Effect of Brief Guided Imagery on Short-Term Outcomes in Patients Undergoing First Elective Total Knee Arthroplasty: Randomized Controlled Trial

<i>Background</i>: Knee osteoarthritis, which is prevalent among older adults, often necessitates total knee arthroplasty (TKA) to alleviate pain and improve function. Postoperative pain and functional limitations remain significant challenges. Brief guided imagery (GI), a non-pharmacological intervention, shows promise in pain management but is underexplored in TKA patients. <i>Aim</i>: The aim of this study is to evaluate the effect of brief GI on postoperative pain, functional outcomes, and anxiety in patients undergoing their first elective TKA. <i>Methods</i>: Randomized controlled trial: 52 patients scheduled for first elective TKA were randomized to an intervention (brief GI plus standard care, n = 19) or control (standard care only, n = 23) group. Brief GI consisted of daily 2-min audio-guided exercises for up to 6 weeks after the operation. Outcome measures included pain intensity (NPRS), functional capacity (NFRS; WOMAC), and state anxiety (STAI). Assessments were conducted preoperatively (baseline), on the first postoperative day, weekly during the first five postoperative weeks, and again at the routine 5-6-week postoperative follow-up visit. <i>Results</i>: Of 52 enrolled participants, 42 completed the study. The intervention group reported significantly lower pain levels (NPRS) at weeks 2 (mean difference: 1.26, <i>p</i> = 0.042) and 5 (mean difference: 1.86, <i>p</i> = 0.004) compared to the control group, with a moderate effect size (Cohen's d = 0.69-1.02). Functional outcomes (NFRS) were significantly better in the intervention group from week 1 through week 6 (<i>p</i> < 0.01). No significant differences were observed in WOMAC scores or STAI anxiety levels between groups. <i>Conclusions</i>: Brief GI, when integrated into postoperative care for TKA patients, significantly reduces pain and enhances functional outcomes over 6 weeks, though it does not affect anxiety levels. These findings support brief GI as a feasible adjunctive intervention for TKA recovery.