title: Guided Imagery for Total Knee Replacement: A Randomized, Placebo-Controlled Pilot Study.
abstract: OBJECTIVE
  To determine the effect of guided imagery (GI) on functional outcomes of total knee replacement (TKR), explore psychological and neuroimmune mediators, and assess feasibility of study implementation.
  
  
  METHODS
  Investigator-blinded, randomized, placebo-controlled pilot study.
  
  
  METHODS
  Hospital, surgeon's office, participant's home.
  
  
  METHODS
  82 persons undergoing TKR.
  
  
  METHODS
  Audiorecordings of TKR-specific GI scripts or placebo-control audiorecordings of audiobook segments.
  
  
  METHODS
  Gait velocity and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Function scale.
  
  
  RESULTS
  Outcomes for 58 participants (29 receiving GI and 29 controls) were analyzed at 6 months after surgery. The most frequent reason for noncompletion was protocol-driven exclusion at 6 months for having the contralateral knee replaced before the study endpoint (n = 15). With imaging ability as a moderator, gait velocity, but not WOMAC Function score, was significantly improved at 6 months in the GI group. Participants in the GI group, but not the control group, had lower WOMAC Pain scores at 3 weeks after surgery than at baseline. Hair cortisol concentration was significantly lower at 6 months after surgery than at baseline in the GI group but not the control group. GI group participants had lower treatment adherence but greater treatment credibility than the control group.
  
  
  CONCLUSIONS
  Randomized controlled trials of GI in the TKR population are feasible, but inclusion/exclusion criteria influence attrition. Further studies are needed to elaborate this study's findings, which suggest that guided imagery improves objective, but not patient-reported, outcomes of TKR. Hair cortisol concentration results suggest that engagement in a time-limited guided imagery intervention may contribute to stress reduction even after the intervention is terminated. Further investigation into optimal content and dosing of GI is needed.
authors.affiliation: 1 Kent State University College of Nursing , Kent, OH.
authors.forename: Ann F
authors.initials: AF
authors.lastname: Jacobson
authors.affiliation: 1 Kent State University College of Nursing , Kent, OH.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Umberger
authors.affiliation: 2 Center for the Treatment and Study of Traumatic Stress , Summa Health System, Akron, OH.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Palmieri
authors.affiliation: 3 Department of Immunology, Summa Health System , Akron, OH.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Alexander
authors.affiliation: 4 Department of Psychiatry, Summa Health System , Akron, OH.
authors.forename: Rodney P
authors.initials: RP
authors.lastname: Myerscough
authors.affiliation: 5 Indiana University School of Nursing , Indianapolis, IN.
authors.forename: Claire B
authors.initials: CB
authors.lastname: Draucker
authors.affiliation: 6 Technische Universität Dresden , Dresden, Germany .
authors.forename: Susann
authors.initials: S
authors.lastname: Steudte-Schmiedgen
authors.affiliation: 6 Technische Universität Dresden , Dresden, Germany .
authors.forename: Clemens
authors.initials: C
authors.lastname: Kirschbaum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation* / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects