Acceptability and feasibility of a cognitive-behavioural intervention for pain management before total knee arthroplasty: a pilot trial

Abstract

Background: Although psychological factors predict the development of persistent pain after total knee arthroplasty (TKA), psychological interventions to prevent persistent pain are under-explored. This pilot trial evaluated the acceptability and feasibility of a cognitive-behavioural intervention targeting risk factors for post-surgical pain among patients scheduled for TKA (UTN: U1111-1243-1067/ACTRN12621001095853). Methods: Patients with elevated expectations of post-surgical pain and anxiety were recruited from TKA waiting lists. Treatment was remotely delivered by a psychologist over 3 sessions, supported by online and written resources. Eligibility, recruitment and completion rates, and perceptions of treatment were collected. Pain, disability, pain- and treatment-expectations, self-efficacy and catastrophizing were measured pre- and post- intervention. Results: Of 241 people pre-screened, 144 were invited to complete screening, 51 declined, 58 did not meet inclusion criteria, 35 enrolled, and 30 completed the trial. Satisfaction ratings were high, and participants found the content understandable, useful and relevant. Pre to post treatment scores for pain intensity and pain catastrophizing improved with small effect sizes. Conclusions: A psychological intervention is acceptable to patients awaiting TKA and may lead to small improvements in pain-relevant outcomes. An RCT aimed at reducing persistent post-surgical pain by combining cognitive behavioural therapy with physical therapy and medical optimisation is planned.