Does a Brief Mindfulness Exercise Improve Outcomes in Upper Extremity Patients? A Randomized Controlled Trial
Open accessAbstract
Background: Mindfulness-based interventions are useful in reducing psychologic distress and pain intensity in patients with chronic pain. However, most mindfulness-based interventions are resource-intensive, lengthy, and not feasible for busy orthopaedic surgical practices. Questions/purposes: The purpose of this study was to determine if a 60-second personalized mindfulness-based video exercise is (1) associated with improved pain intensity, emotional distress, and state anxiety compared with an attention placebo control (a time-matched educational pamphlet about pain and stress); and (2) feasible and acceptable for patients with upper extremity injury in an orthopaedic practice. Methods: This was a single-center, single-blind randomized controlled trial of the mindfulness-based video exercise (60 seconds duration, free online) versus an attention placebo control (an educational pamphlet about pain and stress presented to patients to read over 60 seconds). One hundred forty-nine patients presenting for a new or followup appointment at the office of one of two orthopaedic hand and upper extremity outpatient surgical practices at an urban academic hospital were invited to participate between September 2016 and December 2016. Of 149 patients screened, 125 patients were randomized and completed a demographic questionnaire, the Numeric Rating Scale to assess pain intensity, the State Anxiety subscale of the State Trait Anxiety Inventory to assess state anxiety, and Emotion Thermometers to assess anxiety, anger, and depression before and after the interventions. Postintervention, patients also completed the Client Satisfaction Questionnaire Scale-3 to assess the acceptability. A mean score of 21 or higher is considered acceptable. Feasibility was determined based on number of patients approached who refused participation. The intervention was defined as feasible if refusal rate was lower than 25%. Analysis of covariance was used to test comparative improved pain intensity on the NRS, psychologic distress on the Emotion Thermometers, and state anxiety on the State Anxiety Subscale of the State Trait Anxiety Index after controlling for respective baseline scores. A 1-point minimal clinically important difference (MCID) was used on the NRS for pain intensity. Results: Adjusted for the baseline means, compared with patients who received the attention placebo control, patients who participated in the mindfulness-based video exercise demonstrated improved pain intensity (mindfulness-based video exercise: 3.03 ± 0.12; control: 3.49 ± 0.12; mean difference: 0.46 [0.12-0.80]; p = 0.008); state anxiety (mindfulness-based video exercise: 32.35 ± 0.59; control: 35.29 ± 0.59; mean difference: 2.94 [1.29-4.59]; p = 0.001); anxiety symptoms (mindfulness-based video exercise: 1.49 ± 0.19; control: 2.10 ± 0.19; mean difference: 0.61 [0.08-1.14]; p = 0.024); depression (mindfulness-based video exercise: 1.03 ± 0.10; control: 1.47 ± 0.11; mean difference: 0.44 [0.15-0.73]; p = 0.004); and anger (mindfulness-based video exercise: 0.76 ± 0.12; control: 1.36 ± 0.12; mean difference: 0.60 [0.26-0.94]; p = 0.001). However, the observed differences in pain intensity were below 1 point on the NRS, which is the MCID established in patients with chronic pain. No MCID is available for the other measures. The mindfulness-based video exercise was feasible based on a dropout rate of 0%, and acceptability reached the medium range with similar scores in both groups (mindfulness-based video exercise: 20.70 ± 5.48; control: 20.52 ± 6.42). Conclusions: A 60-second mindfulness-based video exercise is feasible to implement and acceptable to patients in busy orthopaedic practices. This video exercise is also effective in improving momentary pain, anxiety, depression, and anger in this population, but it is unclear whether these improved pain and distress levels are meaningful to patients who present with low levels of pain and psychologic distress. Future studies should seek to discern whether the improved pain and distress levels we observed are clinically important or whether the intervention delivers larger effects in subgroups of patients experiencing greater pain intensity and if the improved pain and distress levels are durable. Such studies might also assess cost-effectiveness, because this mindfulness-based tool takes little time and few resources to use, and the effects and durability of multiple sessions of a mindfulness-based video exercise. Level of Evidence: Level II, therapeutic study.
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Traditional CBT is resource intensive and not feasible to implement in busy hand therapy practices because of prolonged face-to-face encounters and associated cost implications.
“Unfortunately, traditional CBT is resource intensive and not feasible to implement in busy hand therapy practices because of prolonged face-to-face encounters and associated cost implications [42].”
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Leopold, S. (2019) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000000858 · Cited by 3 · see citing works
“By contrast, much less is known about whether patients and providers can bend the curve up by cultivating positive attitudes or habits, such as mindfulness or gratitude [1, 12, 16].”
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“We excluded 17 studies after the full articles were reviewed.(4,15,21,22,28,29,32,37,38,42,45,46,74,83,84,89,91) Additional details regarding the reason(s) for exclusion can be found in Supplemental Appendix 2 (available at http://links.”
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Self-citationMindfulness in Patients with Upper-Extremity Conditions: A Summary of Existing Literature
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Expedited Recovery Pain Management Pathway for Minimally Invasive Repair of Pectus Excavatum (MIRPE)
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“Behavioral interventions, such as relaxation and mindful-ness-based approaches, have been associated with enhanced coping and reduced pain intensity and interference among chronic populations [7,8], including orthopedic injuries [9, 10].”
Perioperative Care of the Patient with Psychiatric Disease
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Integrating Mind-Body Techniques in Physiotherapy Rehabilitation: A Review of Literature
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Self-citationReimbursement Team (2021) · Canadian Journal of Health Technologies · doi:10.51731/cjht.2021.201
CORR Insights®: Surgeons Have an Implicit Preference for Specific Disease Over Nonspecific Illness
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- Authors
- Westenberg, R. F., Zale, E. L., Heinhuis, T. J., Özkan, S., Nazzal, A., Lee, S.-G., Chen, N. C., & Vranceanu, A.-M.
- Affiliations
- Harvard University (US)
- Venue
- Clinical Orthopaedics & Related Research
- Published
- 2018-02-16
- Volume
- 476
- Issue
- 4
- Pages
- 790-798
- ISSN
- 0009-921X (ISSN-L)
- PMC
- PMC6260083
- OpenAlex
- W2800114597
- Cited by
- 52
- References
- 42
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 6 · 2023: 10 · 2022: 7 · 2021: 5 · 2020: 11 · 2019: 4 · 2018: 3
- FWCI
- 6.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Orthopaedics and Related Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- National Center for Complementary and Integrative Health (R34AT009356)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- mindfulness-based interventions, upper extremity injuries, chronic pain, pain intensity, state anxiety, emotional distress, orthopedic patients, feasibility and acceptability, client satisfaction, minimal clinically important difference, patient education pamphlets
- MeSH terms
- Adult, Aged, Arm Injuries, Boston, Emotions, Feasibility Studies, Female, Humans, Male, Mental Health, Middle Aged, Pain Measurement, Stress, Psychological, Time Factors, Video Recording, Single-Blind Method, Treatment Outcome, Upper Extremity, Musculoskeletal Pain, Pain Management, Mindfulness
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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