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ACT for postsurgical pain and dysfunction in at-risk veterans: Multisite, double-blind, cluster RCT.

Lilian Dindo1, Katherine Hadlandsmyth2, Lauren Garvin3

  • 1Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; South Central Mental Illness, Research and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America.

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Summary
This summary is machine-generated.

Acceptance and Commitment Therapy (ACT) and educational support improved pain and function after total knee arthroplasty (TKA). ACT may offer earlier pain reduction and opioid tapering benefits for at-risk Veterans.

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Area of Science:

  • Orthopedics
  • Rehabilitation Medicine
  • Behavioral Medicine

Background:

  • Persistent postsurgical pain (PPSP) and functional limitations are common after total knee arthroplasty (TKA).
  • Veterans undergoing TKA are at elevated risk for PPSP and functional deficits.
  • Preoperative interventions may mitigate PPSP and improve outcomes.

Purpose of the Study:

  • To compare Acceptance and Commitment Therapy (ACT) with an active educational control (AC) for Veterans at-risk for PPSP following TKA.
  • To evaluate the impact of these interventions on pain severity, Activities of Daily Living (ADL), Quality of Life (QoL), and time to opioid cessation.

Main Methods:

  • A multisite, double-blinded randomized controlled trial involving 336 Veterans undergoing unilateral TKA.
  • Participants received a 1-day preoperative group workshop (ACT or AC) and postoperative booster sessions.
  • Primary outcomes included pain severity, ADL, and QoL; secondary outcome was time to opioid cessation.

Main Results:

  • Both ACT and AC groups showed significant reductions in pain severity and improvements in ADL function.
  • ACT demonstrated a trend toward greater pain reduction at 3 months post-TKA.
  • Median time to opioid cessation was similar between groups, with a trend toward earlier cessation in the ACT group for those without complications.

Conclusions:

  • Brief, preoperative group interventions (ACT or educational support) improve pain and function after TKA.
  • ACT may provide additional early benefits in pain reduction and opioid tapering for at-risk Veterans.
  • These findings support the use of preoperative psychological and educational interventions to enhance TKA outcomes.