Journal article
ACT for postsurgical pain and dysfunction in at-risk veterans: Multisite, double-blind, cluster RCT
Journal of psychosomatic research, Vol.198, 112393
11/01/2025
DOI: 10.1016/j.jpsychores.2025.112393
PMID: 41032959
Abstract
Persistent postsurgical pain (PPSP) and functional limitations after total knee arthroplasty (TKA) often vary in severity and duration, with higher levels seen in individuals at elevated risk. This multisite, double-blinded randomized controlled trial compared Acceptance and Commitment Therapy (ACT) to an active educational plus support attention control (AC), in Veterans "at-risk" for PPSP following TKA. Veterans indicated for unilateral TKA and at-risk for PPSP completed a 1-day (5 h) group workshop prior to surgery and at least 1 postoperative phone booster session. 336 patients who underwent TKA were randomized to ACT (N = 173) or to AC (N = 163). Of these, 95 % in the ACT group and 97 % in the AC group received at least 1 booster session. Primary outcomes included self-reported pain severity, Activities of Daily Living (ADL), and Quality of Life (QoL). The secondary outcome was time to opioid cessation. Both groups showed significant reductions in pain severity across time points: at 3 months, ACT participants had greater pain reduction (-2.78) than AC (-2.50), suggesting an earlier advantage. ADL function also improved significantly in both groups (6-month scores: ACT 31.4, AC 29.9). Median time to opioid cessation was similar overall: 2.71 weeks in both groups. Among participants without postoperative complications, ACT showed a non-significant trend toward earlier cessation (2.36 vs. 2.80 weeks). These findings suggest that brief, preoperative group-based interventions-whether ACT or educational support-can improve pain and function following TKA. ACT may offer additional early benefits in pain reduction and opioid tapering in Veterans at elevated risk for PPSP. Trial Registration:Clinicaltrials.gov under the number NCT03965897.
Details
- Title: Subtitle
- ACT for postsurgical pain and dysfunction in at-risk veterans: Multisite, double-blind, cluster RCT
- Creators
- Lilian Dindo - Michael E. DeBakey VA Medical CenterKatherine Hadlandsmyth - University of IowaLauren Garvin - University of IowaJames Marchman - University of IowaM Bridget Zimmerman - University of IowaJoseph A Buckwalter IV - University of Iowa, Orthopedics and RehabilitationDavid M Green - Michael E. DeBakey VA Medical CenterJohn K Wollaeger - William S. Middleton Memorial Veterans HospitalAndrea Strayer - University of IowaKyung Soo Kim - University of IowaWen Liu - University of Iowa, NursingJennie Embree - University of IowaMerlyn Rodrigues - Baylor College of MedicineBarbara A Rakel - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of psychosomatic research, Vol.198, 112393
- DOI
- 10.1016/j.jpsychores.2025.112393
- PMID
- 41032959
- NLM abbreviation
- J Psychosom Res
- ISSN
- 0022-3999
- eISSN
- 1879-1360
- Publisher
- Elsevier
- Language
- English
- Date published
- 11/01/2025
- Academic Unit
- Psychiatry; Psychological and Brain Sciences; Biostatistics; Orthopedics and Rehabilitation; Nursing; Anesthesia; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9984969113202771
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