Effects of Biopsychosocial Model-Based Patient Education on Pain and Pain-Related Risk Factors After Total Knee Arthroplasty: A Retrospective Propensity Score-Matched Study.

BACKGROUND

The impact of interventions based on a biopsychosocial (BPS) model, including components related to sleep and nutrition, on pain after total knee arthroplasty (TKA) remains unclear. The purpose of this study was to develop patient education (PE) based on the BPS model and to clarify its effects on pain after TKA.

METHODS

Participants were 121 patients who had undergone unilateral TKA for knee osteoarthritis. Patients who received usual physiotherapy (control group, n = 71) or usual physiotherapy plus PE (PE group, n = 50) were identified. The primary outcome was the change in Knee injury and Osteoarthritis Outcome Score (KOOS) pain score from baseline to three months post-TKA.

RESULTS

After propensity score matching, there was no statistically significant difference in the change in KOOS pain scores between the control groups and PE ( = 0.143, = 0.240). Regarding pain-related risk factors, the Central Sensitization Inventory ( = 0.041, = 0.238), Pittsburgh Sleep Quality Index ( = 0.040, = 0.239), and Pain Catastrophizing Scale ( = 0.004, = 0.334) scores improved statistically significantly more in the PE group than in the control group. Hospital Anxiety and Depression Scale (HADS)-Anxiety ( = 0.233, = 0.139), HADS-Depression ( = 0.333, = 0.113) were not statistically significantly different between the two groups.

CONCLUSIONS

A BPS model-based PE was developed, and its effects on pain and pain-related risk factors were clarified. PE may improve central sensitization, sleep disturbance, and pain catastrophizing, which are key pain-related risk factors.