Psychologically informed physical therapy interventions for lower extremity surgical injuries: a systematic review and meta-analysis of clinical and self-reported outcomes

This review pooled seven trials (944 patients) testing physical therapy that adds psychological strategies such as pain coping skills, pain neuroscience education, and cognitive behavioral techniques, compared with usual rehabilitation or education, after knee or hip replacement, ACL reconstruction, or lower limb fracture fixation. The pooled results favored the psychological approach for pain catastrophizing (SMD 2.46, 95% CI 0.69 to 4.24, three studies, I2 = 91%), kinesiophobia (SMD 1.56), and Oxford Knee Score (SMD 1.72). However, most individual trials, including both Oxford Knee Score trials and all three kinesiophobia trials, reported no significant between-group difference, and single-study outcomes such as KOOS, PROMIS function, WOMAC, and pain showed no benefit. The very large pooled effects should therefore be treated with strong caution.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersFear of movement and catastrophizing predict poor recovery after TKA and ACL reconstruction, so knowing whether psychologically informed rehab actually helps is relevant to perioperative counseling and rehab referral.

Presenting this at rounds? Start here

• ?Should patients with high preoperative pain catastrophizing or kinesiophobia scores before TKA or ACL reconstruction be routinely screened and referred for psychologically informed rehabilitation, and what cutoff would you use?
• ?For a young athlete after ACL reconstruction with low psychological readiness to return to sport, how would you incorporate confidence and fear-of-reinjury counseling into the rehab plan and return-to-sport decision?