Orthopedics & Sports Medicine

For Arthroplasty Patients, Psychological Intervention Proves Surprisingly Effective

Feb. 10, 2023 - Eden McCleskey

We may never be able to quantify the full impact of the COVID-19 pandemic on society, but there seems no shortage to the amount of scientific knowledge it is generating.

Take a recent study, co-authored by Houston Methodist orthopedic surgeon Dr. Timothy Brown, involving arthritis patients who experienced significant worsening of pain and loss of function over a short period of time because their elective hip and knee arthroplasty surgeries were postponed because of COVID-19.

The randomized controlled trial found dramatic benefits in patients who participated in a psychological intervention program delivered via automated mobile phone messaging. The study examined the program's impact on patient-reported outcomes such as pain intensity, mobility and general physical health.

"We expected the intervention to be helpful to some degree, but I think we were all surprised by how pronounced the results were," says Dr. Brown, who collaborated on the study with researchers at the University of Iowa. "It really speaks to the importance of regular communication with our patients and the impact that anxiety, depression and isolation can have on people's health."

Study design

Ninety patients whose scheduled total hip arthroplasty or total knee arthroplasty were delayed due to the COVID-19 pandemic were randomized into an intervention group or control group.

The intervention group received 14 days of twice daily automated mobile phone messages characterized as acceptance and commitment therapy (ACT) — a tool often used by psychologists. The control group received no messages during the same 14-day period.

Similar to cognitive behavior therapy, ACT is a psychological intervention that seeks to decrease avoidable suffering and augment psychological flexibility. It has proven effective in the management of chronic pain and in the decreased utilization of opioids among at-risk orthopedic surgery patients.

Standard hip and knee patient-reported outcomes measures were reported pre-intervention and post-intervention, subcategorized by injury type.

Clear-cut results

Overall, 24% of patients in the ACT group reported improved knee or hip function after the intervention period, whereas only 2.5% of patients in the control group reported similar improvements (P=.004).

There was also a statistically significant difference between the groups in reported pain intensity at the end of the trial period, with the ACT group reporting a reduction of pain over the 14-day period and the control group reporting an increase in pain.

Seventy-five percent of patients in the ACT group stated they would recommend the intervention program to other patients, and nearly a third indicated they were interested in receiving additional messages as part of the program.

"The findings were clear: the condition of those in the ACT arm stayed stable or improved, and the condition of those in the control arm experienced a steady decline consistent with chronic disease," says Dr. Brown. "The study demonstrates that acceptance and commitment therapy is a powerful clinical tool to help patients cope with chronic disease while awaiting definitive treatment. It is a good reminder of the importance of the psychological aspect of pain and disability in patients with chronic musculoskeletal disease."

Dr. Brown and others continue to look into this issue. All hip and knee surgical patients at Houston Methodist Hospital are now encouraged to enroll in a messaging communication program with the department.

Studies to understand the effects of psychological interventions delivered through the perioperative and early postoperative period in hip and knee replacement are ongoing in hopes of continuing to improve the care of the patient with chronic arthritis pain.

Insights gained will be applicable long after the pandemic, says Dr. Brown.

"COVID-19 brought a lot of these issues to light, but they're just as relevant today," Dr. Brown concludes.

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