60c10aee16f2c110b197d3198b3711cd jouclimed_a2025m1v14.pdf d62f5c5af8e7815df20fb2021db5d22fd8e09db1 jouclimed_a2025m1v14.pdf 7c530ac1bfd0a8316a6904805a3ee7c98b43a07627764eaa2255c7e4d0c5fe8b jouclimed_a2025m1v14.pdf Title: Preoperative Home-Based Multimodal Physiotherapy in Patients Scheduled for a Knee Arthroplasty Who Catastrophize About Their Pain: A Randomized Controlled Trial Subject: Background: Chronic pain affects about 20% of total knee arthroplasty (TKA) patients, with high pain catastrophizing being a key predictor. Screening and addressing this modifiable factor may improve postoperative outcomes. Objective: We aimed to compare the effectiveness of two preoperative home-based multimodal physical therapy interventions on pain catastrophizing in high-catastrophizing TKA patients. Secondarily, the study aimed to assess postoperative outcomes over six months. Methods: A total of 40 patients with symptomatic osteoarthritis and moderate pain catastrophizing were randomly allocated to the control, therapeutic patient education (TPE), and multimodal physiotherapy (MPT) groups. Preoperative interventions comprised pain neuroscience education, coping skills training, and therapeutic exercise, differing in the number of sessions and degree of supervision. All outcomes were assessed before and after the treatment in the preoperative period, and 1, 3, and 6 months post-surgery. The primary outcome measure was pain catastrophizing. Results: Both intervention groups showed a preoperative reduction in pain catastrophizing. TPE patients had lower pain ratings at rest and lower catastrophizing scores at 1 and 6 months post-surgery, reduced kinesiophobia and improved dynamic balance at 3 and 6 months post-surgery, and higher self-efficacy at 1 month post-surgery. MPT patients exhibited lower pain catastrophizing and pain intensity during walking at 1 month post-surgery, and better outcomes in kinesiophobia, self-efficacy, and dynamic balance at 1, 3, and 6 months post-surgery, along with higher walking speed at 6 months post-surgery. Conclusions: Preoperative physiotherapy reduces preoperative pain catastrophizing and improves postoperative pain-related outcomes, behaviors, and cognitions in high-catastrophizing TKA patients. Registration is with the United States Clinical Trials Registry (NCT03847324). Keywords: knee osteoarthritis; total knee arthroplasty; physiotherapy; chronic postsurgical pain; pain catastrophizing Author: Marc Terradas-Monllor, Hector Beltran-Alacreu, Mirari Ochandorena-Acha, Ester Garcia-Oltra, Francisco Aliaga-Orduña and José Hernández-Hermoso Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sun Jan 5 13:10:52 2025 CET ModDate: Sun Jan 5 13:12:38 2025 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 656576 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- GIFXFT+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 SDPLDG+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 NWZPSD+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 FZBMZL+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 KORLVE+VnURWPalladioL Type 1 Custom yes yes yes 32 0 YKPVKG+EURM10 Type 1 Builtin yes yes yes 61 0 WBREXZ+PazoMath-Italic Type 1 Builtin yes yes yes 72 0 GIGFZE+CMR10 Type 1 Builtin yes yes yes 77 0 SVEOTC+CMSY10 Type 1 Builtin yes yes yes 82 0 WKHSBS+URWPalladioL-BoldItal Type 1 Custom yes yes yes 87 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 100 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 104 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 108 0 BCDIEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 112 0 BCDKEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 119 0 BCDLEE+Calibri TrueType WinAnsi yes yes no 124 0 BCDMEE+Arial-BoldMT TrueType WinAnsi yes yes no 128 0 ArialMT TrueType WinAnsi no no no 132 0 TimesNewRomanPSMT TrueType WinAnsi no no no 135 0 FRAXCG+PazoMath-BoldItalic Type 1 Builtin yes yes yes 141 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-05-19 04:11:22 CEST RepresentationInformation: jouclimed_a2025m1v14.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-05-18 20:27:20 CEST Size: 656576 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 332 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Design Destination: subsection.2.1 Item: Title: Participants Destination: subsection.2.2 Item: Title: Sample Size Calculation Destination: subsection.2.3 Item: Title: Randomization and Blinding Destination: subsection.2.4 Item: Title: Interventions Destination: subsection.2.5 Item: Title: Outcome Measures Destination: subsection.2.6 Item: Title: Statistical Analysis Destination: subsection.2.7 Item: Title: Results Destination: section.3 Children: Item: Title: Between-Group Comparisons (Table 2) Destination: subsection.3.1 Item: Title: Intragroup Comparison of Different Operative Periods (Table 3) Destination: subsection.3.2 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Preoperative Home-Based Multimodal Physiotherapy in Patients Scheduled for a Knee Arthroplasty Who Catastrophize About Their Pain: A Randomized Controlled Trial Author: Marc Terradas-Monllor, Hector Beltran-Alacreu, Mirari Ochandorena-Acha, Ester Garcia-Oltra, Francisco Aliaga-Orduña and José Hernández-Hermoso Subject: Background: Chronic pain affects about 20% of total knee arthroplasty (TKA) patients, with high pain catastrophizing being a key predictor. Screening and addressing this modifiable factor may improve postoperative outcomes. Objective: We aimed to compare the effectiveness of two preoperative home-based multimodal physical therapy interventions on pain catastrophizing in high-catastrophizing TKA patients. Secondarily, the study aimed to assess postoperative outcomes over six months. Methods: A total of 40 patients with symptomatic osteoarthritis and moderate pain catastrophizing were randomly allocated to the control, therapeutic patient education (TPE), and multimodal physiotherapy (MPT) groups. Preoperative interventions comprised pain neuroscience education, coping skills training, and therapeutic exercise, differing in the number of sessions and degree of supervision. All outcomes were assessed before and after the treatment in the preoperative period, and 1, 3, and 6 months post-surgery. The primary outcome measure was pain catastrophizing. Results: Both intervention groups showed a preoperative reduction in pain catastrophizing. TPE patients had lower pain ratings at rest and lower catastrophizing scores at 1 and 6 months post-surgery, reduced kinesiophobia and improved dynamic balance at 3 and 6 months post-surgery, and higher self-efficacy at 1 month post-surgery. MPT patients exhibited lower pain catastrophizing and pain intensity during walking at 1 month post-surgery, and better outcomes in kinesiophobia, self-efficacy, and dynamic balance at 1, 3, and 6 months post-surgery, along with higher walking speed at 6 months post-surgery. Conclusions: Preoperative physiotherapy reduces preoperative pain catastrophizing and improves postoperative pain-related outcomes, behaviors, and cognitions in high-catastrophizing TKA patients. Registration is with the United States Clinical Trials Registry (NCT03847324). 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