Nonpharmacological Interventions Improve Postoperative Sleep in Arthroplasty Patients: A Systematic Review and Meta-Analysis.

IF 2.8 Q2 SURGERY

JBJS Reviews Pub Date : 2025-11-14 eCollection Date: 2025-11-01 DOI:10.2106/JBJS.RVW.25.00131

Ali Salmani, Yashar Khani, Ramila Abedi-Azar, Seyedmehrad Namazi, Mahin Akhoundpoor, Yazdan Hasanvand, Amir Mehrvar

{"title":"Nonpharmacological Interventions Improve Postoperative Sleep in Arthroplasty Patients: A Systematic Review and Meta-Analysis.","authors":"Ali Salmani, Yashar Khani, Ramila Abedi-Azar, Seyedmehrad Namazi, Mahin Akhoundpoor, Yazdan Hasanvand, Amir Mehrvar","doi":"10.2106/JBJS.RVW.25.00131","DOIUrl":null,"url":null,"abstract":"Background: Sleep disturbances are common after total joint arthroplasty and can impair recovery, increase complications, and reduce patient satisfaction. Nonpharmacological interventions (NPIs) may offer safer alternatives to medications, but their effectiveness in improving postoperative sleep remains unclear. The aim of this study was to systematically evaluate the impact of NPIs on sleep outcomes following hip or knee arthroplasty.Methods: We conducted a systematic review in November 2024 across PubMed, Scopus, Web of Science, and Embase for studies investigating NPIs related to sleep outcomes after hip or knee arthroplasty. Data extraction and quality assessment were performed independently using the National Institutes of Health tools. A meta-analysis was conducted on studies reporting Pittsburgh Sleep Quality Index scores, and the mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed by the Cochran Q statistic and the I2 test.Results: Ten studies (n = 1,545; mean age 65.69 years, 54.43% female) were included. NPIs were categorized into nursing-based interventions, environmental controls, relaxation techniques, neuromodulation, and movement restriction. The pooled analysis of 6 studies (n = 760) showed that NPIs significantly improved sleep quality compared with controls (MD = -2.61; 95% CI -3.27 to -1.95; p < 0.00001; I2 = 86%). Subgroup analysis revealed the greatest benefit from nursing-based interventions (MD = -3.06; 95% CI -3.39 to -2.73; I2 = 30%), while environmental interventions showed a smaller but significant effect (MD = -1.58; 95% CI -2.75 to -0.40; I2 = 79%). Functional, psychological, and quality-of-life outcomes showed variable results across studies.Conclusion: NPIs, particularly nursing-based interventions and environmental controls, appear effective in improving postoperative sleep after joint arthroplasty. However, heterogeneity and limited high-quality evidence warrant further randomized trials with standardized protocols and objective sleep measures.Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 11","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Reviews","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.RVW.25.00131","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/11/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Sleep disturbances are common after total joint arthroplasty and can impair recovery, increase complications, and reduce patient satisfaction. Nonpharmacological interventions (NPIs) may offer safer alternatives to medications, but their effectiveness in improving postoperative sleep remains unclear. The aim of this study was to systematically evaluate the impact of NPIs on sleep outcomes following hip or knee arthroplasty.

Methods: We conducted a systematic review in November 2024 across PubMed, Scopus, Web of Science, and Embase for studies investigating NPIs related to sleep outcomes after hip or knee arthroplasty. Data extraction and quality assessment were performed independently using the National Institutes of Health tools. A meta-analysis was conducted on studies reporting Pittsburgh Sleep Quality Index scores, and the mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed by the Cochran Q statistic and the I2 test.

Results: Ten studies (n = 1,545; mean age 65.69 years, 54.43% female) were included. NPIs were categorized into nursing-based interventions, environmental controls, relaxation techniques, neuromodulation, and movement restriction. The pooled analysis of 6 studies (n = 760) showed that NPIs significantly improved sleep quality compared with controls (MD = -2.61; 95% CI -3.27 to -1.95; p < 0.00001; I2 = 86%). Subgroup analysis revealed the greatest benefit from nursing-based interventions (MD = -3.06; 95% CI -3.39 to -2.73; I2 = 30%), while environmental interventions showed a smaller but significant effect (MD = -1.58; 95% CI -2.75 to -0.40; I2 = 79%). Functional, psychological, and quality-of-life outcomes showed variable results across studies.

Conclusion: NPIs, particularly nursing-based interventions and environmental controls, appear effective in improving postoperative sleep after joint arthroplasty. However, heterogeneity and limited high-quality evidence warrant further randomized trials with standardized protocols and objective sleep measures.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

查看原文本刊更多论文

非药物干预改善关节置换术患者术后睡眠：系统回顾和荟萃分析。

背景：全关节置换术后睡眠障碍很常见，并且会影响康复，增加并发症，降低患者满意度。非药物干预（npi）可能提供比药物更安全的替代方案，但其在改善术后睡眠方面的有效性尚不清楚。本研究的目的是系统地评估npi对髋关节或膝关节置换术后睡眠结果的影响。方法：我们于2024年11月通过PubMed、Scopus、Web of Science和Embase对髋关节或膝关节置换术后npi与睡眠结果相关的研究进行了系统回顾。使用美国国立卫生研究院的工具独立进行数据提取和质量评估。对报告匹兹堡睡眠质量指数得分的研究进行荟萃分析，计算95%置信区间（ci）的平均差异（md）。采用Cochran Q统计量和I2检验评估异质性。结果：纳入10项研究（n = 1545，平均年龄65.69岁，女性54.43%）。npi分为护理干预、环境控制、放松技术、神经调节和运动限制。6项研究（n = 760）的汇总分析显示，与对照组相比，npi可显著改善睡眠质量（MD = -2.61； 95% CI为-3.27 ~ -1.95;p < 0.00001; I2 = 86%）。亚组分析显示，以护理为基础的干预措施获益最大（MD = -3.06; 95% CI -3.39至-2.73;I2 = 30%），而环境干预的效果较小但显著（MD = -1.58; 95% CI -2.75至-0.40;I2 = 79%）。功能、心理和生活质量的结果在不同的研究中显示出不同的结果。结论：npi，特别是护理干预和环境控制，在改善关节置换术后睡眠方面是有效的。然而，异质性和有限的高质量证据需要进一步的随机试验，采用标准化的方案和客观的睡眠测量。证据等级：治疗性III级。有关证据水平的完整描述，请参见作者说明。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.