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

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research Pub Date : 2025-09-24 DOI:10.1016/j.jpsychores.2025.112393

Lilian Dindo , Katherine Hadlandsmyth , Lauren Garvin , James Marchman , M. Bridget Zimmerman , Joseph A. Buckwalter IV , David M. Green , John K. Wollaeger , Andrea Strayer , Kyung Soo Kim , Wen Liu , Jennie Embree , Merlyn Rodrigues , Barbara A. Rakel

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引用次数: 0

Abstract

Persistent postsurgical pain (PPSP) and functional limitations after total knee arthroplasty (TKA) often vary in severity and duration, with higher levels seen in individuals at elevated risk. This multisite, double-blinded randomized controlled trial compared Acceptance and Commitment Therapy (ACT) to an active educational plus support attention control (AC), in Veterans “at-risk” for PPSP following TKA. Veterans indicated for unilateral TKA and at-risk for PPSP completed a 1-day (5 h) group workshop prior to surgery and at least 1 postoperative phone booster session. 336 patients who underwent TKA were randomized to ACT (N = 173) or to AC (N = 163). Of these, 95 % in the ACT group and 97 % in the AC group received at least 1 booster session. Primary outcomes included self-reported pain severity, Activities of Daily Living (ADL), and Quality of Life (QoL). The secondary outcome was time to opioid cessation. Both groups showed significant reductions in pain severity across time points: at 3 months, ACT participants had greater pain reduction (−2.78) than AC (−2.50), suggesting an earlier advantage. ADL function also improved significantly in both groups (6-month scores: ACT 31.4, AC 29.9). Median time to opioid cessation was similar overall: 2.71 weeks in both groups. Among participants without postoperative complications, ACT showed a non-significant trend toward earlier cessation (2.36 vs. 2.80 weeks). These findings suggest that brief, preoperative group-based interventions—whether ACT or educational support—can improve pain and function following TKA. ACT may offer additional early benefits in pain reduction and opioid tapering in Veterans at elevated risk for PPSP.

Trial Registration: Clinicaltrials.gov under the number NCT03965897

查看原文本刊更多论文

ACT治疗高危退伍军人术后疼痛和功能障碍：多点、双盲、聚类随机对照试验

全膝关节置换术（TKA）后持续的术后疼痛（PPSP）和功能限制通常在严重程度和持续时间上有所不同，高危人群的疼痛程度更高。这项多地点、双盲随机对照试验比较了接受和承诺治疗（ACT）与积极教育加支持性注意力控制（AC）在TKA后PPSP“风险”退伍军人中的作用。有单侧TKA和PPSP风险的退伍军人在手术前完成了1天（5小时）的小组研讨会和至少1次术后电话加强会议。336例接受TKA的患者被随机分为ACT组（N = 173）和AC组（N = 163）。其中，95%的ACT组和97%的AC组接受了至少一次强化治疗。主要结局包括自我报告的疼痛严重程度、日常生活活动（ADL）和生活质量（QoL）。次要终点是阿片类药物停止的时间。两组在不同的时间点上都显示出疼痛严重程度的显著减轻：在3个月时，ACT参与者的疼痛减轻（-2.78）比AC（-2.50）更大，表明更早的优势。两组的ADL功能也显著改善（6个月评分：ACT 31.4, AC 29.9）。阿片类药物停止的中位时间总体上相似：两组均为2.71周。在没有术后并发症的参与者中，ACT显示出早期停止的非显著趋势（2.36周对2.80周）。这些发现表明，简短的术前分组干预，无论是ACT还是教育支持，都可以改善TKA后的疼痛和功能。ACT可能为PPSP高风险退伍军人的疼痛减轻和阿片类药物减少提供额外的早期益处。试验注册：Clinicaltrials.gov，编号NCT03965897。

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来源期刊

Journal of Psychosomatic Research 医学-精神病学

CiteScore

7.40

自引率

6.40%

发文量

314

审稿时长

6.2 weeks

期刊介绍： The Journal of Psychosomatic Research is a multidisciplinary research journal covering all aspects of the relationships between psychology and medicine. The scope is broad and ranges from basic human biological and psychological research to evaluations of treatment and services. Papers will normally be concerned with illness or patients rather than studies of healthy populations. Studies concerning special populations, such as the elderly and children and adolescents, are welcome. In addition to peer-reviewed original papers, the journal publishes editorials, reviews, and other papers related to the journal''s aims.