Effects of Guided Imagery and HRV Biofeedback Training on Psychological Variables and Post-Operative Outcome Measures of Orthopaedic Surgical Patients

Complementary and Alternative Medicine (CAM) is comprised of a range of therapeutic modalities and atypical practices which have been found to successfully accompany standard medical care. Interventions such as guided imagery and stress management education, among many others, have been linked to improved health outcomes and recovery in the area of mind-body research (Freeman, 2005; Tusek et al., 1997). The objective of this study was to ascertain the degree of impact biofeedback and guided imagery have on psychological variables and medical measures as individual and combined interventions among orthopedic patients who underwent joint replacement surgery. Hip and knee arthroplasty patients (n = 60) were randomly assigned to one of four groups where each received some form of preoperative intervention. Participants in the guided imagery, biofeedback, guided imagery and biofeedback, and general education groups all met with the researcher one to two weeks preoperatively where baseline measures were collected, instruction and demonstration on the use of the interventions were provided, and packets were distributed with assessments to be completed during their inpatient stay. Anxiety, stress and coping strategies were all measured at baseline, the day of surgery, and in the hospital on the last day of admission just prior to discharge. In addition, the patients level of reported pain each day following surgery while inpatient was appraised as well as the amount of pain medication needed and length of hospital admission. Results of the present study support continued use of biofeedback and imagery in medicine and demonstrated the enhanced benefit of combining interventions as proposed. The imagery intervention reduced anxiety and perceived pain among the patients. A reduction in state anxiety scores was observed from baseline measurement to the day of discharge and its patients experienced a significant (p < .01) reduction in pain on post-operative day 3 from days 1 and 2. The biofeedback intervention generated positive results on a number of variables evaluated. A steady decline in stress was observed among patients from baseline measurement through discharge from the hospital as well as the continued reduction in medication use from post-operative day 1 through day 3. Furthermore, participants in the biofeedback treatment reported a significant (p < .05) reduction in pain from post-operative day 2 to day 3 (p < .05). Combining both imagery and biofeedback to be used simultaneously as its own intervention elicited the most significant outcomes compared to all other treatment conditions in reducing stress and medication use. Only participants in the combo intervention experienced a significant (p < .001) reduction in stress from the day of surgery to the day of discharge and required significantly (p < .001) less medication administered through the pain pump than any other treatment condition (p < .01). Patients in the general standard of care intervention receiving education experienced a reduction in anxiety from the initial baseline measurement to day of discharge although it was minimal. Positive outcomes were observed for all interventions provided in the present study. Outcomes reflect those reported across much of the CAM research exploring the benefits of interventions such as guided imagery and biofeedback on health related outcomes (Blanchard et al., 1987; Gervitz, Hubbard, & Harpin, 1996; Scherwitz et al., 2005). While guided imagery and biofeedback yielded benefits for the variables evaluated as sole treatment approaches, current findings reflect the efficacy of a combined approach with greater significance. The benefits of patients in any complementary and alternative medical practice can only positively influence the overall experience and potential results. Continued development and evaluation of more multifaceted approaches are essential in order to provide an optimal level of care.