Total knee replacement (TKR) is the third most frequently performed surgery in the United States. Although TKR has demonstrated positive outcomes, a significant proportion of patients report continuing pain, functional limitations, and dissatisfaction up to two years following the surgery. Complementary and alternative strategies that influence mind-body dimensions of the TKR experience have potential for improving outcomes in this large population. Guided imagery (GI) is a widely used mind-body technique that may be effective in promoting surgery outcomes. .Studies of GI for clinical conditions have had inconsistent results and lack generalizability due to absent or inappropriate controls, inadequate or absent theoretical frameworks, and lack of standardization. Sufficiently powered, randomized, controlled trials (RCTs) of the effect of GI and explanation of its mechanism of action are needed to address NCCAM's objective to elucidate emotional, behavioral, and psychological mechanisms of mind-body interventions. Preliminary data are needed for design of a full scale trial include feasibility and acceptability of GI in the clinical population and standardization of the GI and placebo control treatment. The proposed exploratory project will use a mixed method design to produce pilot data for a subsequent randomized, placebo-controlled trial of the effects of GI in patients undergoing total knee replacement:
The specific aims are to: 1). Generate estimates of effect sizes and assess feasibility of procedures for a future RCT testing a model of a standardized, prerecorded guided imagery intervention on functional outcomes of TKR;2). Elucidate the GI responder mechanism through analysis of the effect of imaging ability and other potential moderators on guided imagery's effects on TKR outcomes;3). Analyze the effect of guided imagery on outcome expectancy, psychological distress, and rehabilitation commitment as mediators on TKR outcomes;and 4). Identify patients'perspectives of receiving, and participating in a study of, guided imagery intervention for total knee replacement surgery (TKR). 82 persons scheduled to undergo TKR will be randomly assigned to either the treatment or placebo control group. The treatment will consist of listening to recorded GI scripts developed for this study for 2 weeks before and after surgery. The placebo treatment will be listening to segments of an audio book. The effect of GI on knee pain and function will be assessed at 3 intervals following the surgery and mediating/moderating effects of psychologic affective and dispositional attributes would be examined. A subsequent qualitative phase will be aimed at providing further explanations of relationships among guided imagery and the study variables, as well as analyzing participant benefit and burden and feasibility and acceptability of the study and the intervention.

Public Health Relevance

Guided imagery is a widely used complementary and alternative therapy for numerous health conditions. Research is needed to determine whether this popular technique has beneficial clinical effects. This project will provide preliminary data needed to conduct a rigorous scientific trial testing the effectiveness of guided imagery for persons having total knee replacement, the third most frequently performed surgery in the United States.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZAT1-LD (32))
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Glowa, John R
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Kent State University at Kent
Schools of Nursing
United States
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Draucker, Claire Burke; Jacobson, Ann F; Umberger, Wendy A et al. (2015) Acceptability of a Guided Imagery Intervention for Persons Undergoing a Total Knee Replacement. Orthop Nurs 34:356-64