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Published in: Trials 1/2016

Open Access 01-12-2016 | Study protocol

Home-administered pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): study protocol for a randomised controlled trial

Authors: Roshan das Nair, Pippa Anderson, Simon Clarke, Paul Leighton, Nadina B. Lincoln, Jacqueline R. Mhizha-Murira, Brigitte E. Scammell, David A. Walsh

Published in: Trials | Issue 1/2016

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Abstract

Background

Knee replacement surgery reduces pain for many people with osteoarthritis (OA). However, surgical outcomes are partly dependent on patients’ moods, and those with depression or anxiety have worse outcomes. Approximately one-third of people with OA have mood problems. Cognitive behavioural therapy (CBT), a psychological therapy, is recommended by the National Institute for Health and Care Excellence for improving mood. However, evidence for the effectiveness of CBT before knee surgery in improving pain, mood, and quality of life following this surgery for people with knee OA is lacking.

Methods/Design

This is a multi-centre, mixed-methods feasibility randomised controlled trial to compare treatment as usual (TAU) plus a brief CBT-based intervention with a TAU-only control, for people with knee OA. We will recruit 50 patients with knee OA, listed for knee replacement surgery, with high levels of distress (assessed using a mood questionnaire), and who consent to take part. Participants will be randomly allocated to receive TAU plus intervention or TAU. Up to 10 sessions of CBT will be offered on an individual basis by a psychologist. The assessments and interventions will be completed before surgery. Repeat assessments at 4 and 6 months after randomisation will be sent and received by post.
Two patient-partners will conduct feedback interviews with some participants to assess what aspects of the intervention were helpful or unhelpful, the acceptability of randomisation, the experience of being in a control group, and the appropriateness of the measures used. Interviews will be audio-recorded, transcribed, and analysed using the framework approach. We will examine the feasibility and acceptability of patient-partners conducting the interviews by also interviewing the patient-partners.

Discussion

Findings from this study will be used to design a definitive study that will examine the clinical and cost-effectiveness of the CBT intervention in improving patient outcomes following knee surgery.

