Does cognitive behavioral education reduce pain and improve joint function in patients after total knee arthroplasty? A randomized controlled trial.

Introduction: Cognitive behavioral therapy (CBT) is an effective treatment for reducing the pain of knee osteoarthritis (OA) and improving joint function. However, there are few studies on the effect of CBT on the pain severity after total knee arthroplasty (TKA). This study investigates the effectiveness of a CBT program on pain, knee function, quality of life, and pain catastrophizing in patients after TKA.

Methods: This was a randomized, parallel-group, controlled trial in which 100 patients with knee osteoarthritis (OA) prepared for TKA were randomly assigned to participate in CBT or usual care group. Evaluation outcomes include Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS), Oxford Knee Score (OKS), Knee Range of Motion (ROM), EuroQol Five-Dimensional (EQ-5D), and Hospital for Special Surgery (HSS) Knee Rating Scale before and after surgery.

Results: We found that patients in the CBT group had a lower pain during activity from the fifth day (p = 0.003) to the third month (p = 0.019) after TKA. At the 12th month, the mean VAS score during activity in the CBT and usual care groups decreased from 4.5 to 0.8 and from 4.6 to 0.9, respectively, and there is no significant difference between the two groups. The PCS scores of patients in the CBT group were lower than those in the usual care group at 1st (p = 0.014) and 3rd months (p = 0.027) after surgery. No statistically significantly differences between the two groups in pain during rest, knee ROM, EQ-5D, OKS, and HSS.

Conclusions: The CBT program was superior to usual care in reducing post-operative pain during activity from the fifth day to the third month and pain catastrophing in the first three months after TKA but has no statistically significantly differences in pain during rest, knee ROM, EQ-5D, OKS, and HSS.

Trial Registration: Current Controlled Trials ChiCTR2000032857, date of registration: May, 14, 2020, retrospectively registered.