Brief Nurse-led Mindfulness Based Intervention

Study Overview
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Brief Summary
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This is a single-site, two-arm, parallel-group randomized clinical trial (RCT). The feasibility, acceptability, and clinical effects of the nurse-led, very brief, preoperative mindfulness based intervention for hip and knee replacement patients will be investigated relative to nurse-led preoperative pain psychoeducation. A secondary sub-analysis will compare two different styles of mindfulness practice (mindfulness of breath vs. mindfulness of pain) relative to preoperative pain psychoeducation.

Official Title
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Brief Nurse-led Mindfulness Based Intervention Among Patients Scheduled for Knee and Hip Replacement Surgery

Conditions
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Pain, Osteoarthritis, Knee, Osteoarthritis, Hip

Intervention / Treatment
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* Behavioral: Nurse-led Mindfulness Based Intervention
* Behavioral: Nurse-led Pain Psychoeducation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1) Age ≥18, 2) Scheduled to undergo unilateral total knee arthroplasty Exclusion Criteria: 1) Cognitive impairment preventing completion of study procedures. 2) Current cancer diagnosis, 3) Contralateral knee replaced in the previous 3 months, 4) Intent to have contralateral knee replaced or other, additional surgical procedure during the study period, 5) Intent to add new pain treatments during the study period (except for what is part of the study), 6) Other unstable illness judged by medical staff to interfere with study treatment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nurse-led Mindfulness Based Intervention<br> | Behavioral: Nurse-led Mindfulness Based Intervention<br>* Nurses will read patients a brief (1 minute) scripted, introduction to mindfulness and then have them listen to a very brief (1 minute 30 second) guided mindfulness practice validated in our prior research to encourage focused attention on breath and body sensations and open monitoring and acceptance of discursive thoughts, negative emotions, and pain. Finally, patients will be given an audio recording of the mindful pain management technique for use any time they experience intense pain or take pain medication before and after surgery.<br>Behavioral: Nurse-led Pain Psychoeducation<br>* Nurses will provide psychoeducation about pain along with common pain coping strategies, such as rest, ice, and elevation, for use any time they experience intense pain or take pain medication before and after surgery.<br>|
| Active Comparator: Nurse-led Pain Psychoeducation<br> | Behavioral: Nurse-led Pain Psychoeducation<br>* Nurses will provide psychoeducation about pain along with common pain coping strategies, such as rest, ice, and elevation, for use any time they experience intense pain or take pain medication before and after surgery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Pain Intensity Numeric Rating Scale | Single Likert scale item ranging from 0-10, with 0 indicating no pain and 10 representing the most intense pain imaginable. | baseline and after the 15 minute preoperative nurse visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Pain Unpleasantness Numeric Rating Scale | Single Likert scale item ranging from 0-10, with 0 indicating no pain and 10 representing the most unpleasant pain imaginable. | baseline and after the 15 minute preoperative nurse visit | 
| Change in Pain Medication Desire Numeric Rating Scale | Single Likert scale item ranging from 0-10, with 0 indicating no desire for pain medication and 10 representing a strong desire for pain medication. | baseline and after the 15 minute preoperative nurse visit | 
| Postoperative Patient Reported Outcomes Measurement Information System (PROMIS) Physical Functioning Item Bank, v2.0 | The PROMIS physical functioning computer assisted test draws from a bank of 123 items all scored on a 5 point Likert scale. T-Score distributions are standardized such that a 50 represents the average (mean) for the US general population, and the standard deviation around that mean is 10 points. A high score better physical functioning. | During the 6 weeks prior to surgery and at the 6-week outpatient follow-up appointment |