. Reducing or eliminating these barriers would improve the benefits of timely breast and cervical cancer screening in the United Kingdom.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health & Well-Being, Faculty of Health & Social Care, University of Chester, Chester, UK.
- Institute for Advanced Studies in the Humanities, University of Edinburgh, Edinburgh, UK.
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK.
| | - Nicole Holt
- Department of Allied and Public Health, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
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Zengin Aydın L, Doğan A. The Effect of Guided Imagery on Postoperative Pain Management in Patients Undergoing Lower Extremity Surgical Operations: A Randomized Controlled Trial. Orthop Nurs 2023; 42:105-112. [PMID: 36944205 DOI: 10.1097/nor.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Guided imagery distracts patients from disturbing feelings and thoughts, positively affects emotional well-being, and reduces pain by producing pleasing mental images. This study aimed to determine the effects of guided imagery on postoperative pain management in patients undergoing lower extremity surgery. This randomized controlled study was conducted between April 2018 and May 2019. This study included 60 patients who underwent lower extremity surgery. After using guided imagery, the posttest mean Visual Analog Scale score of patients in the intervention group was found to be 2.56 (1.00 ± 6.00), whereas the posttest mean score of patients in the control group was 4.10 (3.00 ± 6.00), and the difference between the groups was statistically significant (p <.001). Guided imagery reduces short-term postoperative pain after lower extremity surgery.
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Affiliation(s)
- Leyla Zengin Aydın
- Leyla Zengin Aydin, PhD, Department of Nursing, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakır, Turkey
- Aysel Doğan, PhD, Department of Nursing, Faculty of Health Sciences, Toros University, Mersin, Turkey
| | - Aysel Doğan
- Leyla Zengin Aydin, PhD, Department of Nursing, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakır, Turkey
- Aysel Doğan, PhD, Department of Nursing, Faculty of Health Sciences, Toros University, Mersin, Turkey
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Vranceanu AM, Bakhshaie J, Reichman M, Ring D. A Call for Interdisciplinary Collaboration to Promote Musculoskeletal Health: The Creation of the International Musculoskeletal Mental and Social Health Consortium (I-MESH). J Clin Psychol Med Settings 2022; 29:709-715. [PMID: 34605997 DOI: 10.1007/s10880-021-09827-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 12/24/2022]
Abstract
Despite increasing recognition of psychosocial factors in musculoskeletal conditions, its impact on reducing the global toll of musculoskeletal symptoms has been only incremental. It is time to bring together clinicians and researchers with heterogeneous backgrounds, unified by a commitment to reduce the global impact of musculoskeletal illness by addressing mental and social health factors. In 2020, we initiated the International Musculoskeletal Mental and Social Health Consortium. Our current key priority areas are: (1) Develop best practices for uniform terminology, (2) Understand barriers to mental and social health care for musculoskeletal conditions, (3) Develop clinical and research resources. The purpose of this paper is to render a call to interdisciplinary collaboration on the psychological aspects of musculoskeletal health. We believe this international interdisciplinary collaboration is pivotal to the advancement of the biopsychosocial model of musculoskeletal care and has the potential to improve the health of individuals with musculoskeletal conditions globally.
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Affiliation(s)
- Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, 02114, USA.
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Cuñat T, Martínez-Pastor JC, Dürsteler C, Hernández C, Sala-Blanch X. Perioperative medicine role in painful knee prosthesis prevention. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:411-420. [PMID: 35869007 DOI: 10.1016/j.redare.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/25/2021] [Indexed: 06/15/2023]
Abstract
Total knee arthroplasty is one of the most frequently performed orthopaedic surgeries. However, up to 20% of patients develop persistent postoperative pain. Persistent postoperative pain may be an extension of acute postoperative pain, but can also occur after more than 3 months without symptoms. Risk factors associated with persistent postoperative pain after arthroplasty have now been characterised within the patient's perioperative context (preoperative, intraoperative and postoperative), and can be grouped under genetic, demographic, clinical, surgical, analgesic, inflammatory and psychological factors. Identification and prevention of persistent postoperative pain through a multimodal and biopsychosocial approach is essential in the context of perioperative medicine, and has been shown to prevent or ameliorate postoperative pain.
