The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty
Open accessAbstract
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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Most previous reviews examined specific surgery types or limited outcomes to the acute postoperative period.
“Most of the previous reviews have examined the effects of psychological interventions for specific types of interventions, such as orthopedic surgery, cardiac surgery, or abdominal surgery, 52,56,64,70 and/or limited the outcomes to the acute postoperative period.1,34,52,56”
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- Authors
- Sorel, J. C., Overvliet, G. M., Gademan, M. G. J., den Haan, C., Honig, A., & Poolman, R. W.
- Affiliations
- Leiden University Medical Center (NL)
- OLVG (NL)
- Corresponding author
- Sorel, Juliette Caroline
- ORCID
- Venue
- Rheumatology International
- Published
- 2020-07-29
- Volume
- 40
- Issue
- 12
- Pages
- 1961-1986
- ISSN
- 0172-8172 (ISSN-L)
- 1437-160X
- PMC
- PMC7591436
- OpenAlex
- W3045567149
- Cited by
- 28
- References
- 75
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 1 · 2023: 7 · 2022: 5 · 2021: 2
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Rheumatology International (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Leiden Repository (Leiden University) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Sichuan University
- West China Hospital, Sichuan University
- Topics
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- total knee arthroplasty, psychological distress, perioperative interventions, postoperative pain, functional outcome, quality of life, cognitive behavioral therapy, guided imagery, pain coping skills training, Reiki, music therapy, occupational therapy, biofeedback, opioid prescribing, patient education
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pain, Postoperative, Postoperative Pain, Quality of Life, Stress, Psychological, Arthroplasty, Replacement, Knee, Perioperative Care
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