# Effect of Brief Guided Imagery on Short-Term Outcomes in Patients Undergoing First Elective Total Knee Arthroplasty: Randomized Controlled Trial

## TL;DR

A 2-minute daily guided imagery practice helps reduce pain and improve function after knee replacement surgery, offering a low-cost, non-drug option for recovery.

## Contribution

This study shows that brief guided imagery significantly improves postoperative pain and function in TKA patients, with no added clinical burden.

## Key findings

- Guided imagery reduced pain levels at weeks 2 and 5 with moderate effect sizes.
- Functional outcomes were significantly better in the guided imagery group from week 1 to week 6.
- No significant effect on anxiety levels was observed between groups.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Brief guided imagery (GI) offers a low-cost, scalable, non-pharmacological strategy to address postoperative pain and functional limitations—major public health concerns among the growing population undergoing total knee arthroplasty (TKA).Improving early recovery after TKA can reduce healthcare utilization, enhance independence in older adults, and support better long-term quality of life.

Brief guided imagery (GI) offers a low-cost, scalable, non-pharmacological strategy to address postoperative pain and functional limitations—major public health concerns among the growing population undergoing total knee arthroplasty (TKA).

Improving early recovery after TKA can reduce healthcare utilization, enhance independence in older adults, and support better long-term quality of life.

Public health significance—Why is this work of significance to public health?
This study demonstrates that a simple 2-min daily GI practice can meaningfully reduce postoperative pain and improve functional capacity, outcomes that directly influence rehabilitation success and patient well-being.The intervention’s accessibility and minimal resource requirements make it particularly valuable for health systems seeking effective adjuncts to standard postoperative care.

This study demonstrates that a simple 2-min daily GI practice can meaningfully reduce postoperative pain and improve functional capacity, outcomes that directly influence rehabilitation success and patient well-being.

The intervention’s accessibility and minimal resource requirements make it particularly valuable for health systems seeking effective adjuncts to standard postoperative care.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Practitioners and rehabilitation teams can integrate brief GI into routine perioperative education to enhance early recovery without adding clinical burden.Policymakers and researchers may consider brief GI as a feasible component of multimodal pain management strategies and explore its broader implementation across surgical and chronic pain populations.

Practitioners and rehabilitation teams can integrate brief GI into routine perioperative education to enhance early recovery without adding clinical burden.

Policymakers and researchers may consider brief GI as a feasible component of multimodal pain management strategies and explore its broader implementation across surgical and chronic pain populations.

Background: Knee osteoarthritis, which is prevalent among older adults, often necessitates total knee arthroplasty (TKA) to alleviate pain and improve function. Postoperative pain and functional limitations remain significant challenges. Brief guided imagery (GI), a non-pharmacological intervention, shows promise in pain management but is underexplored in TKA patients. Aim: The aim of this study is to evaluate the effect of brief GI on postoperative pain, functional outcomes, and anxiety in patients undergoing their first elective TKA. Methods: Randomized controlled trial: 52 patients scheduled for first elective TKA were randomized to an intervention (brief GI plus standard care, n = 19) or control (standard care only, n = 23) group. Brief GI consisted of daily 2-min audio-guided exercises for up to 6 weeks after the operation. Outcome measures included pain intensity (NPRS), functional capacity (NFRS; WOMAC), and state anxiety (STAI). Assessments were conducted preoperatively (baseline), on the first postoperative day, weekly during the first five postoperative weeks, and again at the routine 5–6-week postoperative follow-up visit. Results: Of 52 enrolled participants, 42 completed the study. The intervention group reported significantly lower pain levels (NPRS) at weeks 2 (mean difference: 1.26, p = 0.042) and 5 (mean difference: 1.86, p = 0.004) compared to the control group, with a moderate effect size (Cohen’s d = 0.69–1.02). Functional outcomes (NFRS) were significantly better in the intervention group from week 1 through week 6 (p < 0.01). No significant differences were observed in WOMAC scores or STAI anxiety levels between groups. Conclusions: Brief GI, when integrated into postoperative care for TKA patients, significantly reduces pain and enhances functional outcomes over 6 weeks, though it does not affect anxiety levels. These findings support brief GI as a feasible adjunctive intervention for TKA recovery.