Study characteristics
| Publication, location, study design, date of study, number of centres | Randomised, mean age, % female | Intervention category | Intervention treatment | Timing of intervention | Control treatment | Follow-up assessments | Pain assessment, adherence to treatment, losses to follow-up |
| Allred et al
38 2010 USA RCT Dates not reported One centre | n=75 (39:36) 64:64 years 50:61% | Relaxation/mindfulness | Listening 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, inhospital | 20 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 therapy | Pain VAS 9 (6:3) did not receive intervention 19 (11:8) not included in analysis |
| Cai et al
39 2018 China Pilot RCT June 2015–October 2016 One centre | n=111 (demographics provided on 100) 65:66 years 64:60% | Behavioural; cognitive | Postoperative CBT-based four session programme of 30 min each aimed at reducing kinesiophobia. | Postoperative, inhospital | Usual care | 4 weeks postintervention and 6 months postintervention | Pain NRS Adherence not reported 11 (5:6) not included in analysis |
| Chen et al
40 2015 Taiwan RCT Dates not reported One centre | n=30 (15:15) 66:70 years 67:67% | Relaxation/mindfulness | Soothing 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 hospital | Usual care | On the ward after surgery | Pain VAS Adherence not reported 0 losses to follow-up |
| das Nair et al
41 2018 UK Feasibility RCT Dates not reported Two centres | n=50 (25:25) 65.7:66.7 years 56:36% | Behavioural; cognitive | CBT-based intervention for anxiety, depression and pain management. Up to 10 1 hour sessions delivered in hospital or participant’s home. | Postoperatively | Usual care | 4 months and 6 months postrandomisation | WOMAC Pain Scale Adherence not reported 13:12 at 6 months |
| Jacobson et al
43 2016 USA Pilot RCT 2011–2012 One centre | n=82 (42:40) 66:64 years 54:70% | Relaxation/mindfulness | Guided 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 postoperative | 17–21 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 postoperative | Pain 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 UK 5-arm RCT Dates not reported One centre | n=89 (18:21:18:21:20) 68 years 65% | Relaxation/mindfulness | Listening 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 hospital | Silent control group: wore noise cancelling headphones with no input. | Postoperative days 1–3 | Pain VRS/NRS and Short-form McGill Pain questionnaire Adherence not reported 9 (2:3:0:1:3) |
| Lee et al
48 2019 Malaysia RCT January 2015–January 2017 One centre | n=24 (8:8:8) 65.6:65.3:67.9 87%:87%:100% | Relaxation/mindfulness | Prerecorded 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, inhospital | Minimal 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 USA RCT Dates not given One centre | n=32 (16:16) 53–80:45–87 years 75%:68.8% | Relaxation/mindfulness | Music 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. | Postoperative | Pedalling 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 USA RCT August 2011–November 2013 One centre | n=308 66:67 60% | Cognitive/behavioural | Enhanced 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. | Postoperative | Usual 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 USA RCT January 2013–June 2016 Five centres | n=402 (130:135:137) 63.2 years 66% | Cognitive/behavioural | Pain 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 postoperative | Arthritis 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 USA RCT June 2006–March 2007 No. centres not reported, assumed to be 1. | n=30 67.3 years 60% | Relaxation/mindfulness | Patient selection music during surgery, on headphones. | Perioperative | White noise control on headphones. | Baseline, 3 hours, 6 hours and 24 hours postsurgery | Pain VAS No losses to follow-up reported Adherence not reported |
| Wang et al
46 2015 Taiwan RCT 2010 One centre | n=66 72.6 years 65.15% | Relaxation/mindfulness | Biofeedback and progressive muscle relaxation during continuous passive motion therapy | Postoperative, inhospital | Standard care during continuous passive motion therapy | 1 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.