{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T18:50:48Z","timestamp":1773082248253,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: 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. Aim: 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. Methods: 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\u20136-week postoperative follow-up visit. Results: Of 52 enrolled participants, 42 completed the study. The intervention group reported significantly lower pain levels (NPRS) at weeks 2 (mean difference: 1.26, p = 0.042) and 5 (mean difference: 1.86, p = 0.004) compared to the control group, with a moderate effect size (Cohen\u2019s d = 0.69\u20131.02). Functional outcomes (NFRS) were significantly better in the intervention group from week 1 through week 6 (p &lt; 0.01). No significant differences were observed in WOMAC scores or STAI anxiety levels between groups. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/ijerph23030340","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T11:06:52Z","timestamp":1773054412000},"page":"340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Brief Guided Imagery on Short-Term Outcomes in Patients Undergoing First Elective Total Knee Arthroplasty: Randomized Controlled Trial"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7184-0849","authenticated-orcid":false,"given":"Anat","family":"Kaplun","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer Sheva 84105, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8853-8758","authenticated-orcid":false,"given":"Omri","family":"Lubovsky","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon 7830604, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8734-476X","authenticated-orcid":false,"given":"Ilia","family":"Prosso","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon 7830604, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5238-5246","authenticated-orcid":false,"given":"Amit","family":"Sagi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon 7830604, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2987-4396","authenticated-orcid":false,"given":"Leonid","family":"Kalichman","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer Sheva 84105, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1002\/art.42089","article-title":"Prevalence trends of site-specific osteoarthritis from 1990 to 2019: Findings from the Global Burden of Disease Study 2019","volume":"74","author":"Long","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jor.2023.07.009","article-title":"Patient reported outcomes do not correlate to functional knee recovery and range of motion in total knee arthroplasty","volume":"43","author":"Yocum","year":"2023","journal-title":"J. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1302\/0301-620X.94B7.28219","article-title":"Patient expectations of arthroplasty of the hip and knee","volume":"94","author":"Scott","year":"2012","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s10067-019-04811-y","article-title":"Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years","volume":"39","author":"Neuprez","year":"2020","journal-title":"Clin. Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"102758","DOI":"10.1016\/j.otsr.2020.102758","article-title":"The ceiling effects of patient reported outcome measures for total knee arthroplasty","volume":"107","author":"Eckhard","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_6","unstructured":"Merriam-Webster (2022, January 08). Guided Imagery. Merriam-Webster.com Medical Dictionary. Available online: https:\/\/www.merriam-webster.com\/medical\/guided%20imagery."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5958\/2349-2996.2017.00017.9","article-title":"Guided imagery: + child guided imagery = reduced pain, stress, and anxiety. Let your child get healed without pain and expenses","volume":"7","author":"George","year":"2017","journal-title":"Asian J. Nurs. Educ. Res."},{"key":"ref_8","first-page":"104","article-title":"Effects of Brief Guided Imagery on Female Patients Diagnosed with Fibromyalgia: An Exploratory Controlled Trial","volume":"27","author":"Kaplun","year":"2021","journal-title":"Altern. Ther. Health Med."},{"key":"ref_9","unstructured":"Epstein, G. (1989). Healing Visualizations, Bantam Books."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s11916-021-00991-y","article-title":"Effect of guided imagery on pain and health-related quality of life in musculoskeletal medicine: A comprehensive narrative review","volume":"25","author":"Kaplun","year":"2021","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.pmn.2023.06.001","article-title":"The Effects of Brief Guided Imagery on Patients Suffering From Chronic Back Pain: An AB Design Study","volume":"24","author":"Kaplun","year":"2023","journal-title":"Pain Manag. Nurs."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1089\/acm.2016.0038","article-title":"Guided imagery for total knee replacement: A randomized, placebo-controlled pilot study","volume":"22","author":"Jacobson","year":"2016","journal-title":"J. Altern. Complement. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.pmn.2017.10.014","article-title":"Relaxation therapy with guided imagery for postoperative pain management: An integrative review","volume":"20","author":"Ferreira","year":"2019","journal-title":"Pain Manag. Nurs."