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

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.