A feasibility study of home-based preoperative multimodal physiotherapy for patients scheduled for a total knee arthroplasty who catastrophize about their pain

Abstract

Background Preoperative pain catastrophizing (PC) and pain are both risk factors for poor outcomes after a total knee arthroplasty (TKA). Despite that, there is limited evidence about physiotherapy interventions' effectiveness on addressing such factors. Purpose To evaluate the feasibility and clinical impact of a home-based multimodal physiotherapy intervention in reducing pain and PC, in patients scheduled for a TKA who present preoperative moderate-to-severe pain and PC. Methods Three-armed parallel-group randomized controlled feasibility study. Subjects with symptomatic osteoarthritis and a score of >= 20 on the Pain Catastrophizing Scale (PCS) were recruited. The control group received usual care. Both experimental groups received pain neuroscience education, coping skills training and therapeutic exercise, but differ in the number of sessions, dosage, hands-on approach, and grade of supervision. All outcomes were measured before and after the intervention. Results A total of 33,7% were eligible for inclusion, and 97,1% agreed to participate. Every participant completed the treatment. Treatment compliance was higher in the group with additional supervision. Both groups showed significant effects in PC and pain reduction. A total of 33 patients would be required for a full trial. Conclusion Preoperative physiotherapy is a feasible and effective treatment in reducing pain intensity and PC in high PCS osteoarthritis subjects scheduled for a TKA.