Table 1

Study characteristics

Publication, location, study design, date of study, number of centresRandomised,
mean age, % female
Intervention categoryIntervention treatmentTiming of interventionControl treatmentFollow-up assessmentsPain assessment, adherence to treatment, losses to follow-up
Allred et al 38 2010
Dates not reported
One centre
n=75 (39:36)
64:64 years
Relaxation/mindfulnessListening to CD of easy listening music on headphones 20 mins before first ambulation and for 20 mins rest period after ambulation. Music had no lyrics, 60–80 beats/min.Postoperative, inhospital20 min quiet rest period.Postoperative day 1–20 min before first physical therapy session, just before physical therapy, immediately after physical therapy, 20 min after physical therapyPain VAS
9 (6:3) did not receive intervention
19 (11:8) not included in analysis
Cai et al 39 2018
Pilot RCT
June 2015–October 2016
One centre
n=111 (demographics provided on 100)
65:66 years
Behavioural; cognitivePostoperative CBT-based four session programme of 30 min each aimed at reducing kinesiophobia.Postoperative, inhospitalUsual care4 weeks postintervention and 6 months postinterventionPain NRS
Adherence not reported
11 (5:6) not included in analysis
Chen et al 40 2015
Dates not reported
One centre
n=30 (15:15)
66:70 years
Relaxation/mindfulnessSoothing piano and Chinese violin music played on a CD player through broadcast speakers. Played for 30 min in the preoperative ward, 30 min in the surgical room waiting area and 1 hour in postoperative recovery.Preoperative and postoperative, in hospitalUsual careOn the ward after surgeryPain VAS
Adherence not reported
0 losses to follow-up
das Nair et al 41 2018
Feasibility RCT
Dates not reported
Two centres
n=50 (25:25)
65.7:66.7 years
Behavioural; cognitiveCBT-based intervention for anxiety, depression and pain management. Up to 10 1 hour sessions delivered in hospital or participant’s home.PostoperativelyUsual care4 months and 6 months postrandomisationWOMAC Pain Scale
Adherence not reported
13:12 at 6 months
Jacobson et al 43 2016
Pilot RCT
One centre
n=82 (42:40)
66:64 years
Relaxation/mindfulnessGuided imagery: 19–21 min audio recordings designed for this project to promote functional outcomes after TKR and recorded with a soothing instrumental music background. Participants were instructed to listen to the CD every day for 2 weeks before and 3 weeks after surgery.Preoperative and postoperative17–21 min commercially available audio recordings (eg, poetry, short stories, essays) at same time points as intervention group.Day of surgery, 3 weeks postoperative, 6 months postoperativePain VAS and WOMAC Pain Scale
6 (5:1) received mixed intervention or discontinued intervention
24 (13:11) excluded from analysis
Finlay et al 42 2016
5-arm RCT
Dates not reported
One centre
n=89 (18:21:18:21:20)
68 years
Relaxation/mindfulnessListening on headphones to 12–15 min of music track with no lyrics, once per day for 3 days after surgery. Four groups assigned music tracks with varying degrees of harmonicity and rhythmicity.Postoperative, in hospitalSilent control group: wore noise cancelling headphones with no input.Postoperative days 1–3Pain VRS/NRS and Short-form McGill Pain questionnaire
Adherence not reported
9 (2:3:0:1:3)
Lee et al 48 2019 Malaysia
January 2015–January 2017
One centre
n=24 (8:8:8)
Relaxation/mindfulnessPrerecorded hypnotic intervention. Presurgery session 35 min, listened to at least once presurgery. Postsurgery listened to at least one 24 hours after surgery.Preoperative and postoperative, inhospitalMinimal treatment effect and treatment as usual. Minimal treatment effect comprised psychoeducation, diaphragmatic breathing, recording of relaxing music (same as background music inhypnosis group).Baseline (NRS, HADS, PCS, treatment expectancy)
Day 1 postoperation two NRSs an hour apart, one before audio recording and one after
Day 2 NRSs
Day 3 NRSs
Day of discharge (NRS, HADS, PCS),hypnosis and minimal treatment effect group asked how often they listened to recordings.
