Telemedicine-Based Digital Cognitive Behavioral Intervention for Perioperative Anxiety and Depression for Total Knee Arthroplasty.
Telemedicine-Based Digital Cognitive Behavioral Intervention for Perioperative Anxiety and Depression for Total Knee Arthroplasty.
复制标题
DOI：
--
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Chelly JE
中科院分区：
文献类型：
--
作者：
Kaynar AM;Zharichenko N;Wasan AD;Chelly JE
在接受初次单侧全膝关节置换术（TKA）的患者中，术前焦虑和抑郁已被证明会增加术后疼痛和阿片类药物消耗高达50%。我们假设，在手术前一个月开始使用基于远程医疗的数字认知行为干预计划（RxWell®）将在手术前控制焦虑和抑郁。这是一项随机对照试验，入组了接受初次单侧TKA的患者。在手术前至少一个月，要求同意参与的患者完成PROMIS®（患者报告结局测量信息系统）情绪焦虑简表8a和PROMIS®情绪抑郁简表-8a问卷。T评分≥ 57的患者在手术前1个月随机分配至无干预（对照组）或RxWell®程序（治疗组）。该概念验证研究的主要结果是RxWell®使患者的PROMIS焦虑T评分正常化的能力。随机分配至RxWell®组的患者的焦虑和抑郁T评分从随机分配时的64.3 ± 3.0显著降低至术前的58.5 ± 2.6（n = 5，p = 0.006），而对照组T评分无变化（随机化时为59.4 ± 4.2 vs. 57.7 ± 6.2; n = 6，p = 0.559）。这些初步数据表明，使用RxWell®程序是一种有效的方法，可以在手术前控制焦虑和抑郁。相比之下，似乎在没有治疗的情况下，焦虑水平在手术前一个月保持相似。
Preoperative anxiety and depression have been shown to increase postoperative pain and opioid consumption by up to 50% in patients undergoing primary unilateral Total Knee Arthroplasty (TKA). We hypothesized that the use of a telemedicine-based digital Cognitive Behavioral Intervention program (RxWell®) started one month prior to surgery would control anxiety and depression prior to surgery. This was a randomized, controlled trial that enrolled patients undergoing primary unilateral TKA. At least a month prior to surgery, patients who gave consent to participate were asked to complete PROMIS® (Patient-Reported Outcomes Measurement Information System) emotional anxiety short form 8a and PROMIS® emotional depression short form-8a questionnaires. Patients with T-scores of ≥ 57 were randomized to either a no intervention (control group) or a RxWell® program (treatment group) for a month prior to surgery. The primary outcome of this proof-of-concept study was the ability of the RxWell® to normalize patients’ PROMIS anxiety T scores. T scores for anxiety and depression among patients randomized to the RxWell® group significantly decreased from 64.3 ± 3.0 at the time of randomization to 58.5 ± 2.6 prior to surgery (n=5, p=0.006), whereas no changes in T scores were recorded in the control group (59.4 ± 4.2 at the time of randomization vs. 57.7 ± 6.2; n=6, p=0.559). These preliminary data suggest that the use of a RxWell® program represents an effective approach to control anxiety and depression prior to surgery. In contrast, it seems that in the absence of treatment, anxiety level remains similar over a month prior to surgery.