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Affiliation(s)
- T Cuñat
- Servicio de Anestesiología, Reanimación y Tratamiento del dolor, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - J C Martínez-Pastor
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - C Dürsteler
- Servicio de Anestesiología, Reanimación y Tratamiento del dolor, Hospital Clínic de Barcelona, Barcelona, Spain
| | - C Hernández
- Servicio de Anestesiología y Reanimación, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Barcelona, Spain
| | - X Sala-Blanch
- Servicio de Anestesiología, Reanimación y Tratamiento del dolor, Hospital Clínic de Barcelona, Barcelona, Spain
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11
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Eymir M, Unver B, Karatosun V. Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2022; 30:2776-2785. [PMID: 34230983 DOI: 10.1007/s00167-021-06657-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/30/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to compare progressive muscle relaxation (PMR) + standard physiotherapy (PT) to standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of post-operative outcomes. The hypothesis was that PMR + standard PT would lead to better pain, function, and neuromuscular outcomes than standard PT. METHODS A total of 106 patients were randomly allocated into PMR or standard rehabilitation (SR) groups. Both groups received standard PT during their hospital stay. PMR group additionally performed PMR exercise on post-operative days 1, 2, and 3. Patients were evaluated regarding pain intensity, functional outcomes, muscle strength, active range of motion, knee edema, anxiety, depression, and kinesiophobia. RESULTS There were no differences between groups at baseline (n.s.). During the inpatient period and at discharge, the PMR group had better results in terms of pain relief (p < 0.05), quadriceps strength (p = 0.001), kinesiophobia level (p = 0.011) compared to the SR group. No difference was detected between groups regarding other evaluation parameters during the inpatient period, at discharge, and third post-operative month (n.s.). The within-group analysis showed statistically significant differences over time in both groups in each variable (p < 0.05). CONCLUSION Our findings support that PMR therapy offers beneficial results in subjective and objective measures of TKA patients during the inpatient period. Therefore, PMR therapy could be implemented into the rehabilitation program of TKA patients to enhance their early recovery from various symptoms following TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Musa Eymir
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey.
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylul University, TR-35340, Balçova, Izmir, Turkey
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12
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Olsen U, Lindberg MF, Rose C, Denison E, Gay C, Aamodt A, Brox JI, Skare Ø, Furnes O, Lee K, Lerdal A. Factors Correlated With Physical Function 1 Year After Total Knee Arthroplasty in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2219636. [PMID: 35816307 PMCID: PMC9274324 DOI: 10.1001/jamanetworkopen.2022.19636] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE More than 1 in 5 patients do not experience improved physical function after total knee arthroplasty (TKA). Identification of factors associated with physical function may be warranted to improve outcomes in these patients. OBJECTIVE To identify preoperative and intraoperative factors associated with physical function at 12 months after TKA in a systematic review and meta-analysis. DATA SOURCES Data from January 2000 to October 2021 were searched in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Physiotherapy Evidence Database (PEDro). No language restrictions were applied. STUDY SELECTION Prospective observational studies or randomized clinical trials on factors associated with physical function after TKA in adult patients with osteoarthritis were selected. A prespecified peer-reviewed protocol was followed. DATA EXTRACTION AND SYNTHESIS Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline, 2 reviewers independently screened titles and abstracts and judged risk of bias using Quality in Prognosis Studies (QUIPS). Multivariate random-effects meta-analyses were performed to estimate mean correlations between factors and physical function with 95% CIs. Sensitivity analyses were conducted for each QUIPS domain. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO). MAIN OUTCOMES AND MEASURES The primary outcome was physical function 12 months after TKA. Secondary outcomes were physical function 3 and 6 months after TKA. All estimates are mean correlations between factors and postoperative function. Positive correlations correspond to better function. RESULTS Among 12 052 articles, 20 studies (including 11 317 patients and 37 factors) were analyzed. Mean correlation with higher BMI was estimated to be -0.15 (95% CI, -0.24 to -0.05; P = .33; moderate-certainty evidence), while mean correlation with better physical function was estimated to be 0.14 (95% CI, 0.02 to 0.26; P = .03; low-certainty evidence) and mean correlation with more severe osteoarthritis was estimated to be 0.10 (95% CI, 0.01 to 0.19; P = .17; high-certainty evidence). In sensitivity analyses, mean correlation with better physical function was estimated to be 0.20 (95% CI, 0.04 to 0.36; P = .02), and so perhaps a larger coefficient than in the main analysis, while mean correlations were estimated to be similar for other factors (BMI: -0.17; 95% CI, -0.28 to -0.06; P < .001; osteoarthritis severity: 0.10; 95% CI, -0.01 to 0.20; P = .05). CONCLUSIONS AND RELEVANCE This study found that higher presurgical BMI was correlated with worse physical function (with moderate certainty) and that better physical function (low certainty) and osteoarthritis severity (high certainty) were correlated with better physical function after TKA. These findings suggest that these factors should be included when testing predictive models of TKA outcomes.
