Rehabilitation interventions incorporating self-management improve psychological factors: A non-randomized controlled trial of patients after total Knee arthroplasty

Psychological factors affect chronic pain and may lead to inactivity after total knee arthroplasty (TKA). This study aimed to determine whether using an activity diary for early postoperative rehabilitation after TKA reduced pain and improved physical functioning and psychological factors. In this non-randomized controlled trial (intervention group: n = 140; control group: n = 150), postoperative rehabilitation with physical and occupational therapy was performed for both groups, and self-monitoring using an activity diary one week postoperatively was implemented for the intervention group. The outcome variables were the numerical rating scale of pain, Timed Up & Go Test score, timed 10 m walk test score, the Pain Catastrophizing Scale (PCS), and the Pain Self-Efficacy Questionnaire (PSEQ). The data were analyzed using ANOVA with post hoc tests. Time-by-group interactions were obtained for PCS and PSEQ (p < .05), which were both more favorable in the intervention group. The intervention group showed greater improvement in PCS and PSEQ four weeks postoperatively, compared with the control group (p < .05). However, no significant results were observed for neither physical performance measures assessed. These results indicated that including an activity diary increased postoperative rehabilitation effectiveness, improved pain catastrophizing and pain self-efficacy. An activity diary is an effective and feasible addition to postoperative care for TKA patients.