The efficacy of pain neuroscience education in combination with cognitive-targeted exercise therapy in total joint arthroplasty: a randomised controlled trial
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Introduction: Identification of factors influencing pain and functional impairment have been studied due to the phenomenon of chronic post-surgically pain. Evidence that chronic pain is present in an unsatisfactory high percentage of individuals that undergo total joint arthroplasty (TJA), have directed this study. High levels of catastrophising and kinesiophobia is also present in individuals that undergo TJA. It needs to be established what the outcome of TJA will be if these factors are addressed as part of a standardised physiotherapy rehabilitation program (SPRP) at 12 weeks post-surgery. Aim: The aim of this study was to evaluate the effect of pain neuroscience education (PNE) with a SPRP, in combination with cognitive-targeted exercise therapy (CTET), compared to the effect of PNE with a SPRP alone on the pain, physical function, pain catastrophising and FOM in patients undergoing TJA. Methodology: A total of 19 individuals participated in this study. The participants were stratified into total hip arthroplasty (THA) and total knee arthroplasty (TKA) subgroups where after they were randomly grouped into a control group (n=9), and an intervention group (n=10). The data was analysed using the repeated measures analysis of variance (ANOVA). The individuals were assessed pre-surgery, on hospital discharge, six weeks and again at 12 weeks post-surgery. The intervention procedure, CTET, was administered prior to surgery and six weeks post-surgery. Results: All outcome measures for pain, physical function, pain catastrophising and FOM had improved in the control and intervention group when baseline scores were compared to 12 weeks post-surgery. The research findings indicate that supplementing PNE and a SPRP with CTET could clinically assist in improved pain severity, pain interference and physical function as well as reduction in rumination and helplessness within the first 12 weeks post-surgery. Comparing the control and intervention group with one another showed no statistical significant difference in improvement in any outcome measure at any stage during this study. Conclusion: PNE with a SPRP, in combination with CTET did not show a statistical significant difference in results compared to PNE with a SPRP alone on the pain, physical function, pain catastrophising and FOM within the first 12 weeks post TJA surgery. CTET may however be beneficial to improve certain aspects of pain, physical function and pain catastrophising within 12 weeks post-surgery.