Improvement in functional outcome 1 year after nonsurgical multidisciplinary treatment for chronic pain after total knee arthroplasty: A prospective cohort study

Abstract

AbstractPurposeThe purpose of this study was to evaluate a multidisciplinary intervention developed for patients with debilitating chronic pain after total knee arthroplasty (TKA) unresponsive to existing treatment options.MethodsA treatment‐based prospective cohort study was caried out in 30 TKA patients with debilitating chronic pain at least 1 year after TKA. The treatment was a multidisciplinary intervention. Main inclusion criteria: no indication for surgery. Primary outcome was function measured by KOOS‐PS, OKS, OKS‐APQ and WORQ. Secondary outcome measures were pain, fear of movement, self‐efficacy, quality of life (QoL), health care and pain medication use, work rehabilitation and patient satisfaction. The assessments took place pre‐ and directly posttreatment, at 1, 3 and 12 months follow‐up. The clinical relevance was assessed by predefined minimal important clinical change (MCIC).ResultsAt baseline patients were on average 64.7 (±7.9) years old, 67% were female, and they had knee pain for 42 (10–360) months. The results at 12‐month follow‐up: first, a significant improvement was shown in function, pain, fear of movement, self‐efficacy and QoL. Second, in 38.5%–69.2% of patients clinical relevant improvement was shown for functional outcome, 31% for pain, and 50% for self‐efficacy. Third, 42% of patients reported ‘no healthcare use in the past three months’.ConclusionOne year after a multidisciplinary treatment a clinically relevant improvement was shown in terms of function, pain, self‐efficacy and QoL. It seems to be a promising treatment option in this difficult‐to‐treat patient group with debilitating chronic pain after TKA. Future research should examine the effect of the treatment in a larger study population, considering a control group, and focusing on the working population and evaluating cost‐efficacy.Level of EvidenceLevel II.