Pain Neuroscience Education in Total Knee Arthroplasty

Study Overview
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Brief Summary
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To determine if education about pain given prior to Knee Arthroplasty will result in better outcomes following surgery

Detailed Description
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To determine if a preoperative pain neuroscience education (PNE) program would result in superior outcomes compared to usual preoperative education for total knee arthroplasty (TKA). Patients will receive traditional hospital preoperative TKA program (usual care group) or receive the same program plus an additional 30-minute PNE program (experimental group). Pre and post measurements at 1, 3 and 6 months for pain, function, fear of movement and pain catastrophization. We will also compare opioid usage, healthcare expenses and patient satisfaction between groups.

Official Title
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A Randomized Clinical Trial of Preoperative Pain Neuroscience Education for Total Knee Arthroplasty

Conditions
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Total Knee Replacement

Intervention / Treatment
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* Behavioral: Pain Neuroscience Education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: be scheduled to have a TKA and their standard preoperative TKA education program, indicate their willingness to participate in the study, ability to read and understand English, as the study included the use of an educational booklet, and be able and willing to complete outcome data for 6 months after TKA Exclusion Criteria: Because all potential participants for this study had been screened and cleared for their orthopedic surgery, the only exclusion criterion was an unwillingness to participate in the study and having had a previous TKA or scheduled for a bilateral TKA.

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: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Usual education control group (CG)<br>The CG received the traditional hospital preoperative program, which was consistent with current preoperative TKA protocols. The CG received education covering anatomy of the knee joint, information about the joint replacement surgery, what to expect when they were admitted for surgery, what to expect immediately after surgery, pain medications, postoperative rehabilitation/physical therapy, etc. The CG received a hospital-based booklet with this information. | Behavioral: Pain Neuroscience Education<br>* See arm/group description<br>|
| Experimental: Experimental group (EG)<br>The EG underwent an additional 30-minute group PNE program, followed by the usual preoperative education program from the hospital. The PNE program used in this TKA study was an adaptation of the PNE program developed for LS. The educational program was designed to be delivered by a physical therapist in a group session to patients prior to their TKA. | Behavioral: Pain Neuroscience Education<br>* See arm/group description<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain | Numeric Pain Rating Scale | Change from Baseline to 1 month, 3 months and 6 months post-surgery | 
| Function | Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) | Change from Baseline to 1 month, 3 months and 6 months post-surgery | 
| Pain Catastrophization | Pain Catastrophization Scale | Change from Baseline to 1 month, 3 months and 6 months post-surgery | 
| Fear of movement | Tampa Scale of Kinesiophobia | Change from Baseline to 1 month, 3 months and 6 months post-surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid Use | Oral Morphine Dose Equivalents | Change at 1 month | 
| Healthcare Expenses | Costs associated with healthcare utilization | Change from Baseline to 1 month, 3 months and 6 months post-surgery | 
| Patient Satisfaction | Likert questions | Change at 1 month, 3 months and 6 months post-surgery |