• Michelle Dowsey, David Castle, Simon Knowles, Kaveh Monshat, Michael Salzberg, Elizabeth Nelson, Anthony Dunin, Jo Dunin, Tim Spelman, and Peter Choong.
• The University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Orthopaedics, St Vincent's Hospital, Melbourne, Australia.
• Complement Ther Med. 2019 Oct 1; 46: 195-201.

ObjectiveTo evaluate the efficacy of Mindfulness-Based Stress Reduction (MBSR) in improving pain and physical function following total joint arthroplasty (TJA).DesignTwo-group, parallel-group, randomised controlled trial, conducted between September 2012 and May 2017.SettingSingle centre study conducted at a University-affiliated, tertiary hospital.InterventionPeople with arthritis scheduled for TJA, with a well-being score <40 (Short Form-12 Survey) were randomly allocated to a pre-surgery eight-week MBSR program or treatment as usual (TAU).Outcome MeasuresSelf-reported joint pain and function at 12 months post-surgery, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were knee stiffness and global improvement (WOMAC); physical and psychological well-being (Veterans RAND 12-item Health Survey); self-efficacy (Arthritis Self-Efficacy Scale); and mindfulness (5-Factor Mindfulness Questionnaire).Results127 participants were randomised; 65 to MBSR and 62 to TAU, of which 45 participants allocated to the intervention and 56 participants allocated to usual care proceeded to surgery and 100 (99%) completed primary outcome measures. Greater improvements in knee pain (mean difference, -10.3 points, 95% CI -19.0 to -1.6; P = 0.021) and function (mean difference, -10.2 points, 95% CI -19.2 to -1.3; P = 0.025) at 12 months post-surgery were observed in the MBSR group compared to the TAU group. A between group difference in global scores (-9.5 points, 95% CI -17.9 to -1.1; P = 0.027) was also observed. No other differences in secondary outcomes were observed.ConclusionMBSR improves post-surgery pain and function in people with psychological distress undergoing TJA. Further research is required to examine potential barriers to broader implementation and uptake.Copyright © 2019. Published by Elsevier Ltd.

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