***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Imagery can improve functional outcomes post-anterior cruciate ligament repair ( ACLR ) . Research is needed to investigate potential mechanisms for this effect . The aim of this study was to ( a ) evaluate the effectiveness of an imagery intervention to improve functional outcomes post-ACLR , and ( b ) explore potential mechanisms . A r and omized-controlled pilot trial was conducted . Participants were r and omized  to guided imagery and st and ard rehabilitation or st and ard rehabilitation alone ( control ) . The primary outcome was knee strength 6-month post-operatively . Secondary outcomes were knee laxity at 6-months , and change in psychological ( self-efficacy ) and neurohormonal ( adrenaline , noradrenaline , dopamine ) variables . Participants ( n=21 ; 62 % male ) were 34.86 ( SD 8.84 ) years . Following the intervention , no statistical differences between groups for knee strength extension at 180 ° /s ( t=-0.43 , P=0.67 ) , or at 60 ° /s ( t=-0.72 , P=0.48 ) were found . A statistically significant effect was found for knee laxity , F=4.67 , P<0.05 , mean difference of -3.02 ( 95 % CI -4.44 to -1.60 ) , favoring the intervention . No differences were found for self-efficacy ; however , an overall effect was found for noradrenaline , F(1 , 19 ) 19.65 , P<0.001 , η(2 ) = 0.52 , and dopamine , F(1 , 19 ) 6.23 , P=0.02 , η(2 ) = 0.29 , favoring the intervention . This imagery intervention improved knee laxity and healing-related neurobiological factors The current trial compared patient education before total hip arthroplasty with the usual verbal information . A r and omized , controlled 24-month prospect i ve single-center study was done . Patients scheduled for a first elective total hip arthroplasty for primary hip osteoarthritis were enrolled . All patients were given the usual information and an information leaflet and completed a  self-evaluation question  naire ( Spielberger State and Trait Anxiety Inventory ) . The patients were assigned r and omly to two groups : Group 1 attended a collective multidisciplinary information session 2 to 6 weeks before surgery and the control group did not attend . All patients completed another State Anxiety Inventory just before surgery and then 1 and 7 days after surgery . One hundred patients were r and omized . Forty-eight attended the collective information session . Patients receiving education were significantly less anxious just before surgery than patients in the control group , in linear regression after adjustment for gender , trait and state anxiety at baseline , depression score , and health assessment question naire score . They experienced less pain before surgery and were able to st and sooner . However , the trend toward lower anxiety scores was not statistically significant after surgery . Patient education decreases preoperative anxiety and pain in patients having hip surgery OBJECTIVE We hypothesised that all areas of health status after total hip replacement could be improved in patients aged over 65 years and over by using telephone support and counselling 2 and 10 weeks after surgery compared with a control group receiving conventional care and treatment . DESIGN A r and omised clinical trial focusing on patients ' health status by using short-form 36 at 4 weeks preoperatively and 3 and 9 months postoperatively was carried out . SAMPLE 180 patients aged 65 years and over were r and omised 4 weeks preoperatively to either control or intervention groups . MEASUREMENTS both groups received conventional surgical treatment , but the intervention group was interviewed by telephone 2 and 10 weeks after surgery . Patients were given counselling within eight main dimensions with reference to their postoperative situation . RESULTS All patients experienced improvement in health status . The intervention significantly reduced the time patients needed to reach their habitual levels in three of eight areas of their health status : the intervention patients reached their habitual levels at 3 months whereas the control patients reached theirs after 9 months . CONCLUSION Intervention by telephone support and counselling in the postoperative phase seems to benefit patients ' improvement in health status This study examined the effect of the Jacobson relaxation technique involving the tongue and jaw , coordinated rhythmic breathing , and a lack of attention to thoughts , words , and speech on the postoperative comfort level in elderly patients with fractured hips . An experimental design was used to test three hypotheses that subjects who used the technique would express a lower level of pain and distress immediately after turning from their back to the unoperated hip within the first 24 hours following surgery . It was also hypothesized that subjects who used the technique would have a lower mean intake of analgesics during the initial 24-hour postoperative period . The sample consisted of 20 older adults , aged 56 to 89 , admitted to two hospitals in northern Ohio for the surgical repair of a fractured hip . Ten subjects each were r and omly assigned to a control and an experimental group . Experimental group subjects were taught the Jacobson relaxation technique according to a three-step instructional protocol that considered the learning needs of older adults . Control group subjects were not taught the technique . Data were collected using Johnson 's Sensation of Pain and Distress scales . The intake of analgesics was collected from the medical record . Results of the study supported the use of the Jacobson relaxation technique in this population as a means of increasing the postoperative level of comfort . Subjects who used the technique when they were turned during the first 24 hours following surgery stated a statistically significant lower level of pain ( p < .05 ) and distress ( p < .001 ) . Subjects also had a statistically significant lower intake of analgesics ( p < .05 ) Objective : To investigate if motivational interviewing improved physical activity , self-efficacy , quality of life , mobility and mental health in people living in the community after hip fracture . Design : Single-blind r and omized controlled trial . Setting : Community . Participants : A total of 30 adults after hip fracture who had been discharged from rehabilitation to independent living in the community and allocated to a control group ( n = 14 ) or an intervention group ( n = 16 ) . Intervention : All participants received usual care . The intervention group also received eight weekly sessions of motivational interviewing as additional input , with the control group having no additional matching input . Main outcomes : The primary outcome was physical activity levels as measured by an accelerometer ( steps taken per day , time spent walking per day , and time spent sitting or lying each day ) . Secondary outcomes included self-efficacy ( confidence about walking and not falling ) , health-related quality of life , mobility and mental health . Results : Relative to usual care , the motivational interviewing group took significantly more steps per day ( mean = 1237 steps , 95 % confidence interval ( CI ) 12 to 2463 ) , walked for longer per day ( mean = 14.4 minutes , 95 % CI 0.6 to 28.8 ) , had improved self-efficacy evidence d by being more confident about walking ( mean = 1.6 units out of 10 , 95 % CI 0.3 to 2.9 ) and not falling ( mean = 1.1 units out of 10 , 95 % CI 0.3 to 1.9 ) and improved health-related quality of life and mental health . Conclusion : This study provides preliminary evidence that motivational interviewing can result in clinical ly meaningful improvements in physical activity and psychosocial outcomes for people recovering from hip fracture Purpose To examine whether patients who received an empowerment model of education for preoperative orthopaedic teaching  had improved outcomes compared to patients who received the traditional education .  Design An experimental ( empowerment teaching method ) group vs. comparison ( traditional teaching method ) group posttest design . Sample Seventy-four patients undergoing elective orthopaedic surgery . Methods Following the preoperative teaching session , patients in both groups completed a question naire design ed to measure their perceptions of the teaching ( empowerment ) and self-efficacy ( belief in their ability to carry out perioperative tasks ) . A chart audit and phone interview was done after discharge to assess length of stay , pain management , complications , and patient perceptions of the ability to complete perioperative tasks . Findings Patients in the empowerment group felt the educational approach was more empowering and had significantly higher self-efficacy scores than those in the traditional teaching group . There was much less variation in empowerment and self-efficacy scores in the empowerment group . The empowerment group reported feeling greater confidence in performing perioperative tasks . There were no differences in length of stay , complications or pain control . Conclusion Use of an empowerment teaching approach enabled patients to become more confident in their ability to carry out perioperative tasks and become a more integral part of the preoperative teaching process . Implication s for Nursing Research The theoretical model will be used to structure other educational programs and guide research . More sensitive measures of complications and pain control should be considered for future studies Effective pain management is crucial for patient recovery after total knee arthroplasty ( TKA ) .  Biofeedback therapy , which encourages relaxation and helps alleviate various conditions associated with stress , may help to decrease postoperative pain in patients undergoing TKA . A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion ( CPM ) therapy .  Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and r and omly assigned to the intervention or control group . The intervention group received biofeedback training twice daily for 5 days , concurrent with CPM therapy , whereas the control group did not receive the biofeedback intervention .  Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5 . The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score . Results of repeated- measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group ( f = 29.70 , p < 0.001 ) . The study results provide preliminary support for biofeedback relaxation , a non-invasive and non-pharmacological intervention , as a complementary treatment option for pain management in this population Background Catastrophic thinking and fear-avoidance belief are negatively influencing severe acute pain following surgery causing delayed ambulation and discharge . We aim ed to examine if a preoperative intervention of cognitive-behavioural therapy ( CBT ) could influence the early postsurgical outcome following lumbar spinal fusion surgery ( LSF ) . Methods Ninety patients undergoing LSF due to degenerative spinal disorders were r and omly allocated to either the CBT group or the control group . Both groups received surgery and postoperative rehabilitation . In addition , the CBT group received a preoperative intervention focussed on pain coping using a CBT approach . Primary outcome was back pain during the first week ( 0–10 scale ) . Secondary outcomes were mobility , analgesic consumption , and length of hospitalisation . Data were retrieved using self-report question naires , assessment s made by physical therapists and from medical records . Results No difference between the groups ’ self-reported back pain ( p = 0.76 ) was detected . Independent mobility was reached by a significantly larger number of patients in the CBT group than the control group during the first three postoperative days . Analgesic consumption tended to be lower in the CBT group , whereas length of hospitalisation was unaffected by the CBT intervention . Conclusion Participation in a preoperative CBT intervention appeared to facilitate mobility in the acute postoperative phase , despite equally high levels of self-reported acute postsurgical pain in the two groups , and a slightly lower intake of rescue analgesics in the CBT group . This may reflect an overall improved ability to cope with pain following participation in the preoperative CBT intervention . Trial registration The study was approved by the Danish Protection Agency ( 2011 - 41 - 5899 ) and the Ethics Committee of the Central Denmark Region ( M-20110047 ) . The trial was registered in Current Controlled Trials ( IS RCT N42281022 ) Objectives Our primary aim of this pilot study was to test feasibility of the planned design , the interventions ( education plus telephone coaching ) , and the outcome measures , and to facilitate a power calculation for a future r and omized controlled trial to improve adherence to recovery goals following hip fracture . Design This is a parallel 1:1 r and omized controlled feasibility study . Setting The study was conducted in a teaching hospital in Vancouver , BC , Canada . Participants Participants were community-dwelling adults over 60 years of age with a recent hip fracture . They were recruited and assessed in hospital , and then r and omized after hospital discharge to the intervention or control group by a web-based r and omization service . Treatment allocation was concealed to the investigators , measurement team , and data entry assistants and analysts . Participants and the research physiotherapist were aware of treatment allocation . Intervention Intervention included usual care for hip fracture plus a 1-hour in-hospital educational session using a patient-centered educational manual and four videos , and up to five postdischarge telephone calls from a physiotherapist to provide recovery coaching . The control group received usual care plus a 1-hour in-hospital educational session using the educational manual and videos . Measurement Our primary outcome was feasibility , specifically recruitment and retention of participants . We also collected selected health outcomes , including health-related quality of life ( EQ5D-5L ) , gait speed , and psychosocial factors ( ICEpop CAPability measure for Older people and the Hospital Anxiety and Depression Scale ) . Results Our pilot study results indicate that it is feasible to recruit , retain , and provide follow-up telephone coaching to older adults after hip fracture . We enrolled 30 older adults ( mean age 81.5 years ; range 61–97 years ) , representing a 42 % recruitment rate . Participants excluded were those who were not community dwelling 
    Output:
    
Patient education and relaxation techniques produced the most consistent positive effects , showing benefits on pain , anxiety , and recovery .
Cognitive or behavioral techniques improved recovery .
Furthermore , larger effects were found for studies that included acute surgeries compared to elective surgeries .
PERSPECTIVE : In this meta- analysis of RCTs in orthopedic surgeries , significant benefits in postoperative pain , perioperative anxiety , and recovery were found , suggesting that psychosocial interventions , especially patient education and relaxation techniques , are useful in improving clinical care