title: Effect of Structured Touch and Guided Imagery for Pain and Anxiety in Elective Joint Replacement Patients--A Randomized Controlled Trial: M-TIJRP.
abstract: BACKGROUND
  Postoperative management of pain after total joint arthroplasty remains a challenge despite advancements in analgesics. Evidence shows that complementary modalities with mind-body and tactile-based approaches are valid and effective adjuncts to reduce pain and anxiety postoperatively.
  
  
  OBJECTIVE
  To investigate the effectiveness of the "M" Technique (M), a registered method of structured touch using a set sequence and number of strokes, and a consistent level of pressure on hands and feet, compared with guided imagery and usual care, for the reduction of pain and anxiety in patients undergoing elective total knee or hip replacement surgery.
  
  
  METHODS
  Randomized controlled trial: M-TIJRP (MiTechnique and guided Imagery in Joint Replacement Patients [Mighty Junior P]). At a community hospital, 225 male and female patients, aged 38 to 90 years, undergoing elective total hip or knee replacement were randomly assigned to 1 of 3 groups (75 patients in each): M, guided imagery, or usual care. They were blinded to their assignment until the intervention.
  
  
  METHODS
  Reduction of pain and anxiety postoperatively. Secondary outcomes measured use of pain medication and patient satisfaction.
  
  
  RESULTS
  This study yielded positive findings for the management of pain and anxiety in patients undergoing elective joint replacement using M and guided imagery for 18 to 20 minutes compared with usual care. M showed the largest predicted decreases in both pain and anxiety between groups. There was no significant difference in narcotic pain medication use between groups. Patient satisfaction survey ratings were highest for M, followed by guided imagery.
  
  
  CONCLUSIONS
  The benefit of M may be because of the specifically structured sequence of touch by competent caring, trained providers.
authors.affiliation: Internist and Integrative Holistic Physican for Internal Medicine of Morris County, LLC, in Mine Hill, NJ. eladelante@aol.com.
authors.forename: John Brent
authors.initials: JB
authors.lastname: Forward
authors.affiliation: Team Leader, for the Center for Complementary Medicine at Saint Clare's Health Systems in Dover, NJ. ngreuter@cs.com.
authors.forename: Nancy Elizabeth
authors.initials: NE
authors.lastname: Greuter
authors.affiliation: Practitioner for Integrative Medicine and Mental Health and Wellness in Bergen County, NJ. santa4247@verizon.net.
authors.forename: Santa J
authors.initials: SJ
authors.lastname: Crisall
authors.affiliation: Statistician at the Nebraska Evaluation and Research (NEAR) Center, University of Nebraska-Lincoln. houston.lester@huskers.unl.edu.
authors.forename: Houston F
authors.initials: HF
authors.lastname: Lester
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000628:therapy*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D017060:Patient Satisfaction; D014110:Touch