Trial Registration

Current Controlled Trials ISRCTN80222865; Date: 19 June 2014.
Literature
1.
go back to reference National Joint Registry for England and Wales. 7th Annual Report. 2010. National Joint Registry for England and Wales. 7th Annual Report. 2010.
2.
go back to reference Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg. 2004;86:1909–16.PubMedCrossRef Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg. 2004;86:1909–16.PubMedCrossRef
3.
go back to reference Lingard EA, Katz JN, Wright EA, Sledge CB. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg. 2004;86:2179–86.PubMed Lingard EA, Katz JN, Wright EA, Sledge CB. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg. 2004;86:2179–86.PubMed
4.
go back to reference Rosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg. 2006;14:397–405.PubMed Rosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg. 2006;14:397–405.PubMed
5.
go back to reference Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, et al. Ranawat Award Paper: Predicting Total Knee Replacement Pain: A Prospective, Observational Study. Clin Orthop Relat Res. 2003;416:27–36.PubMedCrossRef Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, et al. Ranawat Award Paper: Predicting Total Knee Replacement Pain: A Prospective, Observational Study. Clin Orthop Relat Res. 2003;416:27–36.PubMedCrossRef
6.
go back to reference Lingard EA, Riddle DL. Impact of psychological distress on pain and function following knee arthroplasty. J Bone Joint Surg. 2007;89:1161–9.PubMedCrossRef Lingard EA, Riddle DL. Impact of psychological distress on pain and function following knee arthroplasty. J Bone Joint Surg. 2007;89:1161–9.PubMedCrossRef
8.
go back to reference Rosenberger PH, Kerns R, Jokl P, Ickovics JR. Mood and attitude predict pain outcomes following arthroscopic knee surgery. Ann Behav Med. 2009;37:70–6.PubMedCrossRef Rosenberger PH, Kerns R, Jokl P, Ickovics JR. Mood and attitude predict pain outcomes following arthroscopic knee surgery. Ann Behav Med. 2009;37:70–6.PubMedCrossRef
9.
go back to reference Yohannes AM, Baldwin RC. Medical comorbidities in late-life depression. Psychiatr Times. 2008;25:197–203. Yohannes AM, Baldwin RC. Medical comorbidities in late-life depression. Psychiatr Times. 2008;25:197–203.
10.
go back to reference Bosch JA, Engeland CG, Cacioppo JT, Marucha PT. Depressive symptoms predict mucosal wound healing. Psychosom Med. 2007;69:597–605.PubMedCrossRef Bosch JA, Engeland CG, Cacioppo JT, Marucha PT. Depressive symptoms predict mucosal wound healing. Psychosom Med. 2007;69:597–605.PubMedCrossRef
11.
go back to reference Faller H, Kirschner S, König A. Psychological distress predicts functional outcomes at three and twelve months after total knee arthroplasty. Gen Hosp Psychiatry. 2003;25:372–3.PubMedCrossRef Faller H, Kirschner S, König A. Psychological distress predicts functional outcomes at three and twelve months after total knee arthroplasty. Gen Hosp Psychiatry. 2003;25:372–3.PubMedCrossRef
13.
go back to reference Chrischilles E, Lemke J, Wallace R, Drube G. Prevalence and characteristics of multiple analgesic drug use in an elderly study group. J Am Geriatr Soc. 1990;38:979–84.PubMedCrossRef Chrischilles E, Lemke J, Wallace R, Drube G. Prevalence and characteristics of multiple analgesic drug use in an elderly study group. J Am Geriatr Soc. 1990;38:979–84.PubMedCrossRef
14.
go back to reference Rosemann T, Backenstrass M, Joest K, Rosemann A, Szecsenyi J, Laux G. Predictors of depression in a sample of 1,021 primary care patients with osteoarthritis. Arthritis Care Res. 2007;57:415–22. doi:10.1002/art.22624.CrossRef Rosemann T, Backenstrass M, Joest K, Rosemann A, Szecsenyi J, Laux G. Predictors of depression in a sample of 1,021 primary care patients with osteoarthritis. Arthritis Care Res. 2007;57:415–22. doi:10.​1002/​art.​22624.CrossRef
15.
go back to reference Rosemann T, Gensichen J, Sauer N, Laux G, Szecsenyi J. The impact of concomitant depression on quality of life and health service utilisation in patients with osteoarthritis. Rheumatol Int. 2007;27:859–63.PubMedCrossRef Rosemann T, Gensichen J, Sauer N, Laux G, Szecsenyi J. The impact of concomitant depression on quality of life and health service utilisation in patients with osteoarthritis. Rheumatol Int. 2007;27:859–63.PubMedCrossRef
16.
go back to reference Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, Van Balkom A, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011;72:341–8.PubMedCrossRef Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, Van Balkom A, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011;72:341–8.PubMedCrossRef
17.
go back to reference Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. American Psychol. 1998;53:1209.CrossRef Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. American Psychol. 1998;53:1209.CrossRef
18.
go back to reference Munafò MR, Stevenson J. Anxiety and surgical recovery: Reinterpreting the literature. J Psychosom Res. 2001;51:589–96.PubMedCrossRef Munafò MR, Stevenson J. Anxiety and surgical recovery: Reinterpreting the literature. J Psychosom Res. 2001;51:589–96.PubMedCrossRef
19.
go back to reference Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, et al. Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res. 2008;466:424–31.PubMedPubMedCentralCrossRef Mancuso CA, Graziano S, Briskie LM, Peterson MG, Pellicci PM, Salvati EA, et al. Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties. Clin Orthop Relat Res. 2008;466:424–31.PubMedPubMedCentralCrossRef
20.
go back to reference Prouty A, Cooper M, Thomas P, Christensen J, Strong C, Bowie L, et al. Multidisciplinary patient education for total joint replacement surgery patients. Orthop Nurs. 2006;25:257–61.PubMedCrossRef Prouty A, Cooper M, Thomas P, Christensen J, Strong C, Bowie L, et al. Multidisciplinary patient education for total joint replacement surgery patients. Orthop Nurs. 2006;25:257–61.PubMedCrossRef
21.
go back to reference Suva D, Lübbeke A, Hudelson P, Lataillade L, Hoffmeyer P. Patient information before hip replacement: positive effects of group-session patient education prior to total hip replacement. Rev Med Suisse. 2007;3:2878–81.PubMed Suva D, Lübbeke A, Hudelson P, Lataillade L, Hoffmeyer P. Patient information before hip replacement: positive effects of group-session patient education prior to total hip replacement. Rev Med Suisse. 2007;3:2878–81.PubMed
23.