1 month—NRSs and BPI
3 months—NRSs and BPI
6 months—NRSs and BPI
(1,3,6 months done by phone)
Pain NRS for recent pain intensity and daily pain intensity
Adherence not reported
One lost to follow-up
Leonard47 2019
Dates not given
One centre
n=32 (16:16)
53–80:45–87 years
Relaxation/mindfulnessMusic therapy during bicycling pedalling exercise postoperatively. Live music was played by a music therapist during PT supported pedalling exercise for 2 min, then pedalling alone with no music. Music included singing with paced guitar accompaniment. Songs were based on individual preference, and at a moderate/fast tempo.PostoperativePedalling exercise with no music.Baseline (1 min after flexion assessment), after each 2 min intervention period (two periods).Pain NRS
Adherence not reported.
No losses to follow-up reported.
Losina et al 44 2016
August 2011–November 2013
One centre
Cognitive/behaviouralEnhanced postoperative management. Participants received 10 calls from navigators over the course of a 6 months post-TKA recovery period. Participants were helped to identify postsurgical objectives and motivational interviewing techniques were used to elicit statements of self-efficacy and aid the patient in developing specific strategies to achieve goals.PostoperativeUsual care including inpatient physiotherapy, and outpatient physio after discharge.Baseline, 3 months postoperation, 6 monthspostoperatively.
Pain only reported as difference between baseline and 6 months postoperation
WOMAC pain score
Losses to follow-up: 21 (14 lost to follow-up and 7 withdrawn)
109 had ≥7 calls
23 had 5 or 6 calls
22 had <5 calls
134 had at least 1 call
Adherence: 97% of patients had consistent navigator.
Riddle et al 45 2019
January 2013–June 2016
Five centres
n=402 (130:135:137)
63.2 years
Cognitive/behaviouralPain coping skills programme. Eight 50 min sessions delivered over a 2-month period, beginning 2 weeks prior to surgery and ending 6 weeks following surgery. One session in person, remaining sessions via telephone.Preoperative and postoperativeArthritis education and usual care. Arthritis education delivered in the same format as pain coping skills programme.Baseline, 2, 6, and 12 months after surgery.WOMAC Pain Scale
73%patients received 5 or more sessions, reported as good adherence.
Losses to follow-up:
2 months—19 intervention and 17 control
6 months—20 intervention and 18 control
12 months—19 intervention and 15 control
Simock et al 37 2008
June 2006–March 2007
No. centres not reported, assumed to be 1.
67.3 years
Relaxation/mindfulnessPatient selection music during surgery, on headphones.PerioperativeWhite noise control on headphones.Baseline, 3 hours, 6 hours and 24 hours postsurgeryPain VAS
No losses to follow-up reported
Adherence not reported
Wang et al 46 2015
One centre
72.6 years
Relaxation/mindfulnessBiofeedback and progressive muscle relaxation during continuous passive motion therapyPostoperative, inhospitalStandard care during continuous passive motion therapy1 day, 2 days, 3 days, 4 daysand5 days postoperatively
Before and aftercontinuous passive motiontherapy
Pain intensity NRS
CMP-elicited pain score
Losses to follow-up: n=6 (4 intervention and 2 control).
Adherence not reported.
  • BPI, Brief Pain Inventory ; CBT, cognitive–behavioural therapy; CD, compact disc; HADS, Hospital Anxiety and Depression Scale; NRS, Numerical Rating Scale; PCS, Pain Catastropizing Scale; RCT, randomised controlled trial; TKR, total knee replacement; VAS, Visual Analogue Scale; WOMAC, The Western Ontario and McMaster Universities Osteoarthritis Index.