Abstract
This study aims to assess the effectiveness of psychosocial techniques to decrease
postoperative pain and improve perioperative clinical care in orthopedic surgery.
A systematic review and meta-analysis was performed to evaluate the effects of psychosocial
methods among adults undergoing orthopedic surgeries. The systematic review included
both randomized and nonrandomized trials, but only randomized controlled clinical
trials (RCTs) were included in the meta-analysis. Key outcomes were postoperative
pain, analgesic requirement, perioperative anxiety, quality of life, and recovery.
After searching the databases from January 1980 to September 2016, a total of 62 RCTs
were included with a pooled sample size of 4,908. Psychosocial interventions significantly
reduced postoperative pain (Hedges’ g = 0.31 [95% confidence interval = 0.14, 0.48]),
and preoperative and postoperative anxiety (g = 0.26 [0.11, 0.42] and g = 0.4 [0.21,
0.59], respectively). Furthermore, psychosocial interventions improved recovery (g = 0.38
[0.22, 0.54]). However, no significant effects were found for postoperative analgesic
use (g = 0.16 [−0.01, 0.32]) and quality of life (g = 0.14 [−0.05, 0.33]). Patient
education and relaxation techniques produced the most consistent positive effects,
showing benefits on pain, anxiety, and recovery. Cognitive or behavioral techniques
improved recovery. Furthermore, larger effects were found for studies that included
acute surgeries compared to elective surgeries. The results indicate that psychosocial
interventions, especially patient education and relaxation training, may reduce perioperative
side effects and improve recovery in patients undergoing orthopedic procedures, but
the quality of evidence is generally low. More well-powered, high-quality studies
are needed to increase confidence.
Perspective
In this meta-analysis of RCTs in orthopedic surgeries, significant benefits in postoperative
pain, perioperative anxiety, and recovery were found, suggesting that psychosocial
interventions, especially patient education and relaxation techniques, are useful
in improving clinical care.
Key words
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Published online: May 25, 2018
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☆Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing, arrangements) that might pose a conflict of interest in connection with the submitted article.
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