Brief Mindfulness Intervention Benefits Patients in Outpatient Orthopedics Clinic
Key findings
- A 60-second interactive personalized mindfulness video is feasible for use in an outpatient orthopedic practice
- Compared with patients who read an educational pamphlet, those who watched the short video showed detectable improvements in pain, anxiety, depression and anger levels
- Further research is necessary to determine whether the improvements are clinically meaningful
There is increasing evidence that mindfulness training can decrease distress, pain and fatigue during medical procedures and among patients with various types of illnesses. Such training aims to help people move unpleasant thoughts, feelings and bodily sensations “to the background” and not allow them to dictate behavior.
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Researchers at Massachusetts General Hospital have become the first to show that a short mindfulness-based exercise is enough for patients in an orthopedics clinic to experience improved pain and psychological outcomes. They describe the benefits of a 60-second video in Clinical Orthopaedics and Related Research.
Interim Chief of the Hand & Arm Center Neal C. Chen, MD, and colleagues suspected that a mindfulness intervention, delivered prior to clinic appointments, could set the tone for more positive experiences for both patients and clinicians. They designed a randomized, single-blind study that they conducted at the Hand & Arm Center from September to December 2016.
The participants were 125 adults (50% female, average age 55). Of those, 42% had traumatic injuries and 59% had nontraumatic injuries. The median duration of pain was eight months, and 42% of participants had other musculoskeletal pain in addition to the pain from their injury. Ten percent were using narcotics and 35% were using nonnarcotic pain medication.
The patients were randomly assigned either to watch a 60-second interactive mindfulness video, available free on the Internet at www.pixelthoughts.co, or to read a pamphlet about the relationship between pain and stress, which takes about 60 seconds to read. The video asks viewers to type a distressing thought, and the researchers asked patients to enter a thought connected to their orthopedic musculoskeletal pain.
Before and after the intervention, all patients completed a numerical rating scale of present pain intensity, the State Anxiety Subscale of the State Trait Anxiety Inventory, and three Emotion Thermometers to rate their current anxiety, depression and anger levels. Following the intervention, they rated its acceptability on a standardized “client satisfaction” scale.
Compared with the control group, patients who participated in the mindfulness video reported significantly improved levels of pain intensity, state anxiety, anxiety symptoms, depression and anger. However, the researchers had prespecified that the minimal clinically important difference (MCID) on the pain scale was 1, and the difference between groups during the study was 0.9.
The researchers could not determine whether the other improvements were clinically meaningful because no MCIDs exist for the other questionnaires.
Ratings of the acceptability of the two interventions were mid-range and did not differ between the video group and the control group. This is important, the researchers comment, because patients are not expecting to receive pain and stress management interventions at an orthopedic surgical clinic.
They conclude that a single 60-second mindfulness exercise may be sufficient to induce changes in pain and psychological distress. Such an exercise may be feasible for use in the waiting room, and it could be continued at home and possibly motivate patients to learn more about mindfulness.
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