Feasibility, Mediation, Total Knee Replacement
Conditions
Brief summary
The goal of this pilot study is to develop a randomized control trial study with sufficient power to definitely address if a preop mindfulness meditation intervention can improve post-total knee arthroplasty mental well-being or physical health compared to controls, and if a preop mindfulness meditation intervention can train resilience. The main questions it aims to answer are: 1. Is this preoperative mindfulness meditation study feasible at Hospital for Special Surgery? 2. Can we estimate a control and intervention group central tendency and variability to be used to determine sample size in future study? 3. Does a preoperative mindfulness meditation interventions improve post-total knee arthroplasty mental well-being or physical health compared to controls? Can preoperative a mindfulness meditation intervention train resilience (as measured by increased resilience score)? Participants will be randomly assigned to be in the intervention group or the waitlist control group. The intervention group gets the mindfulness mediation intervention prior to their day of surgery, and the control group will be given the mindfulness meditation intervention 90 days after their day of surgery. The waitlist control group allows for comparison between those who got the mindfulness meditation intervention prior to surgery and those who did not while still offering the potential benefits of the intervention after 90 days.
Detailed description
This study will investigate the effect of a preoperative mindfulness meditation intervention (MMI) on outcomes for total knee arthroplasty (TKA) patients at the Hospital for Special Surgery in a randomized controlled trial. Mindfulness meditation is a practice well-known to psychology research based on sustained attention on the present and a non-judgment of one's current situation. It has been used for numerous psychological issues including stress, anxiety, and depression. This intervention group will be compared against a waitlist control group (patients will be told they are on a waitlist to receive the mindfulness intervention, which will occur after data collection has finished for their group). This control has been utilized in several mindfulness meditation studies. Measures of anxiety, depression, resilience, pain and pain unpleasantness, and overall physical and mental health will be taken after randomization, but before the intervention (or being told they are on the waitlist). Overall physical and mental health measures will also be taken on the day of surgery and final surveys will be collected at 90 days post-op. The goal of this pilot study is to develop a randomized control trial study with sufficient power to definitely address if a preop mindfulness meditation intervention can improve post-total knee arthroplasty mental well-being or physical health compared to controls, and if a preop mindfulness meditation intervention can train resilience. The main questions it aims to answer are: 1. Is this preoperative mindfulness meditation study feasible at Hospital for Special Surgery? 2. Can we estimate a control and intervention group central tendency and variability to be used to determine sample size in future study? 3. Does a preoperative mindfulness meditation interventions improve post-total knee arthroplasty mental well-being or physical health compared to controls? Can preoperative a mindfulness meditation intervention train resilience (as measured by increased resilience score)? Participants will be randomly assigned to be in the intervention group or the waitlist control group. The intervention group gets the mindfulness mediation intervention prior to their day of surgery, and the control group will be given the mindfulness meditation intervention 90 days after their day of surgery. The waitlist control group allows for comparison between those who got the mindfulness meditation intervention prior to surgery and those who did not while still offering the potential benefits of the intervention after 90 days.
Interventions
OTHERMindfulness Meditation Intervention
The mindfulness intervention is a scripted, \~12min audio recording based on core tenets of mindfulness meditation and contextualized for patients undergoing total knee arthroplasty. It teaches sustained attention on the present, body awareness, acceptance of the body's current state, and transformational strategies to cope with emotional or physical stimuli as they arise. It has been created by the study team based on the teachings of Jon Kabat Zinn (founder of mindfulness meditation) and the PI's history teaching yoga and meditation. Patients will be encouraged to review the audio recording once a week.
