Effectiveness of cognitive behavioral therapy for patients after total knee arthroplasty: a systematic review and meta-analysis

ABSTRACT

Total knee arthroplasty (TKA) is considered a common surgical option in patients with end-stage osteoarthritis of the knee. This systematic review and meta-analysis aimed to determine the effectiveness of cognitive behavioral therapy (CBT) for patients after TKA. PubMed, EMBASE, the Cochrane Library, Web of Science and CINAHL were searched for randomized controlled trials (RCTs) from inception to 20 August 2021. Included studies were evaluated with the Cochrane risk-of-bias tool. Six RCTs were included. Our study results demonstrated that a significant reduction in pain catastrophing was seen in patients receiving CBT at post-intervention (SMD −0.48, 95% CI = −0.72 to −0.23, I² 17.2%, p = 0.00) but not in 3-month or 12-month follow-up. There were no significant differences between CBT and usual-care patients regarding pain intensity or knee function at different time-points. This is the first time that meta-analysis has been conducted to determine the effectiveness of CBT for patients after TKA. It is necessary to conduct longer follow-ups, include larger samples and conduct rigorous RCTs to further explore this issue.

KEYWORDS:

• Total knee arthroplasty
• cognitive behavioral therapy
• meta-analysis
• pain

Acknowledgements

The authors would like to acknowledge Standardization of Traditional Chinese Medicine, China Administration of Traditional Chinese Medicine (GZY-FJS-2020-213); Traditional Chinese Medicine Project of Gansu Province, China (No. GZKZ-2020-3); Key Project of Science and Technology Department of Gansu Province, China (No. 21ZD4FA009) and Science and Technology Program of Gansu Province, China (No. 21JR7RA681).

Disclosure statement

No potential conflict of interest was reported by the authors.

Author contributions

All authors listed have made contributions to the meta-analysis. TM designed the study. TM, JHP and XFW participated in performing the review and collecting the data. TM and BLY took part in analyzing the data. TM, JHP, FFS and BLY wrote and revised the manuscript. All authors read and approved the final manuscript.

Additional information

Funding

This work was supported by the Standardization of Traditional Chinese Medicine, China Administration of Traditional Chinese Medicine (No. GZY-FJS-2020-213); Traditional Chinese Medicine Project of Gansu Province, China (No. GZKZ-2020-3); Key Project of Science and Technology Department of Gansu Province, China (No. 21ZD4FA009); Science and Technology Program of Gansu Province, China (No. 21JR7RA681).