Perioperative experiences of patients with high pain catastrophizing and knee arthroplasty after receiving or not preoperative physiotherapy: Qualitative study.

This qualitative study looked at how people with high pain catastrophizing (a tendency toward excessive worry, helplessness, and rumination about pain) experienced the period around total knee arthroplasty (TKA) surgery. Researchers drew 14 participants from a larger randomized controlled trial, comparing those who had received preoperative physiotherapy with those who had not, and conducted face-to-face semi-structured interviews analyzed thematically. Two main themes emerged: preoperative experiences related to health, functioning, cognition, and behaviour, and the perioperative rehabilitation process itself. Participants who had not received preoperative physiotherapy described limited coping strategies after surgery and continued hypervigilance, rumination, or avoidance of activity, similar to before surgery.

Those who had received preoperative physiotherapy described feeling more able to cope with pain, empowered, and involved in their rehabilitation. As a qualitative study with a small sample, these findings describe participant experiences rather than proving the intervention caused these differences.

This study explored what it was like for 14 people with high pain catastrophizing (a pattern of excessive worry and negative thinking about pain) to go through knee replacement surgery. Researchers interviewed them in person and compared the experiences of those who had received physiotherapy before surgery with those who had not. People who had not had preoperative physiotherapy described struggling to cope during recovery, still feeling on high alert about pain, dwelling on it, or avoiding activities, much as they had before surgery.

Those who had received preoperative physiotherapy described feeling more able to manage their pain, more empowered, and more actively involved in their own rehabilitation. Because this was a small qualitative study based on interviews with 14 people, it cannot tell us whether preoperative physiotherapy actually caused these differences or how common these experiences are among all knee replacement patients. It offers insight into what some patients felt and experienced, not proof that the therapy changed outcomes.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This qualitative sub-study drew 14 participants from a randomized controlled trial to explore perioperative experiences of patients with high pain catastrophizing undergoing TKA, using face-to-face semi-structured interviews and thematic analysis. Two themes were identified: preoperative experiences spanning health, functioning, cognition, and behaviour, and the perioperative rehabilitation process, where experiences diverged by group. Those without preoperative physiotherapy described limited coping strategies and persistence of pre-surgical cognitions such as hypervigilance, rumination, and activity avoidance during postoperative rehabilitation.

Those who received the preoperative intervention described greater coping ability, empowerment, and active involvement in rehabilitation. These findings offer contextual and experiential insight relevant to acceptability and engagement with preoperative physiotherapy in this population, but the small purposive sample and qualitative design mean the results cannot establish effectiveness, causation, or generalizability beyond the interviewed participants.

The findings complement, rather than substitute for, quantitative outcome data from the parent trial.