The effect of bio psychosocial model of rehabilitation on pain and quality of life after total knee replacement: A randomized controlled trial

Background: Osteoarthritis (OA) is one of the most prevalent joint disorder and its prevalence in people aged over 65 years is 33.6%. After total knee replacement, 10%–34% of patients report persistent long term pain because of central and peripheral sensitization. A recent systematic review provided moderate-level evidence that for chronic post-surgical pain in case of TKR, pain catastrophizing can be used as an independent predictor. There is paucity of literature on bio psychosocial model based rehabilitation on TKR. Methods: Subjects were randomized into two groups, experimental group received biopsychosocial model based rehabilitation (pain coping skill training). Control group received standard protocol post-TKR for the facilities in research setting. Primary outcome measure used was pain catastrophizing scale (PCS) and secondary outcome measures were SF-36 and Timed up and go test (TUG). Subjects were assessed for outcomes before the surgery and after 4 weeks of intervention. Results: Total 30 subjects were enrolled out of which 12 subjects in the experimental group and 11 subjects in the control group were analysed. Between group analysis showed statistical significance in PCS total (p = 0.0001). SF- 36 PCS component showed statistical significance (p = 0.0001). SF-36 MCS component and TUG did not show statistical significance between the groups. Conclusion: Bio psychosocial model based rehabilitation involving pain coping skill training reduces pain catastrophizing after total knee replacement surgery. Biopsychosocial model based rehabilitation was found to be effective in improving pain, quality of life and function post TKR.