Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial.
Roshan das Nair, Jacqueline R Mhizha-Murira, Pippa Anderson and 8 others
PMID 29424236WHAT IT FOUND
A home-based psychological therapy before knee surgery was feasible but had high dropout.
One physical function score improved significantly at six months, but the authors state this is likely a chance finding due to multiple comparisons. Most participants did not complete the planned sessions.
Key findings
01The trial demonstrated feasibility of recruitment and retention, but only 6 of 23 participants who started the intervention completed it as planned.
02Western Ontario and McMaster Universities Osteoarthritis Index physical function scores were significantly higher in the intervention group at six months, but the authors note this is likely a chance finding.
03Qualitative feedback indicated that while some participants found value in relaxation and psychoeducation, others doubted the link between thoughts, mood, and pain.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This was a feasibility trial with a small sample size (51 randomized), designed to inform a future larger trial rather than to test efficacy. The significant improvement in physical function was likely a chance finding due to multiple comparisons, as noted by the authors. Attrition was high for the intervention completion, with most participants not finishing the planned sessions. There was no active control group (e.g., attention placebo), so the effects of attention versus specific psychological content cannot be separated. Outcome assessments were short-term (4 and 6 months), which may not capture post-surgical recovery trajectories fully.
Declared interests
The study was funded by the National Institute for Health Research–Research for Patient Benefit Programme. The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that this psychological intervention improves physical function after knee replacement. The only significant positive outcome was flagged by the authors as likely a chance finding due to multiple comparisons, and the study was a small feasibility trial not powered to detect efficacy.