The effect of an empowerment program on pain control and self-efficacy in patients undergoing total knee arthroplasty in Iran: a quasi-experimental study

Abstract

BACKGROUND: Knee osteoarthritis significantly limits mobility and increases pain in patients. Pain self-efficacy, a crucial psychological construct, is essential for optimal recovery outcomes. This study,grounded in Bandura's self-efficacy theory and Linton's cognitive-behavioral model, evaluated the effectiveness of an empowerment program on pain intensity indices and self-efficacy in patients undergoing total knee arthroplasty. METHODS: A quasi-experimental design was employed. Ninety-eight patients were recruited via convenience sampling and randomly assigned to intervention (n=49) or control (n=49) groups. The intervention group received six structured sessions (one preoperative, five postoperative) including education on pain management, coping strategies, and goal setting, in addition to routine care. Pain intensity was assessed using the Short McGill Pain Questionnaire (SF-MPQ), Present Pain Intensity (PPI) index, and Visual Analogue Scale (VAS), while Pain self-efficacy was measured with the Pain Self-Efficacy Questionnaire (PSEQ). Evaluations were conducted at baseline (preoperatively) and six weeks postoperatively. Demographic (age, sex, education), medical (BMI), and theory-related variables were collected. Analysis of covariance, adjusting for confounders, was used to compare outcomes, with statistical significance set at p < 0.05. RESULTS: Among 98 participants (predominantly women; mean age 62.72 years, mean BMI 29.77, limited formal education), no significant baseline differences existed between groups. Post-intervention, the intervention group demonstrated significantly greater pain reduction: sensory-affective pain (MD = 1.8, 95% CI [-3.86 to -0.96], p = 0.015), Present Pain Intensity (0.62, [-1.04 to -0.18], p = 0.023), and Visual Analogue Scale scores (1.57, [-2.12 to -1.01], p < 0.001). Pain self-efficacy increased significantly (9.81, [0.71 to 1.24], p < 0.001). Analysis of covariance confirmed intervention effectiveness after adjusting for confounding variables. CONCLUSIONS: The empowerment program proved effective as an interactive, applicable, and non-invasive approach for enhancing pain management and self-efficacy in total knee arthroplasty patients.