JOA - 2026-07-01 - Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Sleep Management Combined With Rehabilitation Exercise to Alleviate Chronic Pain Following Total Knee Arthroplasty: A Randomized Controlled Trial.
Han X, Zhao X, Ge Y, Wang B, Shang X, Lu Z, Ma Y, Li F
Topics
Key Takeaway
CBT-I combined with structured rehabilitation produced significantly greater improvements in VAS pain scores, HSS scores, ROM, and PSQI sleep quality versus conventional analgesics from week 2 onward in patients with chronic post-TKA pain (P<0.05 at all follow-up points through 12 weeks).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This single-center RCT asked whether CBT-I plus tailored rehabilitation exercise outperforms conventional analgesics for chronic pain persisting ≥3 months after TKA. Eighty patients were randomized 1:1 and assessed at weeks 1, 2, 4, and 12 post-intervention. The intervention group showed statistically superior improvements in VAS, HSS, ROM, limb circumference, PSQI, and HADS from week 2 onward, with no serious adverse events.
Key Limitation
The control group received only conventional analgesics without a sham or attention-matched control, making it impossible to isolate the effect of CBT-I from the nonspecific benefits of structured therapist contact and increased physical activity.
Original Abstract
BACKGROUND
Chronic pain following total knee arthroplasty (TKA) remains a frequent and debilitating complication that impairs recovery and quality of life. Current pharmacological treatments provide limited relief for persistent pain, especially when complicated by sleep or mood disorders. This study investigated whether combining cognitive behavioral therapy for insomnia (CBT-I) with structured rehabilitation exercise could offer a nonpharmacologic solution.
METHODS
A single-center, randomized controlled trial was conducted with 80 patients experiencing persistent pain ≥ three months after TKA. Participants were randomized into two groups (n = 40 each): an intervention group receiving CBT-I plus tailored physical rehabilitation and a control group receiving conventional analgesics. Assessments were performed at baseline and at weeks one, two, four, and 12 postintervention. Primary outcomes included Visual Analog Scale (VAS), Hospital for Special Surgery (HSS) score, range of motion (ROM), and knee joint swelling (measured by limb circumference). The secondary outcomes included the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS). Safety indicators were monitored.
RESULTS
All follow-up assessments (week one, two, four, and 12) were calculated from the start of the intervention (baseline, T0). All participants were enrolled three to seven months after TKA (means ± standard deviation (SD): 4.8 ± 1.2 months); therefore, the reported weeks represent "postintervention" rather than "postsurgery" time points. Compared to baseline, the intervention group demonstrated significantly greater improvements in VAS, HSS, ROM, and swelling from week two onward (P < 0.05). Sleep quality (PSQI) and psychological health (HADS) were also significantly improved at multiple time points compared to the control group (P < 0.05). There were no serious adverse events reported, and treatment adherence was high.
CONCLUSIONS
A multimodal intervention combining CBT-I and rehabilitation exercises offers an effective, safe, and patient-centered strategy to manage chronic pain after TKA. This approach not only relieves pain and inflammation but also enhances sleep quality and psychological well-being.