The Effect of Guided Imagery Technique on Anxiety, Pain, and Analgesic Use in Total Joint Arthroplasty Patients

The Effect of Guided Imagery Applied Before and After Surgery on Surgical Anxiety, Pain, and Analgesic Consumption in Patients Undergoing Total Joint Arthroplasty: A Randomized Controlled Trial

This randomized controlled study will investigate the effects of guided imagery on preoperative anxiety and postoperative pain and analgesic consumption in patients undergoing total joint arthroplasty. Conducted between September 2025 and June 2026 at a public hospital in Zonguldak, Turkey, the study will include patients scheduled for total joint arthroplasty following ethics committee approval. The intervention group will receive guided imagery twice preoperatively and once daily at 48 and 72 hours postoperatively. Outcomes will be assessed using the Surgical Anxiety Scale, surgery-specific anxiety scale, Numerical Rating Scale (NRS), and analgesic consumption tracking.

This study aimed to investigate the effects of preoperative guided imagery on anxiety and postoperative guided imagery on pain intensity and analgesic consumption in patients undergoing total joint arthroplasty. This randomized controlled trial (RCT) study's population consisted of patients undergoing total joint arthroplasty at the Orthopedics and Traumatology Clinic of a public hospital in Zonguldak province between September 2025 and June 2026. The required sample size and power calculations for this study were performed using the G*Power program, with an effect size of 0.76 for the independent samples t-test. The minimum number of participants to provide 80% test power at a 95% confidence level was 58 for each surgical group, totaling 116 participants. The following data collection tools will be used: a "Descriptive Patient Information Form," a "Surgical Anxiety Scale," a "Surgery-Specific Anxiety Scale," a "Numerical Rating Scale (NRS)," and an "Analgesic Consumption Tracking Form." In the first stage, the "Descriptive Patient Information Form" will be administered to both the intervention and control groups. Then, surgical anxiety levels will be assessed using the "Surgical Anxiety Scale" and the "Surgery-Specific Anxiety Scale" in both the intervention and control groups. Guided imagery will then be administered to the intervention group twice preoperatively (in the afternoon and evening) one day before the scheduled surgery date and once at the 48th and 72nd hours postoperatively. At the end of the intervention, the "Surgical Anxiety Scale" and the "Surgery-Specific Anxiety Scale" will be administered again to the intervention group. In the postoperative period, the pain intensity of the intervention group will be measured with the "NRS" at the 48th and 72nd postoperative hours, before and immediately after the intervention. The surgical anxiety levels of the control group patients will be assessed simultaneously with the intervention group using the "Surgical Anxiety Scale" and "Surgery-Specific Anxiety Scale" without any intervention. In the postoperative period, the pain intensity of the control group will be measured with the "NRS" at the 48th and 72nd postoperative hours and will be measured again after these measurements simultaneously with the intervention group. Finally, the analgesic consumption of the intervention and control groups will be assessed on the 2nd and 3rd postoperative days using the "Analgesic Consumption Tracking Form," concluding the intervention phase. Microsoft-Excel 2019 and International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) 22.0 will be used for data analysis.

Inclusion Criteria:

• Patients who have undergone unilateral arthroplasty surgery,
• Without cognitive impairment,
• Who speak and write Turkish,
• Without hearing or vision problems,
• Without any other acute illness causing pain or anxiety,
• Who received the same analgesic agent in the treatment protocol during the postoperative period,
• And who volunteered to participate in the study will be included.

Exclusion Criteria:

• Having a diagnosis of chronic pain syndrome or neuropathic pain,
• Having a diagnosis of psychiatric illness/being under treatment
• Continuous use of analgesic/sedative medication that may affect the pain threshold,
• Hearing impairment or severe cognitive impairment that prevents participation in guided imagery applications.