Sponsors
Hospital for Special Surgery, New York
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Masking description
Patients, research assistants, surgeons, and anesthesiologists are all unblinded
Intervention model description
Randomized control trial of two groups, intervention vs waitlist control
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients undergoing primary total knee arthroplasty with a participating surgeon * Patients on these medications for anxiety/depression: Fluoxetine, Paroxetine, Citalopram, Escitalopram, Sertraline, Fluvoxamine, Venlafaxine, Duloxetine, Levomilnacipran, Desvenlafaxine, Bupropion, Mirtazapine, Amitriptyline, Nortriptyline, Clonazepam, Alprazolam, Lorazepam, Diazepam, Oxazepam, Chlordiazepoxide * Patients receiving intraoperative auricular acupuncture as part of participating surgeon's preferred anesthetic care * Patients fluent in English * ASA I-III * BMI \< 40
Exclusion criteria
* Patient not fluent in English (inability to understand the intervention video will likely affect ability to utilize the mindfulness techniques taught) * Pediatric patients \< 18 years of age * Patients with contraindications to intra-op protocol * Patients with contraindications to auricular acupuncture (non-native ear, active ear infection, gauges in the ears) * Patients unable/unwilling to participate in the questionnaires or view the scripted intervention * Patients scheduled for consecutive or staged surgeries * Patients allergic to local anesthetics or study medications * Patients who have kidney disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall mental health score | 1 week prior to surgery to post operative day 90 | PROMIS Mental Health Questionnaire is to assess general mental health in patients 1 week prior to surgery, post operative day 14, and post operative day 90. The responses to these questionsare excellent, very good, good, fair, or poor. |
| Anxiety | 1 week prior to surgery to post operative day 90 | Generalized Anxiety Disorder Assessment (GAD-7) is used to assess severe anxiety in patients 1 Week prior to surgery, post operative day 14, and post operative day 90. The responses to these questions are not at all sure, several days, over half the days, or nearly every day. |
| Depression | 1 week prior to surgery to post operative day 90 | The Patient Health Questionnaire (PHQ-9) is to assess depression in patients 1 week prior to surgery, post operative day 14, and post operative day 90. The responses to these questions are not at all, Several days, more than half the days, and nearly every day. |
| Overall physical health scores | 1 week prior to surgery to post operative day 90 | PROMIS Physical Health Questionnaire is used to assess general physical health in patients 1 week prior to surgery, post operative day 14, and post operative day 90. The responses to these questions are excellent, very good, good, fair, or poor. |
| Knee health | 1 week prior to surgery to pre operative holding | The KOOS-JR questionnaire will assess knee health after a total knee replacement surgery 1 week prior to surgery, post operative day 14, and post operative day 90. The responses to these questions are none, mild, moderate, severe, or extreme. |
| MMI Practice Survey | pre-operative holding to post-operative day 90 | The mindfulness meditation intervention practice survey helps to assess enrollment, retention, intervention completion and use measured by time to full enrollment, dropout number/proportion, number of MMI views/uses. The MMI practice survey is asked to the intervention group in pre-operative holding, post-operative day 14 and post-operative day 90. There are several different responses to these questions. These responses include yes or no; from 1-5+; emotional destress or physical pain; Not at all, somewhat improved, improved, or greatly improved. |
| Exit Survey | pre-operative holding to post-operative day 90 | The exit survey is used to assess ease and helpfulness of the mindfulness meditation intervention to the patients. This is asked to the intervention group in pre-operative holding, post-operative day 14 and post-operative day 90. This survey includes several different respnses to its questions. Responses include; open ended responses; yes or no; \< 1 week, 1-2 weeks, 3-4 weeks, or 4+ weeks. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain outcomes of patients | 1 week prior to surgery to post operative day 90 | The Pain Unpleasantness scale uses verbal descriptors to asses pain at 1 week prior to surgery, day of surgery, post-acute care unit (PACU), post operative day 14, and post operative day 90. The response to this questionnaire are slightly unpleasant, slightly annoying, unpleasant, annoying, slightly, distressing, very unpleasant, distressing, very annoying, slightly intolerable, very distressing, intolerable, or very intolerable. |
| Numerical Rating Scale (NRS) | 1 week prior to surgery to post operative day 90 | The NRS assesses pain levels on a scale from 0-10 in the operative knee 1 week prior to surgery, day of surgery, post-acute care unit (PACU), post operative day 14, and post operative day 90. |
| Resilience training | 1 week prior to surgery to post operative day 90 | The Brief Resilience Scale is used to assess the ability to recover from stress 1 Week prior to surgery, post operative day 14, and post operative day 90. The responses to this questionnaire are strongly agree, disagree, neutral, agree, strongly agree. |
| Patient satisfaction | Post operative day 14 | The patient satisfaction survey will assess patient satisfaction with results of the total knee replacement surgery taken on post operative day 14. The responses to this questionnaire range from 0-10, 0 being strongly dissatisfied and 10 being strongly satisfied. |
| Pain catastrophizing scale | 1 week prior to surgery | The pain catastrophizing scale assess pain experience and ability to cope with pain 1 week prior to surgery. The responses to this questionnaire are not at all, to a slight degree, to a moderate degree, to a great degree, or all the time. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORChristopher Li, MD
Hospital for Special Surgery, New York
Outcome results
None listed