全膝关节置换术患者的简要术前身心疗法：一项随机对照试验。
Brief preoperative mind-body therapies for total joint arthroplasty patients: a randomized controlled trial.
机构信息
Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah College of Social, Salt Lake City, UT, United States.
College of Social Work, University of Utah College of Social, Salt Lake City, UT, United States.
出版信息
Pain. 2021 Jun 1;162(6):1749-1757. doi: 10.1097/j.pain.0000000000002195.
Although knee and hip replacements are intended to relieve pain and improve function, up to 44% of knee replacement patients and 27% of hip replacement patients report persistent postoperative joint pain. Improving surgical pain management is essential. We conducted a single-site, 3-arm, parallel-group randomized clinical trial conducted at an orthopedic clinic, among patients undergoing total joint arthroplasty (TJA) of the hip or knee. Mindfulness meditation (MM), hypnotic suggestion (HS), and cognitive-behavioral pain psychoeducation (cognitive-behavioral pain psychoeducation) were each delivered in a single, 15-minute group session as part of a 2-hour, preoperative education program. Preoperative outcomes-pain intensity, pain unpleasantness, pain medication desire, and anxiety-were measured with numeric rating scales. Postoperative physical functioning at 6-week follow-up was assessed with the Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test. Total joint arthroplasty patients were randomized to preoperative MM, HS, or cognitive-behavioral pain psychoeducation (n = 285). Mindfulness meditation and HS led to significantly less preoperative pain intensity, pain unpleasantness, and anxiety. Mindfulness meditation also decreased preoperative pain medication desire relative to cognitive-behavioral pain psychoeducation and increased postoperative physical functioning at 6-week follow-up relative to HS and cognitive-behavioral pain psychoeducation. Moderation analysis revealed the surgery type did not differentially impact the 3 interventions. Thus, a single session of a simple, scripted MM intervention may be able to immediately decrease TJA patients' preoperative clinical symptomology and improve postoperative physical function. As such, embedding brief MM interventions in surgical care pathways has the potential to improve surgical outcomes for the millions of patients receiving TJA each year.
虽然膝关节和髋关节置换术旨在缓解疼痛和改善功能，但多达 44%的膝关节置换患者和 27%的髋关节置换患者报告术后持续关节疼痛。改善手术疼痛管理至关重要。我们在一家骨科诊所进行了一项单站点、3 臂、平行组随机临床试验，纳入接受髋关节或膝关节全关节置换术（TJA）的患者。正念冥想（MM）、催眠暗示（HS）和认知行为疼痛心理教育（认知行为疼痛心理教育）在单次 15 分钟的小组会议中进行，作为 2 小时术前教育计划的一部分。术前结局-疼痛强度、疼痛不适、疼痛药物需求和焦虑-用数字评分量表测量。术后 6 周随访时使用患者报告的结局测量信息系统身体功能计算机自适应测试评估身体功能。总共 285 名 TJA 患者被随机分为术前 MM、HS 或认知行为疼痛心理教育组。正念冥想和 HS 可显著降低术前疼痛强度、疼痛不适和焦虑。与认知行为疼痛心理教育相比，正念冥想还降低了术前疼痛药物需求，并与 HS 和认知行为疼痛心理教育相比，增加了术后 6 周随访时的身体功能。调节分析显示手术类型不会对 3 种干预措施产生差异影响。因此，单次简单脚本化 MM 干预可能能够立即减轻 TJA 患者的术前临床症状并改善术后身体功能。因此，在手术护理途径中嵌入简短的 MM 干预措施有可能改善每年接受 TJA 的数百万患者的手术结果。
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