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M. Ochandorena-Acha1,2, A. Escribà-Salvans1,2, M. Terradas-Monllor1,2,3
1University of Vic - Central University of Catalonia, Faculty of Health Sciences and Welfare, Vic, Spain, 2Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Vic, Spain, 3Pain Medicine Section, Anaesthesiology Dept, Hospital Clinic de Barcelona, Barcelona, Spain
Background: Among the risk factors studied for persistent pain after total knee arthroplasty (TKA), pain catastrophizing stands out above the others. In this regard, preoperative interventions based on pain neuroscience education or multimodal physiotherapy have been shown to be effective in reducing pain catastrophizing. The present study pretends to respond to the following research question: How do patients experience rehabilitation after undergoing TKA surgery, whether they have received or not a preoperative physiotherapy intervention?
Purpose: The present qualitative study pretends to explore the influence of preoperative physiotherapy intervention in patients’ rehabilitation experience after undergoing TKA surgery.
Methods: A qualitative study was carried out following a constructivist and inductive approach and thematic analysis. Based on the purposive sampling approach, 12 persons participated in face-to-face semi-structured interviews between 2021 and 2023. Participants showed preoperative pain catastrophizing, were admitted at the German Trials i Pujol Hospital (Spain) and underwent a TKA due to symptomatic primary osteoarthritis after receiving as preoperative intervention the usual care, neuroscience pain education or multimodal physiotherapy.
The conversations lasted approximately 45-60 minutes and were audio-recorded with the participant’s written permission. The interviewer developed a verbatim transcript of each interview, and final transcriptions were returned to the participants to ensure the accuracy of the data. The sample size was achieved when data saturation was considered accomplished.
Thematic analysis was performed following six phases protocol: a) familiarization, b) coding, c) initial theme generation, d) developing and reviewing themes, e) defining and naming themes, and f) writing the report. The authors assume the reflexivity of their backgrounds and experience in the analysis. Atlas.ti software was used for all the analysis.
The conversations lasted approximately 45-60 minutes and were audio-recorded with the participant’s written permission. The interviewer developed a verbatim transcript of each interview, and final transcriptions were returned to the participants to ensure the accuracy of the data. The sample size was achieved when data saturation was considered accomplished.
Thematic analysis was performed following six phases protocol: a) familiarization, b) coding, c) initial theme generation, d) developing and reviewing themes, e) defining and naming themes, and f) writing the report. The authors assume the reflexivity of their backgrounds and experience in the analysis. Atlas.ti software was used for all the analysis.
Results: The main theme identified was regarding the rehabilitation process after a TKA, which is divided into two subthemes: 1) Changes perceived by participants that received a preoperative physiotherapy intervention and 2) Experiences perceived by participants that did not receive a preoperative physiotherapy intervention.
Conclusions: During the pre-surgery phase, participants that received both the multimodal physiotherapy and the pain neuroscience education, reported that it helped them understand their pain and create adaptive perceptions that improved their ability to cope with their pain, increase self-efficacy and self-management, and change certain pain cognitions (avoidance, hypervigilance). In the postoperative phase, those participants felt empowered and were involved in their rehabilitation, taking an active role in their recovery, feeling engaged, not fearful regarding exercise and being aware that pain was temporary and part of the rehabilitation process. Participants that did not receive any preoperative physiotherapy intervention showed limited coping strategies during post-surgery rehabilitation and the same cognitions as before (hypervigilance, rumination, or avoidance of activities).
Implications: This is the first qualitative study that interviews and explores the experiences of TKA patients, who preoperatively catastrophized about their pain and received preoperative pain education, multimodal physiotherapy or the usual care. The present results might help understanding how physiotherapy interventions modify the way patients cope with pain and perceive their rehabilitation process after a TKA.
Funding acknowledgements: This work was funded by The Catalan Board of Physical Therapists (Spain).
Keywords:
Total knee arthroplasty
Pain management
Multimodal physiotherapy
Total knee arthroplasty
Pain management
Multimodal physiotherapy
Topics:
Pain & pain management
Education: clinical
Musculoskeletal
Pain & pain management
Education: clinical
Musculoskeletal
Did this work require ethics approval? Yes
Institution: University of Vic – Central University of Catalonia
Committee: Ethics and Research Committee
Ethics number: Reference Number: 1115/2020. Approval date: February of 2021.
All authors, affiliations and abstracts have been published as submitted.
