Optimising Treatment Expectations Using a Video-Based Intervention in Orthopaedic Surgery: Results From a Randomised Controlled Trial.

BACKGROUND

Psychological interventions designed to optimise patients' treatment expectations have proven effective in surgical populations. Since these interventions are often resource-intensive, their clinical application is limited. We aimed to optimise treatment expectations in patients undergoing elective orthopaedic surgery with a brief video-based expectation-focused intervention. Additionally, the role of violated expectations was investigated exploratively.

METHODS

In a three-arm randomised clinical trial, participants (N = 125) scheduled to undergo elective orthopaedic surgery received either an expectation-focused video intervention aiming at fostering realistically positive treatment expectations, an active control video or standard medical care. The primary outcome was pain intensity. Measurements were taken at baseline as well as on postoperative days one and seven.

RESULTS

The intervention group reported increased treatment expectations compared to the standard medical care and the control group. No significant intervention effect on pain intensity was found. Patients indicating negative postsurgical expectation violation (feeling worse than expected) reported higher pain intensity, regardless of the study condition. No differences in pain intensity were found between patients, indicating positive or no expectation violation (feeling better or exactly as expected respectively).

CONCLUSIONS

Patients' treatment expectations can be optimised with a brief video-based intervention. However, the clinical relevance of this effect may be questionable. Postoperative pain intensity differed by expectation violation profiles. Avoiding a negative expectation violation might be a promising approach for expectation-focused interventions in surgical populations.

SIGNIFICANCE: Our findings suggest that treatment expectations can be improved through a brief video-based intervention, though this did not translate into improved postoperative outcomes. These results underscore both the potential and the limitations of very brief expectation-focused approaches and can inform the refinement of such interventions.

TRIAL REGISTRATION: German ClinicalTrials.gov identifier: www.drks.de, ID: DRKS00031516.