go back to reference Johnston L, MacLennan G, McCormack K, Ramsay C, Walker A. The Knee Arthroplasty Trial (KAT) design features, baseline characteristics, and two-year functional outcomes after alternative approaches to knee replacement. J Bone Joint Surg Am. 2009;91:134–41.PubMedCrossRef Johnston L, MacLennan G, McCormack K, Ramsay C, Walker A. The Knee Arthroplasty Trial (KAT) design features, baseline characteristics, and two-year functional outcomes after alternative approaches to knee replacement. J Bone Joint Surg Am. 2009;91:134–41.PubMedCrossRef
24.
go back to reference Dakin H, Gray A, Fitzpatrick R, MacLennan G, Murray D, Group KT. Rationing of total knee replacement: a cost-effectiveness analysis on a large trial data set. BMJ Open. 2012;2, e000332.PubMedPubMedCentralCrossRef Dakin H, Gray A, Fitzpatrick R, MacLennan G, Murray D, Group KT. Rationing of total knee replacement: a cost-effectiveness analysis on a large trial data set. BMJ Open. 2012;2, e000332.PubMedPubMedCentralCrossRef
25.
go back to reference Lack D, Ries M, Sack K, Fong C. Psychological Aspects of Total Joint Arthroplasty. Indep Pract. 2010;30:63–6. Lack D, Ries M, Sack K, Fong C. Psychological Aspects of Total Joint Arthroplasty. Indep Pract. 2010;30:63–6.
27.
go back to reference Zhang W, Doherty M, Peat G, Bierma-Zeinstra SM, Arden N, Bresnihan B, et al. EULAR evidence based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2010;69:483–9.PubMedCrossRef Zhang W, Doherty M, Peat G, Bierma-Zeinstra SM, Arden N, Bresnihan B, et al. EULAR evidence based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis. 2010;69:483–9.PubMedCrossRef
28.
go back to reference Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361–70.PubMedCrossRef Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361–70.PubMedCrossRef
29.
go back to reference Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, et al. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol. 2010;29:1277–83.PubMedCrossRef Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, et al. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol. 2010;29:1277–83.PubMedCrossRef
30.
go back to reference Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52:69–77.PubMedCrossRef Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52:69–77.PubMedCrossRef
31.
go back to reference Bellamy N. WOMAC Osteoarthritis Index User Guide. Version V. Brisbane; 2002. Bellamy N. WOMAC Osteoarthritis Index User Guide. Version V. Brisbane; 2002.
33.
go back to reference Beck A, Steer R, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation; 1996. Beck A, Steer R, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation; 1996.
34.
go back to reference Beck A, Steer R. Beck Anxiety Inventory Manual. San Antonio: The Psychological Corporation. Harcourt Brace & Company; 1993. Beck A, Steer R. Beck Anxiety Inventory Manual. San Antonio: The Psychological Corporation. Harcourt Brace & Company; 1993.
35.
go back to reference Group TE. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRef Group TE. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRef
36.
go back to reference Moreton B, Wheeler M, Walsh D, Lincoln N. Rasch analysis of the intermittent and constant osteoarthritis pain (ICOAP) scale. Osteoarthritis Cartilage. 2012;20:1109–15.PubMedPubMedCentralCrossRef Moreton B, Wheeler M, Walsh D, Lincoln N. Rasch analysis of the intermittent and constant osteoarthritis pain (ICOAP) scale. Osteoarthritis Cartilage. 2012;20:1109–15.PubMedPubMedCentralCrossRef
38.
go back to reference Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005;4:287–91.CrossRef Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005;4:287–91.CrossRef
39.
go back to reference Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133:581.PubMedCrossRef Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133:581.PubMedCrossRef
40.
go back to reference Morley S. Efficacy and effectiveness of cognitive behaviour therapy for chronic pain: Progress and some challenges. Pain. 2011;152(3 Suppl):S99–106.PubMedCrossRef Morley S. Efficacy and effectiveness of cognitive behaviour therapy for chronic pain: Progress and some challenges. Pain. 2011;152(3 Suppl):S99–106.PubMedCrossRef
41.
go back to reference Team GPM. Gloucester Pain Management Training Manual. 2nd ed. Gloucester: Gloucester Royal Infirmary; 1998. Team GPM. Gloucester Pain Management Training Manual. 2nd ed. Gloucester: Gloucester Royal Infirmary; 1998.
42.
go back to reference Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18:59–82.CrossRef Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18:59–82.CrossRef
43.
go back to reference Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25:1229–45.PubMedCrossRef Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25:1229–45.PubMedCrossRef
44.
go back to reference Lincoln NB, Yuill F, Holmes J, Drummond AE, Constantinescu CS, Armstrong S, et al. Evaluation of an adjustment group forpeople with multiple sclerosis and lowmood: a randomized controlled trial. Mult Scler J. 2011;17:1250–7.CrossRef Lincoln NB, Yuill F, Holmes J, Drummond AE, Constantinescu CS, Armstrong S, et al. Evaluation of an adjustment group forpeople with multiple sclerosis and lowmood: a randomized controlled trial. Mult Scler J. 2011;17:1250–7.CrossRef
45.
go back to reference Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. Analysing qualitative data. London: Routledge; 1993. p. 173–94. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. Analysing qualitative data. London: Routledge; 1993. p. 173–94.
46.
go back to reference Ritchie J, Lewis J. Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: Sage; 2003. Ritchie J, Lewis J. Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: Sage; 2003.
47.
go back to reference Pope C, Ziebland S, Mays N. Qualitative research in healthcare: analysing qualitative data. British Med J. 2000;320:114–6.CrossRef Pope C, Ziebland S, Mays N. Qualitative research in healthcare: analysing qualitative data. British Med J. 2000;320:114–6.CrossRef
Metadata
Title
Home-administered pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): study protocol for a randomised controlled trial
Authors
Roshan das Nair
Pippa Anderson
Simon Clarke
Paul Leighton
Nadina B. Lincoln
Jacqueline R. Mhizha-Murira
Brigitte E. Scammell
David A. Walsh
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Trials / Issue 1/2016
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-016-1165-z

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