Department of Orthopedic Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Department of Psychology, Lund University, Lund, Sweden.
J Pain. 2018 Nov;19(11):1231-1252. doi: 10.1016/j.jpain.2018.05.006. Epub 2018 May 25.
This study aims to assess the effectiveness of psychosocial techniques to decrease postoperative pain and improve perioperative clinical care in orthopedic surgery. A systematic review and meta-analysis was performed to evaluate the effects of psychosocial methods among adults undergoing orthopedic surgeries. The systematic review included both randomized and nonrandomized trials, but only randomized controlled clinical trials (RCTs) were included in the meta-analysis. Key outcomes were postoperative pain, analgesic requirement, perioperative anxiety, quality of life, and recovery. After searching the databases from January 1980 to September 2016, a total of 62 RCTs were included with a pooled sample size of 4,908. Psychosocial interventions significantly reduced postoperative pain (Hedges' g = 0.31 [95% confidence interval = 0.14, 0.48]), and preoperative and postoperative anxiety (g = 0.26 [0.11, 0.42] and g = 0.4 [0.21, 0.59], respectively). Furthermore, psychosocial interventions improved recovery (g = 0.38 [0.22, 0.54]). However, no significant effects were found for postoperative analgesic use (g = 0.16 [-0.01, 0.32]) and quality of life (g = 0.14 [-0.05, 0.33]). Patient education and relaxation techniques produced the most consistent positive effects, showing benefits on pain, anxiety, and recovery. Cognitive or behavioral techniques improved recovery. Furthermore, larger effects were found for studies that included acute surgeries compared to elective surgeries. The results indicate that psychosocial interventions, especially patient education and relaxation training, may reduce perioperative side effects and improve recovery in patients undergoing orthopedic procedures, but the quality of evidence is generally low. More well-powered, high-quality studies are needed to increase confidence. PERSPECTIVE: In this meta-analysis of RCTs in orthopedic surgeries, significant benefits in postoperative pain, perioperative anxiety, and recovery were found, suggesting that psychosocial interventions, especially patient education and relaxation techniques, are useful in improving clinical care.
本研究旨在评估心理社会技术在减少骨科手术后疼痛和改善围手术期临床护理方面的有效性。系统评价和荟萃分析评估了成年人接受骨科手术后心理社会方法的效果。系统评价包括随机和非随机试验，但荟萃分析仅包括随机对照临床试验 (RCT)。主要结果是术后疼痛、镇痛需求、围手术期焦虑、生活质量和恢复。从 1980 年 1 月至 2016 年 9 月搜索数据库后，共纳入 62 项 RCT，总样本量为 4908 例。心理社会干预显著降低了术后疼痛（Hedges'g=0.31[95%置信区间=0.14,0.48]）和术前及术后焦虑（g=0.26[0.11,0.42]和 g=0.4[0.21,0.59]）。此外，心理社会干预改善了恢复（g=0.38[0.22,0.54]）。然而，术后镇痛使用（g=0.16[-0.01,0.32]）和生活质量（g=0.14[-0.05,0.33]）没有显著效果。患者教育和放松技术产生了最一致的积极效果，对疼痛、焦虑和恢复都有好处。认知或行为技术改善了恢复。此外，对于包括急性手术的研究，发现的效果更大，而对于选择性手术的研究则没有。结果表明，心理社会干预，尤其是患者教育和放松训练，可能减少骨科手术患者的围手术期副作用并改善其恢复，但证据质量普遍较低。需要更多的有力、高质量的研究来提高信心。观点：在这项骨科手术 RCT 的荟萃分析中，术后疼痛、围手术期焦虑和恢复均有显著改善，表明心理社会干预，尤其是患者教育和放松技术，在改善临床护理方面是有用的。
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