},{"key":"ref_14","first-page":"1022","article-title":"Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis","volume":"17","author":"Ferraz","year":"1990","journal-title":"J. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"306","DOI":"10.5152\/j.aott.2021.20108","article-title":"The effect of a preoperative physical therapy education program on short-term outcomes of patients undergoing elective total hip arthroplasty: A controlled prospective clinical trial","volume":"55","author":"Pinskiy","year":"2021","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1007\/s00264-015-2754-2","article-title":"Preoperative education prior to elective hip arthroplasty surgery improves postoperative outcome","volume":"39","author":"Moulton","year":"2015","journal-title":"Int. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"206","DOI":"10.3138\/physio.62.3.206","article-title":"Educational needs of patients undergoing total joint arthroplasty","volume":"62","author":"Soever","year":"2010","journal-title":"Physiother. Can."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1016\/j.arth.2016.02.061","article-title":"Unfulfilled expectations after Total hip and knee arthroplasty surgery: There is a need for better preoperative patient information and education","volume":"31","author":"Tilbury","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1136\/ard.37.4.378","article-title":"Studies with pain rating scales","volume":"37","author":"Downie","year":"1978","journal-title":"Ann. Rheum. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1016\/j.jpain.2010.02.025","article-title":"Assessing pain in older people with persistent pain: The NRS is valid but only provides part of the picture","volume":"11","author":"Wood","year":"2010","journal-title":"J. Pain"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1136\/ard.2010.135483","article-title":"Validation of a numerical rating scale to assess functional impairment in hip and knee osteoarthritis: Comparison with the WOMAC function scale","volume":"70","author":"Ornetti","year":"2011","journal-title":"Ann. Rheum. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1007\/s100670050126","article-title":"Validation study of a Hebrew version of WOMAC in patients with osteoarthritis of the knee","volume":"18","author":"Wigler","year":"1999","journal-title":"Clin. Rheumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S467","DOI":"10.1002\/acr.20561","article-title":"Measures of anxiety: State-trait anxiety inventory (STAI), Beck anxiety inventory (BAI), and Hospital anxiety and Depression scale-anxiety (HADS-A)","volume":"63","author":"Julian","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_24","unstructured":"Spielberger, C.D., Gorsuch, R.L., and Lushene, R.E. (1970). Manual for the State-Trait Anxiety Inventory, Consulting Psychologists Press. Available online: https:\/\/www.google.com.hk\/url?sa=t&source=web&rct=j&opi=89978449&url=https:\/\/digitalcollections.lrc.usuhs.edu\/digital\/api\/collection\/p16005coll10\/id\/58509\/download&ved=2ahUKEwj7p4yo2I-TAxUF2jgGHeK4IpMQFnoECC0QAQ&usg=AOvVaw0z5ZcdceSOD5IuuyTi62hf."},{"key":"ref_25","unstructured":"Teichman, Y., and Melnick, H. (1985). The Hebrew Manual for the State-Trait Anxiety Inventory, Ramot."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lee, T.H., Liu, C.H., Chen, P.C., Liou, T.H., Escorpizo, R., and Chen, H.C. (2022). Effectiveness of mental simulation practices after total knee arthroplasty in patients with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0269296"},{"key":"ref_27","first-page":"314","article-title":"The Effects of Guided Imagery on Postoperative Pain and State Anxiety in Total Knee Arthroplasty Patients","volume":"61","author":"Choojaturo","year":"2017","journal-title":"Siriraj Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"van Dijk, H., K\u00f6ke, A.J.A., Elbers, S., Mollema, J., Smeets, R.J.E.M., and Wittink, H. (2023). Physiotherapists using the biopsychosocial model for chronic pain: Barriers and facilitators\u2014A scoping review. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021634"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Samoborec, S., Ruseckaite, R., Ayton, D., and Evans, S. (2018). Biopsychosocial factors associated with non-recovery after a minor transport-related injury: A systematic review. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198352"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1080\/09593985.2016.1194651","article-title":"Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education","volume":"32","author":"Wijma","year":"2016","journal-title":"Physiother. Theory Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101037","DOI":"10.1016\/j.ijotn.2023.101037","article-title":"Pain management education needs for nurses caring for older adults undergoing total knee replacement","volume":"52","author":"Piyakhachornrot","year":"2024","journal-title":"Int. J. Orthop. Trauma Nurs."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/3\/340\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T11:08:11Z","timestamp":1773054491000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/3\/340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,8]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["ijerph23030340"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23030340","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,8]]}}}