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Affiliation(s)
- Unni Olsen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Maren Falch Lindberg
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Christopher Rose
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Eva Denison
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Caryl Gay
- Department of Family Health Care Nursing, University of California, San Francisco
- Department of Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Skare
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kathryn Lee
- Department of Family Health Care Nursing, University of California, San Francisco
| | - Anners Lerdal
- Department of Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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13
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Edwards RR, Campbell C, Schreiber KL, Meints S, Lazaridou A, Martel MO, Cornelius M, Xu X, Jamison RN, Katz JN, Carriere J, Khanuja HP, Sterling RS, Smith MT, Haythornthwaite JA. Multimodal prediction of pain and functional outcomes 6 months following total knee replacement: a prospective cohort study. BMC Musculoskelet Disord 2022; 23:302. [PMID: 35351066 PMCID: PMC8966339 DOI: 10.1186/s12891-022-05239-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/16/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence and impact around the globe. In the U.S., the rising prevalence of knee OA has been paralleled by an increase in annual rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, post-operative trajectories of pain and functional status vary substantially; a significant minority of patients report ongoing pain and impaired function following TKA. A number of studies have identified sets of biopsychosocial risk factors for poor post-TKA outcomes (e.g., comorbidities, negative affect, sensory sensitivity), but few prospective studies have systematically evaluated the unique and combined influence of a broad array of factors. METHODS This multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity. RESULTS The majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related "positive" psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA patients with the most pain and dysfunction exhibited lower resilience and enhanced temporal summation of pain. CONCLUSIONS This study underscores the importance of considering psychosocial (particularly positively-oriented resilience variables) and sensory profiles, as well as their interaction, in understanding post-surgical pain trajectories.
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Affiliation(s)
- Robert R Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA.
| | - Claudia Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Samantha Meints
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Asimina Lazaridou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Marc O Martel
- Faculties of Dentistry & Medicine, McGill University, Strathcona Anatomy & Dentistry building 3640 University Street, Montreal, Qc, H3A 2B2, Canada
| | - Marise Cornelius
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Xinling Xu
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Robert N Jamison
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Pain Management Center, 850 Boylston St, MA, 02467, Chestnut Hill, USA
| | - Jeffrey N Katz
- Departments of Medicine and Orthopedic Surgery, Orthopedic and Arthritis Center for Outcomes Research, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | | | - Harpal P Khanuja
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert S Sterling
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T Smith
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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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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15
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Mohammad HR, Gooberman-Hill R, Delmestri A, Broomfield J, Patel R, Huber J, Garriga C, Eccleston C, Pinedo-Villanueva R, Malak TT, Arden N, Price A, Wylde V, Peters TJ, Blom AW, Judge A. Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme. PLoS One 2022; 16:e0261850. [PMID: 34972159 PMCID: PMC8719727 DOI: 10.1371/journal.pone.0261850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/11/2021] [Indexed: 12/27/2022] Open
Abstract
Objective Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Methods Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Results Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). Conclusions We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.
