Single-session, Preoperative Mindfulness-based Interventions for Total Joint Arthroplasty Patients: Pre- and Postoperative Outcomes from Three Randomized Clinical Trials

Abstract

These three studies examined whether a brief, preoperative mindfulness-based intervention (MBI) could improve pre- and postoperative TJA outcomes. We conducted three, single-site, three-arm, parallel-group randomized clinical trials at an orthopedic clinic among patients undergoing TJA of the hip or knee. Study 1 (N=285) compared the effects of preoperative mindfulness meditation, hypnotic suggestion, and cognitive-behavioral pain psychoeducation interventions – each delivered in a single, 15-minute group session – on preoperative pain and postoperative physical function. Study 2 (N=118) compared the effects of two different styles of preoperative mindfulness meditation – mindfulness of breath and mindfulness of pain – and cognitive-behavioral pain psychoeducation delivered in a single, 20-minute group session on preoperative pain and postoperative pain and opioid use in the month following surgery. Study 3 (N=127) compared the effects of ultra-brief (i.e., 3-minute), nurse-led, mindfulness of breath and mindfulness of pain interventions on preoperative pain and postoperative physical function relative to a standard nurse consultation. In study 1, the preoperative MBI significantly decreased preoperative pain intensity (p=.006), pain unpleasantness (p=.008), pain medication desire (p=.028) and anxiety (p<.001) while increasing postoperative physical function at 6-week follow-up (p=.010). In study 2, mindfulness of breath was found to most effectively decrease preoperative pain (p=.007), while mindfulness of pain resulted in the least amount of postoperative pain intensity (p=.003) and interference (p=.016). Both mindfulness of breath and mindfulness of pain decreased postoperative opioid use (p<.001). In study 3, mindfulness of breath and mindfulness of pain decreased preoperative pain intensity (p=.022) and unpleasantness (p<.001), and mindfulness of pain also decreased preoperative pain medication desire (p<.001). MBI related changes in preoperative pain unpleasantness predicted better postoperative physical function (p<.001). Embedding brief MBIs in surgical care pathways may be a scalable method of improving patient outcomes.