Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions

Purpose: To summarize evidence on preoperative and postoperative psychologically informed physical therapy (PIPT) for improving outcomes after degenerative spine, hip, or knee surgery. Methods: Four electronic databases were searched. Randomized trials were included if they examined the efficacy of a preoperative or postoperative intervention involving the delivery of psychologically based strategies by a physical therapist for improving function/disability, pain, quality of life, or psychological factors. Outcomes at 12 months or longer were considered long-term. Results: Twelve articles representing 10 unique studies (total N = 1,127 patients, 636 (56.4%) females) in lumbar (n = 7) or cervical spine surgery (n = 1), total knee arthroplasty (n = 1), and total knee/hip arthroplasty (n = 1) were included. The most common PIPT components were coping skills training, psychoeducation, and positive reinforcement. Greater improvements following PIPT were reported in 5 (56%) studies for function/disability, 6 (60%) for pain, 5 (71%) for quality of life, and 7 (70%) for psychological factors. Of these, greater long-term benefit was reported in three studies for function/disability, two for pain or quality of life, and four for psychological factors. Conclusion: When examining postoperative effects, there is no clear superiority of PIPT after surgery. However, the data illustrate potential for further development of PIPT in the context of surgery.