Distraction Techniques for Postoperative Pain After Total Knee Arthroplasty: A Randomized Controlled Trial

Izmir Tinaztepe University

Status: Completed

Conditions: Postoperative Pain; Total Knee Arthroplasty

Treatments: Behavioral: VR Distraction; Behavioral: Poetry Reading Distraction; Behavioral: Tactile Distraction With Squishy

Study type: Interventional

Funder types: Other

Identifiers

NCT07375472

İzmirTınaztepeÜ-B.Dizer-003

Details and patient eligibility

About

This randomized controlled trial evaluates the effectiveness of three distraction techniques-virtual reality (VR) headset, squishy (squeeze toy), and poetry reading-on postoperative pain control in adults undergoing total knee arthroplasty. Participants are randomized into four parallel groups (three intervention arms and one usual care control). Pain intensity is assessed using the Visual Analog Scale (VAS), with primary assessment at 24 hours after surgery.

Full description

Total knee arthroplasty is a common orthopedic procedure that can be associated with significant postoperative pain. In addition to standard pharmacological analgesia, non-pharmacological approaches such as distraction techniques may help reduce perceived pain by redirecting attention away from nociceptive stimuli. This single-center, parallel-group randomized controlled trial will be conducted in the Orthopedics and Traumatology Clinic of Osmaniye State Hospital in Türkiye. Eligible adults (≥18 years) undergoing total knee arthroplasty will be randomized using a stratified block randomization approach based on baseline pain severity (VAS 0-3, 4-6, 7-10) to ensure balanced allocation across groups. The intervention arms include (1) VR headset distraction, (2) use of a squishy (squeeze toy) as a tactile distraction method, and (3) poetry reading as a cognitive distraction method. The control group receives usual postoperative care without a structured distraction intervention. All groups follow the same postoperative analgesia protocol. The primary outcome is postoperative pain intensity measured by VAS at 24 hours after surgery.

Enrollment: 140 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18 years or older
• Undergoing total knee arthroplasty
• Hospitalized in the postoperative period at Osmaniye State Hospital
• Able to communicate and complete pain assessment (Visual Analog Scale)
• Provides written informed consent
• Managed under the same postoperative analgesia protocol and operated by the same surgeon (as per study protocol)

Exclusion criteria

• Severe cognitive impairment or inability to provide valid pain assessment
• Postoperative complications that may interfere with participation or pain assessment
• Contraindication to the assigned distraction method (e.g., intolerance to wearing a VR headset, severe nausea/dizziness, claustrophobia)
• Refusal or withdrawal of consent

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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140 participants in 4 patient groups

Virtual Reality (VR) Headset

Experimental group

Description:

Participants will receive routine postoperative care and standard analgesia according to the hospital protocol. In addition, they will receive a structured distraction intervention using a virtual reality (VR) headset during the postoperative pain period while hospitalized (e.g., within the first 24 hours after surgery). The VR content is delivered under supervision at the bedside as a non-pharmacological distraction method.

Treatment:

Behavioral: VR Distraction

Squishy (Squeeze Toy)

Experimental group

Description:

Participants will receive routine postoperative care and standard analgesia according to the hospital protocol. In addition, they will use a squishy (squeeze toy) as a tactile distraction method during the postoperative pain period while hospitalized (e.g., within the first 24 hours after surgery). Participants are instructed to use the squeeze toy during episodes of pain/discomfort as a non-pharmacological distraction technique.

Treatment:

Behavioral: Tactile Distraction With Squishy

Poetry Reading

Experimental group

Description:

Participants will receive routine postoperative care and standard analgesia according to the hospital protocol. In addition, they will perform poetry reading as a cognitive distraction method during the postoperative pain period while hospitalized (e.g., within the first 24 hours after surgery). Poetry reading is provided as a structured non-pharmacological distraction intervention at the bedside.

Treatment:

Behavioral: Poetry Reading Distraction

Usual Care Control

No Intervention group

Description:

articipants will receive routine postoperative care and standard analgesia according to the hospital protocol. No structured distraction intervention (VR, squishy, or poetry reading) will be provided.