Sleep experiences in patients undergoing a total knee replacement
Research type
Research Study
Full title
Exploring sleep behaviour and problems in patients undergoing total knee replacement surgery
IRAS ID
246988
Contact name
Katie Whale
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
1 years, 5 months, 30 days
Research summary
Research Summary
Total knee replacement is the third most common non-emergency procedure in the UK. It involves replacing a damaged or painful joint with an artificial joint in order to reduce pain and improve function. Results after a total knee replacement are good, however up to 20% of patients will continue to experience dissatisfaction with their surgical outcome and mild to severe long-term pain after surgery. In order address this issue, new approaches are needed to improve surgical outcomes and reduce pain in this patient group.
The aim of this study is the preliminary development of a new non-pharmacological approach to improve sleep quality and duration in patients undergoing total knee replacement. Sleep is bidirectionally linked to pain and improving sleep in this population has the potential to significantly benefit a wide range of patients and improve long-term outcomes.
The first step in this process is to fully understand the problem and its causes. To date, very little is known about the exact nature of sleep behaviour and problems in the total knee replacement population. This study will use a mixed-methods approach to explore individual sleep experiences and patterns through the use of qualitative focus groups, questionnaires, and wearable sleep monitors. This data will enable us to identify the nature of sleep problems within this population, which of these problems have the greatest potential for change, and how to can bring about this change.
Summary of Results
Background: Up to 20% of patients experience long-term pain and dissatisfaction after total knee replacement, with negative impact on their quality of life. New approaches are needed to reduce the proportion of people to go on to experience chronic post-surgical pain. Sleep and pain are bidirectionally linked with poor sleep linked to greater pain. Interventions to improve sleep among people undergoing knee replacement offer a promising avenue. Health beliefs and barriers to engagement were explored using behaviour change theory. This study followed stages 1-4 of the Medical Research Council’s guidance for complex intervention development to develop a novel intervention aimed at improving sleep in pre-operative knee replacement patients.
Methods: Pre-operative focus groups and post-operative telephone interviews were conducted with knee replacement patients. Before surgery, focus groups explored sleep experiences and views about existing sleep interventions (cognitive behavioural therapy for insomnia, exercise, relaxation, mindfulness, sleep hygiene), and barriers to engagement. After surgery, telephone interviews explored any changes in sleep and views about intervention appropriateness. Data were audio-recorded, transcribed, anonymised, and analysed using framework analysis.
Results: Overall 23 patients were recruited, 17 patients attended pre-operative focus groups and 7 took part in a post-operative telephone interview. Key sleep issues identified were problems getting to sleep, frequent waking during the night, and problems getting back to sleep after night waking. The main reason for these issues were knee pain and discomfort, and busy mind. Participants felt that all the sleep interventions described were generally acceptable with no general preference for one intervention over the others. Views of delivery mode varied with split views on digital delivery, and group versus one-to-one delivery.
Conclusion: Existing sleep interventions were found to be acceptable to knee replacement patients. Key barriers to engagement related to participants’ health beliefs. Addressing beliefs about the relationship between sleep and pain and enhancing understanding of the bidirectional / cyclical relationship could benefit engagement and motivation. Individuals may also require support to break the fear and avoidance cycle of pain and coping. A future intervention should ensure that patients’ preferences for sleep interventions and delivery mode can be accommodated in a real-world context.
REC name
South West - Cornwall & Plymouth Research Ethics Committee
REC reference
18/SW/0281
Date of REC Opinion
23 Dec 2018
REC opinion
Favourable Opinion