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Affiliation(s)
- Hasan Raza Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - John Broomfield
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Rita Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Bristol, United Kingdom
| | - Joerg Huber
- Department of Orthopedics, Stadtspital Triemli, Zurich, Switzerland
| | - Cesar Garriga
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Christopher Eccleston
- Department for Health, Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Tamer T Malak
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Bristol, United Kingdom
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
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Speed TJ, Jung Mun C, Smith MT, Khanuja HS, Sterling RS, Letzen JE, Haythornthwaite JA, Edwards RR, Campbell CM. Temporal Association of Pain Catastrophizing and Pain Severity Across the Perioperative Period: A Cross-Lagged Panel Analysis After Total Knee Arthroplasty. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:1727-1734. [PMID: 33532859 PMCID: PMC8502458 DOI: 10.1093/pm/pnab035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Although numerous studies show that preoperative pain catastrophizing is a risk factor for pain after total knee arthroplasty (TKA), little is known about the temporal course of the association between perioperative pain catastrophizing and pain severity. The present study investigated temporal changes and their dynamic associations between pain catastrophizing and pain severity before and after TKA. DESIGN A secondary data analysis of a larger observational parent study featuring prospective repeated measurement over 12 months. SETTING Dual-site academic hospital. SUBJECTS A total of 245 individuals who underwent TKA. METHODS Participants completed pain catastrophizing and pain severity questionnaires at baseline, 6 weeks, and 3, 6, and 12 months after TKA. Cross-lagged panel analysis was conducted with structural equation modeling including age, sex, race, baseline anxiety, and depressive symptoms as covariates. RESULTS Reduction in pain catastrophizing from baseline to 6 weeks after TKA was associated with lower pain severity at 3 months after TKA (standardized β = 0.14; SE = 0.07, P = 0.046), while reduction in pain severity at 6 weeks after TKA was not associated with pain catastrophizing at 3 months after TKA (P = 0.905). In the chronic postsurgical period (>3 months), pain catastrophizing at 6 months after TKA predicted pain severity at 12 months after TKA (β = 0.23, P = 0.009) with controlling for auto-correlation and covariates, but not vice versa. CONCLUSIONS We provide evidence that changes in pain catastrophizing from baseline to 6 weeks after TKA are associated with subsequent pain severity. Future studies are warranted to determine whether targeting pain catastrophizing during the perioperative period may improve clinical outcomes for individuals undergoing TKA.
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Affiliation(s)
- Traci J Speed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Sterling
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cuñat T, Martínez-Pastor JC, Dürsteler C, Hernández C, Sala-Blanch X. Perioperative medicine role in painful knee prosthesis prevention. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00142-0. [PMID: 34325900 DOI: 10.1016/j.redar.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/07/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
Total knee arthroplasty is one of the most frequently performed orthopaedic surgeries. However, up to 20% of patients develop persistent postoperative pain. Persistent postoperative pain may be an extension of acute postoperative pain, but can also occur after more than 3 months without symptoms. Risk factors associated with persistent postoperative pain after arthroplasty have now been characterised within the patient's perioperative context (preoperative, intraoperative and postoperative), and can be grouped under genetic, demographic, clinical, surgical, analgesic, inflammatory and psychological factors. Identification and prevention of persistent postoperative pain through a multimodal and biopsychosocial approach is essential in the context of perioperative medicine, and has been shown to prevent or ameliorate postoperative pain.
