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The aim of this study is to investigate, whether a patient education with focus on pain coping is able to improve physical function and experienced pain level in patients with high levels of pain catastrophizing before Total Knee Arthroplasty. Resent studies indicates that these patients do not achieve a satisfactory pain relief and physical function after TKA. Furthermore, the aim is to determine if there is a difference in physical activity and muscle mass among patients with high levels of pain catastrophizing compared to patients with low levels of pain catastrophizing.
In Denmark, are approximately 8000 patients operated annually with Knee Arthroplasty. Most of these patients will have less pain and higher functional ability after the surgery. However, some patients respond poorly to the surgery and approximately 20% of the patients report persistent function-limiting pain six months or more following a total knee arthroplasty (TKA).
Research has shown that patients with high pain catastrophizing scores are at higher risk of having persistent pain and lower physical function after the operation.
This study consists of two parts. The first part is a randomised controlled trial where 56 patients with high levels of pain catastrophizing before TKA are randomised to either treatment as usual (control group 1), which implies surgery and the standard postoperative rehabilitation, or in addition to this, a patient education focusing on pain behaviour and pain coping (patient education). In the second part the patients in control group 1 will be matched on age, BMI and gender with additionally 28 patients with a low levels of pain catastrophizing (control group 2).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patienteducation | Experimental | (Patients with PCS>22). An education in pain coping delivered by physiotherapists. The education consist of seven sessions over a four months period. Each session is individual and will last 30 minutes. Focus will be on pain behaviour and pain coping based on Cognitive Behavioral Therapy. |
|
| Control group 1 | No Intervention | (Patients with PCS>22). Patients randomly assigned to this arm will undergo usual treatment for total knee arthroplasty. | |
| Control group 2 | No Intervention | (Patients with PCS<12). Patients in this arm will undergo usual treatment for total knee arthroplasty. Patients in this arm are not randomized but matched by age, gender and BMI with patients in control group 1. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Patient education | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pain measured on a Visual Analog Scale (0-100) | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Six-minute Walk Test | 12 months | |
| Sit-to-stand in 30 seconds | 12 months | |
| EuroQol (EQ-5D) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Torben B Hansen, professor,MD | University Clinic for Hand, Hip and Knee Surgery, HolstebroRegional Hospital, Aarhus University, Denmark | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Regional Hospital Holstebro | Holstebro | 7500 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28320421 | Derived | Birch S, Stilling M, Mechlenburg I, Hansen TB. Effectiveness of a physiotherapist delivered cognitive-behavioral patient education for patients who undergoes operation for total knee arthroplasty: a protocol of a randomized controlled trial. BMC Musculoskelet Disord. 2017 Mar 21;18(1):116. doi: 10.1186/s12891-017-1476-6. |
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| ID | Term |
|---|---|
| D020370 | Osteoarthritis, Knee |
| ID | Term |
|---|---|
| D010003 | Osteoarthritis |
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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| ID | Term |
|---|---|
| D010353 | Patient Education as Topic |
| ID | Term |
|---|---|
| D006266 | Health Education |
| D011314 | Preventive Health Services |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
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| 12 months |
| Pain Catastrophizing Scale | 12 months |
| Knee injury and Osteoarthritis Outcome Score (KOOS) | 12 months |
| Short Form 36 (Physical Function) | 12 months |
| Dual Energy X-ray Absorptiometry (DXA) scan | To detect muscle mass | 12 months |
| Tri-axial-accelerometer | To measure physical activity for seven days | 12 months |
| Oxford Knee Score | 12 months |
| Pain Self-Efficacy Questionnaire (PSEQ) | 12 months |
| D012216 |
| Rheumatic Diseases |