Abstract
Objective
Mindfulness-based interventions have been shown to improve total joint arthroplasty patient outcomes. However, traditional mindfulness-based interventions are not always accessible to total joint arthroplasty patients and they use many different styles of mindfulness practice. Thus, critical steps in improving total joint arthroplasty patient outcomes include (1) improving accessibility to mindfulness-based interventions and (2) identifying the most effective style of mindfulness practice for total joint arthroplasty patients.
Method
We conducted a single site, three-arm, randomized clinical trial to evaluate the effects of two different nurse-led, ultra-brief (i.e., 3-min), mindfulness-based interventions on total joint arthroplasty patients’ (n = 127) preoperative (i.e., pain intensity, pain unpleasantness, and pain medication desire) and postoperative (physical function) outcomes. Participants were randomly assigned to either a standard, preoperative nurse consultation, a preoperative nurse consultation that included a 3-min mindfulness of breath practice, or a preoperative nurse consultation that included a 3-min mindfulness of pain practice.
Results
The mindfulness of breath and mindfulness of pain practices resulted in less pain intensity (Breath: -0.69, p = 0.006; Pain: -0.57, p = 0.010) and pain unpleasantness (Breath: -0.94, p = 0.001; Pain: -0.62, p = 0.026) relative to the standard nurse consultation. Additionally, the mindfulness of pain practice resulted in less pain medication desire relative to the mindfulness of breath practice (-0.92, p = 0.011) and standard nurse consultation (-1.12, p = 0.002). No effect was observed on postoperative physical function.
Conclusion
Embedding nurse-led, ultra-brief, mindfulness-based interventions in total joint arthroplasty patients’ surgical care pathways appears to be an effective nonpharmacological pain management strategy.
Preregistration
ClinicalTrials.gov NCT04800354.
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Data Availability Statement
Data will be made available to qualified individuals following written request.
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Funding
Adam W. Hanley was supported by grant number R21DA050792 from the National Institutes of Health during the preparation of this manuscript. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Eric L. Garland was supported by grant number R01DA042033 from the National Institutes of Health during the preparation of this manuscript. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Contributions
Adam W. Hanley: Conceptualization, Methodology, Data Analyses, Writing—Original Draft. Jan Hinich: Conceptualization, Investigation, Writing – Reviewing and Editing. Alexandra Kennedy: Conceptualization, Investigation. Chyrese Newman: Investigation. Geraldine Martorella: Consultation, Writing – Reviewing and Editing. Lucas Anderson: Supervision, Writing – Reviewing and Editing. Christopher Pelt: Supervision, Writing – Reviewing and Editing. Jeremy Gililland: Supervision, Writing – Reviewing and Editing. Eric L. Garland: Conceptualization, Methodology, Writing – Reviewing and Editing.
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Ethics Statement
The University of Utah’s Institutional Review Board approved all study procedures: IRB_00085446.
Informed Consent
This study was performed in accordance with the ethical standards stipulated by the 1964 Declaration of Helsinki.
Conflict of Interest Statement
Lucas Anderson is a consultant for Medacta and orthogrid. Jeremy Gililland is a consultant for Stryker, DJO Surgical, and OrthoGrid; recievies royalties/equity from OrthoGrid, and MiCare Path; is on the Editorial Board at the Journal of Arthroplasty and serves on the American Association of Knee and Hip Surgeons’ Program Committee and the American Association of Knee and Hip Surgeons’ Education Committee. Eric L. Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. He also receives royalties from the sale of books related to Mindfulness Oriented Recovery Enhancement and is a consultant to BehaVR, LLC. Christopher Pelt reports no conflicts that appear relevant to the present work, but does report personal fees from Zimmer Biomet, personal fees from 3 M KCI, personal fees from Smith and Nephew, personal fees from Total Joint Orthopaedics, personal fees from Immunis, and stocks in Joint Development Inc., all outside the submitted work. The other authors declare they have no conflicting interests.
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Hanley, A.W., Hinich, J., Kennedy, A. et al. The Analgesic Effects of Nurse-Led, Ultra-Brief Mindfulness Interventions: A Randomized Controlled Trial. Mindfulness 14, 1113–1124 (2023). https://doi.org/10.1007/s12671-023-02112-9
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DOI: https://doi.org/10.1007/s12671-023-02112-9