Perioperative Mental Health in Orthopedic Surgery
Purpose
This Hybrid 1 Study will test the effectiveness of a bundled intervention comprised of behavioral activation and medication optimization in reducing symptoms of depression and anxiety in older adults undergoing Orthopedic surgery (compared with usual care), while examining implementation outcomes.
Conditions
- Orthopedic Surgery
- Older Adults
- Depression
- Anxiety
Eligibility
- Eligible Ages
- Over 60 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- Adults ≥ 60 years - Scheduled primary hip or primary knee arthroplasty procedure - PHQ-ADS ≥ 10, indicating clinically significant depression or anxiety symptoms
Exclusion Criteria
- Barrier to communication (Unable to read, speak, and understand English) - Severe cognitive impairment screened by the SBT (Short Blessed Test) >10 - Acutely suicidal - Previous participation in this study or another CPMH study of the intervention bundle or its feasibility.
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Intervention Model Description
- Hybrid Type 1 effectiveness-implementation randomized controlled trial design
- Primary Purpose
- Treatment
- Masking
- Double (Investigator, Outcomes Assessor)
- Masking Description
- Study staff responsible for administering ratings and collecting outcomes throughout the study are blinded. The investigator(s) are also blinded. This blinding is kept throughout the study until data collection is complete. At the end of the follow-up, the study coordinator will complete a blinding question to try to guess the arm to which each participant was allocated.
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental Behavioral activation and medication optimization |
Behavioral activation (BA) will begin perioperatively and will span across 3 months postoperatively, with sessions approximately weekly or biweekly, depending on patient preference & health condition. Medications will be reviewed by a team of interventionists to minimize brain-toxic medications and optimize doses of antidepressants and other mental health medications. In-hospital and after discharge, the interventionists' role will include coordinating with the care teams to ensure that medication changes that were introduced preoperatively are maintained. |
|
|
Other Control (treatment as usual) |
Participants in control arm will continue care as usual. They will receive printed resources for supporting sleep hygiene, stress reduction, cognitive and mental health exercises, as well as community resources for older adults. |
|
Recruiting Locations
More Details
- Status
- Recruiting
- Sponsor
- Washington University School of Medicine
