Patients' Perception of a Brief Web- and Mindfulness-Based Intervention for Pain Following Discharge After Total Joint Arthroplasty: Qualitative Description.

Abstract

Background: Important levels of pain are reported upon discharge from major surgery, with a risk of becoming chronic. Further, individuals express the need for support in managing pain after discharge. However, very few studies address pain management interventions in the postdischarge phase after surgery, including for individuals undergoing total joint arthroplasty (TJA). We have conducted a pilot randomized controlled trial testing a brief mindfulness intervention targeting people at risk for chronic postsurgical pain 2 weeks after surgery. Although the intervention we proposed was judged acceptable based on ratings obtained through a questionnaire, the nuanced perceptions of why and how it is considered acceptable are critical in refining the intervention. Moreover, the acceptability of mindfulness interventions in the perioperative context remains generally unknown and even more so in the postdischarge setting.

Objective: The purpose of this study was to use qualitative data to explore the individual perception of acceptability of a brief 4-week, Web- and mindfulness-based intervention for pain following discharge after a TJA.

Methods: A qualitative description was used to assess patients' perception of the preliminary version of the intervention for pain management following discharge after surgery. The qualitative assessment was done at the end of the 4-week intervention (6 weeks after surgery). Semistructured interviews with open-ended questions were used to encourage free expression from participants (n=16) before proceeding to content analysis.

Results: When reflecting on the benefits of the intervention, the main themes that emerged were mindfulness, pain acceptance, and supplementary relief. Overall, the intervention was perceived as relevant and suitable during recovery, although participants experienced a few challenges related to the novelty of mindfulness practice. Engagement and readiness were discussed in relation to adherence to the intervention. Addressing expectations and personal beliefs before the intervention could improve participants' adherence. Offering additional support when spikes of pain occur could help overcome some challenges related to mindfulness practice during postoperative recovery.

Conclusions: Given the increasing number of TJA surgeries performed annually and the effectiveness of nonpharmacological interventions, such as mindfulness-based approaches, in supporting recovery and well-being, efforts should be made to increase patient access to these promising adjunctive treatments. Combining nonpharmacological interventions before and after surgery may be an interesting avenue to optimize pain relief and recovery, as well as prevent complications. Finally, the use of technology could improve the accessibility, scalability, and adoption of these promising approaches for individuals with limited resources and mobility.