Cost-Effectiveness of Using Mind-Body Techniques
for Total Knee-Joint Replacement
Margaret M. Huddleston and Benjamin E. Bierbaum
An increasing focus on cost-containment in medical care has drawn attention to both provider and patient factors which can reduce health care utilization. Surgical procedures are costly interventions physiologically, emotionally and financially and may create significant risks of pain, discomfort and medical complications.
The purpose of this randomized controlled study of patients undergoing total knee-joint replacement was to examine by group the cost-effectiveness of Huddleston’s protocol of mind-body techniques on length of stay and selected measures of anxiety prior to surgery. Huddleston’s protocol consists of 1) relaxation 2) visualization 3) forming a support group and 4) use of therapeutic statements during surgery. Each of these techniques has been documented to improve surgical outcomes when implemented individually. This study investigated the benefits that accrue when the four techniques are used synergistically.
Forty-four subjects comprised the study sample. They were recruited from the New England Baptist Hospital, a Tufts University Medical School teaching hospital. Twenty control group subjects received traditional medical care and twenty-four intervention group subjects received a one-hour Prepare for Surgery, Heal Faster Workshop, book and relaxation audio-tape as their instruction.
Descriptive statistics revealed a significant difference in the length of stay between the two groups. The mean number of hours for the control group was 114.29 (4.75 days) and 82.75 (3.44 days) for the experimental group, Mann-Whitney U 105.5, p=0.000. In addition, using the Spielberger State Trait Inventory Scale (STAI) subjects receiving the intervention had less anxiety during the study period when compared to the control group. The mean anxiety (state) scores decreased over time for the experimental group and there was a significant interaction of group by time. The General Linear Model repeated measure, revealed F=5.075, p=.032. A visual analog scale to measure anxiety over the 3 time periods revealed similar significant results.
Between groups, no significant differences were found by body surface (BSA), smoking and on 11 medical conditions (stroke, MI, amputation, circulatory problem, asthma, stomach condition, depression, seizures, alcohol and drug use). No significant differences were found in the demographics using the Mann-Whitney test statistic on: marital status (married vs. other); job (working vs. not working); gender (males vs. female); age; education (HS graduate vs. not HS graduate); and income (<$20,000 vs. >$20,000).
These results are both statistically significant and clinically relevant indicating that the intervention group was discharged from the hospital one-and-a-third days (31.54-hours) sooner than the control group. Implications include the value of Huddleston’s workshop, book and audio-tape as a multidimensional four-step, mind-body intervention to reduce patient anxiety prior to surgery and length of stay in the hospital.
Since clinical use of the investigated intervention reports a reduction in post-surgical nausea, lessening in use of pain medication and increase in patient satisfaction, these outcome measures will be included in future trials of the intervention.
Benjamin E. Bierbaum, MD, former Chief of Orthopedic Surgery, New England Baptist Hospital