Improvement in functional outcome 1 year after nonsurgical multidisciplinary treatment for chronic pain after total knee arthroplasty: A prospective cohort study

Purpose The purpose of this study was to evaluate a multidisciplinary intervention developed for patients with debilitating chronic pain after total knee arthroplasty (TKA) unresponsive to existing treatment options. Methods A treatment‐based prospective cohort study was caried out in 30 TKA patient...

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Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2024-02, Vol.32 (2), p.461-472
Main Authors: Hoevenaars, Evelien H. W., Smolders, José M. H., Veenstra, Kirsten, O'Dowd, John, Heesterbeek, Petra J. C.
Format: Article
Language:English
Subjects:
Arthroplasty, Replacement, Knee - adverse effects
biopsychosocial
chronic pain
Chronic Pain - etiology
Chronic Pain - therapy
Female
Humans
Knee Joint - surgery
Male
multidisciplinary pain management
Osteoarthritis, Knee - surgery
Patient Reported Outcome Measures
poor outcome TKA
Prospective Studies
Quality of Life
Recovery of Function
self‐management
total knee arthroplasty (TKA)
Treatment Outcome
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Summary:Purpose The purpose of this study was to evaluate a multidisciplinary intervention developed for patients with debilitating chronic pain after total knee arthroplasty (TKA) unresponsive to existing treatment options. Methods A treatment‐based prospective cohort study was caried out in 30 TKA patients with debilitating chronic pain at least 1 year after TKA. The treatment was a multidisciplinary intervention. Main inclusion criteria: no indication for surgery. Primary outcome was function measured by KOOS‐PS, OKS, OKS‐APQ and WORQ. Secondary outcome measures were pain, fear of movement, self‐efficacy, quality of life (QoL), health care and pain medication use, work rehabilitation and patient satisfaction. The assessments took place pre‐ and directly posttreatment, at 1, 3 and 12 months follow‐up. The clinical relevance was assessed by predefined minimal important clinical change (MCIC). Results At baseline patients were on average 64.7 (±7.9) years old, 67% were female, and they had knee pain for 42 (10–360) months. The results at 12‐month follow‐up: first, a significant improvement was shown in function, pain, fear of movement, self‐efficacy and QoL. Second, in 38.5%–69.2% of patients clinical relevant improvement was shown for functional outcome, 31% for pain, and 50% for self‐efficacy. Third, 42% of patients reported ‘no healthcare use in the past three months’. Conclusion One year after a multidisciplinary treatment a clinically relevant improvement was shown in terms of function, pain, self‐efficacy and QoL. It seems to be a promising treatment option in this difficult‐to‐treat patient group with debilitating chronic pain after TKA. Future research should examine the effect of the treatment in a larger study population, considering a control group, and focusing on the working population and evaluating cost‐efficacy. Level of Evidence Level II.
ISSN:0942-2056
1433-7347
DOI:10.1002/ksa.12058