Telemedicine-Based Digital Cognitive Behavioral Intervention for Perioperative Anxiety and Depression for Total Knee Arthroplasty

INTRODUCTION: Preoperative anxiety and depression have been shown to increase postoperative pain and opioid consumption by up to 50% in patients undergoing primary unilateral Total Knee Arthroplasty (TKA). We hypothesized that the use of a telemedicine-based digital Cognitive Behavioral Intervention program (RxWell(®)) started one month prior to surgery would control anxiety and depression prior to surgery. MATERIALS AND METHODS: This was a randomized, controlled trial that enrolled patients undergoing primary unilateral TKA. At least a month prior to surgery, patients who gave consent to participate were asked to complete PROMIS(®) (Patient-Reported Outcomes Measurement Information System) emotional anxiety short form 8a and PROMIS(®) emotional depression short form-8a questionnaires. Patients with T-scores of ≥ 57 were randomized to either a no intervention (control group) or a RxWell(®) program (treatment group) for a month prior to surgery. The primary outcome of this proof-of-concept study was the ability of the RxWell(®) to normalize patients’ PROMIS anxiety T scores. RESULTS: T scores for anxiety and depression among patients randomized to the RxWell(®) group significantly decreased from 64.3 ± 3.0 at the time of randomization to 58.5 ± 2.6 prior to surgery (n=5, p=0.006), whereas no changes in T scores were recorded in the control group (59.4 ± 4.2 at the time of randomization vs. 57.7 ± 6.2; n=6, p=0.559). CONCLUSION: These preliminary data suggest that the use of a RxWell(®) program represents an effective approach to control anxiety and depression prior to surgery. In contrast, it seems that in the absence of treatment, anxiety level remains similar over a month prior to surgery.