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Affiliation(s)
- T Cuñat
- Servicio de Anestesiología, Reanimación y Tratamiento del dolor, Hospital Clínic de Barcelona, Barcelona, España.
| | - J C Martínez-Pastor
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Clínic de Barcelona, Barcelona, España
| | - C Dürsteler
- Servicio de Anestesiología, Reanimación y Tratamiento del dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - C Hernández
- Servicio de Anestesiología y Reanimación, Hospital Sant Joan de Déu de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - X Sala-Blanch
- Servicio de Anestesiología, Reanimación y Tratamiento del dolor, Hospital Clínic de Barcelona, Barcelona, España
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Sveinsdóttir H, Kristiansen K, Skúladóttir H. Health related quality of life in patients having total knee replacement and associations with symptoms, recovery, and patient education: A six month follow up study. Int J Orthop Trauma Nurs 2020; 42:100830. [PMID: 33518438 DOI: 10.1016/j.ijotn.2020.100830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 01/16/2023]
Abstract
AIM To describe the symptoms, recovery, patient education, and health related quality of life (HRQOL) of patients having total knee replacements at three time points and to detect experiences and situations that predict HRQOL six weeks and six months post-surgery. METHOD A prospective exploratory two-site study assessing 123 patients, while in hospital (T1), at six weeks (T2), and at six months (T3) post-discharge. HRQOL was measured using the SF-36v2 and symptoms were measured with the Hospital and Anxiety Scale. Two questions considered pain and two considered movement and tiredness while two questions addressed recovery and patient education. Linear regression models were used to calculate predictors of mental and physical HRQOL at T2 and T3. RESULTS HRQOL improved from T1 to T3. The main predictors of higher physical scores at T2 were; being older, fewer symptoms of depression and little distress related to movement. At T3 the main predictors were; having resumed work, finding patient education very useful, experiencing no pain in the last 24 h and fewer symptoms of depression. The main predictors of higher mental scores at T2 were fewer symptoms of anxiety and depression and little distress related to movement while at T3 these were fewer symptoms of anxiety and depression and experiencing no pain last 24 h. CONCLUSION Apart from pain, function and resumption of activities, the symptoms of anxiety and depression influence HRQOL. These symptoms should be assessed during the hospital stay.
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Affiliation(s)
- Herdís Sveinsdóttir
- University of Iceland, Faculty of Nursing, Eirberg, Eiríksgötu 34, 101, Reykjavík, Iceland; Landspitali University Hospital, Surgical Services, 101, Reykjavík, Iceland.
| | | | - Hafdís Skúladóttir
- University of Iceland, Faculty of Nursing, Eirberg, Eiríksgötu 34, 101, Reykjavík, Iceland; University of Akureyri, School of Health Sciences, Iceland
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Yu R, Zhuo Y, Feng E, Wang W, Lin W, Lin F, Li Z, Lin L, Xiao L, Wang H, Huang Y, Wu C, Zhang Y. The effect of musical interventions in improving short-term pain outcomes following total knee replacement: a meta-analysis and systematic review. J Orthop Surg Res 2020; 15:465. [PMID: 33036637 PMCID: PMC7547446 DOI: 10.1186/s13018-020-01995-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A growing number of patients continue to receive total knee replacement (TKR) surgery. Nevertheless, such surgeries result in moderate to severe postoperative pain and difficulty in managing it. Musical interventions are regarded as a type of multimodal analgesia, achieving beneficial results in other clinical treatments. This study aims to evaluate the effect of musical interventions in improving short-term pain outcomes following TKR in order to determine a more reasonable and standard way of delivering musical intervention. METHODS A systematic search was conducted to identify available and relevant randomized controlled trials (RCTs) regarding musical interventions compared against non-musical interventions in patients treated with TKR in Embase, MEDLINE, Cochrane Library, Web of Science, CNKI, and Wanfang Med Online up to 8 January 2020. The authors independently assessed study eligibility and risk of bias and collected the outcomes of interest to analyze. The statistical analysis was conducted using the Review Manager (RevMan) version 5.30 software. RESULTS Eight RCTs comprised of 555 patients satisfied the inclusion criteria and were enrolled in the present study. The results showed no significant difference between the music and control groups in pain of the visual analog scale (VAS), during postoperative recovery room, back to the ward after surgery; anxiety degree of VAS; heart rate; respiratory rate; oxygen saturation; blood pressure, systolic blood pressure, and diastolic blood pressure. Nevertheless, significant differences were observed between the two groups in average increase in continuous passive motion (CPM) angles and LF/HF ratio (one kind index of heart rate variability). CONCLUSIONS Musical interventions fail to demonstrate an obvious effect in improving short-term pain outcomes following TKR. A reasonable standardization of musical interventions, including musical type, outcome measures used, outcomes measured, duration, timing and headphones or players, may improve pain outcomes with certain advantages and should be further explored after TKR.
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Affiliation(s)
- Rongguo Yu
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Youguang Zhuo
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Eryou Feng
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Wulian Wang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Wentao Lin
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Feitai Lin
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Zhanglai Li
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Liqiong Lin
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Lili Xiao
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Haiyang Wang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Yuting Huang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Chunlin Wu
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China
| | - Yiyuan Zhang
- Department of Orthopedics, Fuzhou second Hospital Affiliated to Xiamen University, Fuzhou, 350007, Fujian, China.
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20
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Schwartz AM, Wilson JM, Farley KX, Roberson JR, Guild GN, Bradbury TL. Modifiability of Depression's Impact on Early Revision, Narcotic Usage, and Outcomes After Total Hip Arthroplasty: The Impact of Psychotherapy. J Arthroplasty 2020; 35:2904-2910. [PMID: 32553794 DOI: 10.1016/j.arth.2020.05.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Depression is known to negatively influence functional recovery, patient satisfaction, narcotic requirements, implant survivorship, and perioperative resource utilization after total hip arthroplasty (THA). The degree to which this effect is modifiable is largely unknown, with mixed results on preoperative pharmacological intervention, and concomitant concerns over side effects. We aim to investigate the influence of psychotherapy before THA on surgical outcomes, medical complications, and resource utilization. METHODS A retrospective chart review of Truven MarketScan Databases was performed to generate 3 cohorts: patients without depression, patients with depression who did not receive preoperative psychotherapy, and patients with depression who received psychotherapy before surgery. Outcomes of interest were resource utilization, surgical and medical complications, narcotic requirements, and 1-year and 3-year revision rates. RESULTS On multivariate analysis, depressed patients who did not receive psychotherapy were more likely to be discharged to inpatient rehabilitation facility (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.10-1.48, P < .001) and require 2 or more postoperative narcotic prescriptions (OR 1.20, 95% CI 1.06-1.37, P = .004) than depressed patients who received psychotherapy. Patients who did not receive psychotherapy were more likely to have continued narcotic requirements within 1 year after surgery (OR 1.23, 95% CI 1.08-1.39, P < .001) and undergo revision at 1 year (OR 1.74, 95% CI 1.17-2.58, P = .006) and 3 years (OR 1.92, 95% CI 1.10-3.34, P = .021) than depressed patients who received psychotherapy. CONCLUSION The negative influence of depression on narcotic requirements, resource utilization, and implant survivorship after THA appears to be modifiable with preoperative psychotherapy.
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Affiliation(s)
- Andrew M Schwartz
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, Atlanta, GA
| | - Jacob M Wilson
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, Atlanta, GA
| | - Kevin X Farley
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, Atlanta, GA
| | - James R Roberson
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, Atlanta, GA
| | - George N Guild
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, Atlanta, GA
| | - Thomas L Bradbury
- Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, Atlanta, GA
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