Orthopedic injuries and illnesses are the leading cause of hospital admissions in the USA. It is estimated that one in five Americans are limited by and continue to seek care for musculoskeletal pain.
To help people recover from musculoskeletal injury, we developed a four-session intervention called “The Toolkit for Optimal Recovery” (TOR). A recent study aimed to evaluate the TOR delivered via secure live video versus usual care for patients with orthopedic injuries from an urban, level I trauma clinic who screen in as at-risk for persistent limitations related to musculoskeletal pain (1). We documented the feasibility of recruitment and acceptability of screening. Satisfaction with the program, adherence to treatment sessions, and treatment fidelity were all high.
Mindfulness-based interventions may be useful for patients with musculoskeletal conditions in orthopedic surgical practices. Typical mindfulness programs are lengthy and impractical in busy surgical practices. We found high feasibility, usefulness, and acceptability of a brief, 60-second mindfulness video intended to reduce pain and negative emotions in patients presenting to an orthopedic surgical practice (2). Participants showed improvements in state anxiety, pain intensity, distress, anxiety, depression and anger after watching the video, which suggests that people with musculoskeletal pain seeking orthopedic care seem receptive and interested in brief mindfulness exercises that enhance comfort and calmness.
Another trial estimated the effect of a mind-body skills-based intervention (RRCB) in reducing the magnitude of limitations and pain intensity as compared to standard care in patients with acute musculoskeletal trauma (3). The RRCB was found to be a feasible and acceptable method of addressing mood and coping strategies in patients with acute orthopedic trauma.
Another study of a workbook designed to optimize rehabilitation by improving psychological response to injury using recognized psychological techniques (the LEARN technique and goal-setting) versus a workbook containing details of stretching exercises in the otherwise routine management of a distal radius fracture found no differences among people recovering from a fracture of the distal radius.
Our research on teaching people how to optimize their inner narrative is focusing on several areas:
- We will continue to establish the feasibility of a recovery toolkit and study procedures at other trauma centers with more diverse patient populations and different clinical practices.
- We plan on testing a recovery toolkit for efficacy in a phase III hybrid efficacy-effectiveness multi-site clinical trial.
- We will investigate if there is a subgroup of patients with a negative psychological response to injury that benefits from psychological intervention and, if so, how best to identify these patients and intervene.
References
- Vranceanu AM, Jacobs C, Lin A, Greenberg J, Funes CJ, Harris MB, Heng MM, Macklin EA, Ring D. Results of a feasibility randomized controlled trial (RCT) of the Toolkit for Optimal Recovery (TOR): a live video program to prevent chronic pain in at-risk adults with orthopedic injuries. Pilot Feasibility Stud. 2019 Feb 20;5:30. doi: 10.1186/s40814-019-0416-7. eCollection 2019. PubMed PMID: 30820341; PubMed Central PMCID: PMC6381627.
- Chad-Friedman E, Talaei-Khoei M, Ring D, Vranceanu AM. First Use of a Brief 60-second Mindfulness Exercise in an Orthopedic Surgical Practice; Results from a Pilot Study. Arch Bone Jt Surg. 2017 Nov;5(6):400-405. PubMed PMID: 29299495.
- Vranceanu AM, Hageman M, Strooker J, Ter Meulen D, Vrahas M, Ring D. A preliminary RCT of a mind body skills based intervention addressing mood and coping strategies in patients with acute orthopaedic trauma. Injury. 2014 Nov 10. pii: S0020-1383(14)00553-1. doi:10.1016/j.injury.2014.11.001. [Epub ahead of print] PubMed PMID: 25435134.
- Goudie S, Dixon D, McMillan G, Ring D, McQueen M. Is Use of a Psychological Workbook Associated With Improved Disabilities of the Arm, Shoulder and Hand Scores in Patients With Distal Radius Fracture? Clin Orthop Relat Res. 2018 Feb doi: 10.1007/s11999.0000000000000095. [Epub ahead of print] PubMed PMID:29406451.