First Use of a Brief 60-second Mindfulness Exercise in an Orthopedic Surgical Practice; Results from a Pilot Study

Document Type : RESEARCH PAPER


1 Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

2 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital/ Harvard Medical School, Boston, MA , USA

3 Dell Medical School, University of Texas at Austin, Austin, TX, USA

4 Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA


Background: Mindfulness based interventions may be useful for patients with musculoskeletal conditions in orthopedic surgical practices as adjuncts to medical procedures or alternatives to pain medications. However, typical mindfulness programs are lengthy and impractical in busy surgical practices. We tested the feasibility, acceptability and preliminary effect of a brief, 60-second mindfulness video in reducing pain and negative emotions in patients presenting to an orthopedics surgical practice. Methods: This was an open pilot study. Twenty participants completed the Numerical Rating Scale to assess pain intensity, the State Anxiety subscale of the State Trait Anxiety Scale to assess state anxiety, and emotional thermometers to assess distress, anxiety, anger and depression immediately prior to and following the mindfulness video exercise. At the end of the exercise patients also answered three questions assessing satisfaction with the mindfulness video. Results: Feasibility of the mindfulness video was high (100%). Usefulness, satisfaction and usability were also high. Participants showed improvements in state anxiety, pain intensity, distress, anxiety, depression and anger after watching the video. These changes were both statistically significant and clinically meaningful, when such information was available. Conclusion: People with musculoskeletal pain seeking orthopedic care seem receptive and interested in brief mindfulness exercises that enhance comfort and calm.


Main Subjects

1. Veehof MM, Oskam M-J, Schreurs KMG, Bohlmeijer ET.
Acceptance-based interventions for the treatment of
chronic pain: A systematic review and meta-analysis.
Pain. 2011; 152(3):533–42.
2. Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs
KM. Acceptance- and mindfulness-based interventions
for the treatment of chronic pain: A meta-analytic
review. Cogn Behav Ther. 2016; 45(1):5-31.
3. Lauche R, Cramer H, Dobos G, Langhorst J, Schmidt S. A
systematic review and meta-analysis of mindfulnessbased
stress reduction for the fibromyalgia syndrome.
J Psychosom Res. 2013; 75(6):500-10.
4. Draucker CB, Jacobson AF, Umberger WA, Myerscough
RP, Sanata JD. Acceptability of a guided imagery
intervention for persons undergoing a total knee
replacement. Orthop Nurs. 2015; 34(6):356-64.
5. Park ER, Traeger L, Vranceanu AM, Scult M, Lerner
JA, Benson H, et al. The development of a patientcentered
program based on the relaxation response:
the relaxation response resiliency program (3RP).
Psychosomatics. 2013; 54(2):165-74.
6. Kabat-Zinn J, Hanh TN. Full catastrophy living: using
the wisdom of your body and mind to face stress, pain
and illness. New York: Delta; 1990.
7. Hayes SC, Strosahl KD, Wilson KG. Acceptance and
commitment therapy. New York: Guilford Press; 1999.
8. Beard C, Stason WB, Wang Q, Manola J, Dean-Clower
E, Dusek JA, et al. Effects of complementary therapies
on clinical outcomes in patients being treated with
radiation therapy for prostate cancer. Cancer. 2011;
9. Soo MS, Jarosz JA, Wren AA, Soo AE, Mowery YM,
Johnson KS, et al. Imaging-guided core-needle breast
biopsy: impact of meditation and music interventions
on patient anxiety, pain, and fatigue. J Am Coll Radiol.
2016; 13(5):526-34.
10. Park ER, Traeger L, Willett J, Gerade B, Webster
A, Rastegar S, et al. A relaxation response training
for women undergoing breast biopsy: Exploring
integrated care. Breast. 2013; 22(5):799-805.
11. Jacobson AF, Umberger WA, Palmieri PA, Alexander
TS, Myerscough RP, Draucker CB, et al. Guided
imagery for total knee replacement. A randomized,
placebo-controlled pilot study. J Altern Complement
Med. 2016; 22(7):563-75.
12. Zqierska AE, Burzinski CA, Cox J, Kloke J, Stegner A,
Cook DB, et al. Mindfulness and cognitive behavioral
therapy intervention reduces pain severity and
sensitivity in opioid-treated chronic low back pain:
Pilot findings from a randomized controlled trial. Pain
Med. 2016; 17(10):1865-81
13. Rounsaville BJ, Carroll KM, Onken LS. A stage model
of behavioral therapies research: getting started and
moving on from stage I. Clin Psycho. 2001; 8(2):133-42.
14. Wewers ME, Lowe NK. A critical review of visual
analogue scales in the measurement of clinical
phenomena. Res Nurs Health. 1990; 13(4):227-36.
15. Spielberger CD. Manual for the State-Trait Anxiety
Inventory (Form Y). Palo Alto, CA: Consulting
Psychologists Press, 1983.
16. Mitchell AJ. Pooled results from 38 analyses of the
accuracy of distress thermometer and other ultrashort
methods of detecting cancer-related mood
disorders. J Clin Oncol. 2007; 25(29):4670–81.
17. Rampling J, Mitchell AJ, Von Oertzen T, Docker J, Jackson
J, Cock H, et al. Screening for depression in epilepsy
clinics: A comparison of conventional and visualanalog
methods. Epilepsia. 2012; 53(10):1713-21.
18. Julian LJ. Measures of anxiety: state-trait anxiety
anventory (stai), beck anxiety inventory (bai),
and hospital anxiety and depression scale-anxiety
(hads-a). Arthritis Care Res (Hoboken). 2011;
63(Suppl 11):S467-72.
19. Knight RG, Waal-Manning HJ, Spears GF. Some norms
and reliability data for the State--Trait Anxiety
Inventory and the Zung Self-Rating Depression scale.
Br J Clin Psychol. 1983; 22(Pt 4):245-9.
20. Bijur PE, Latimer CT, Gallagher EJ. Validation of a
verbally administered numerical rating scale of acute
pain for use in the emergency department. Acad
Emerg Med. 2003; 10(4):390-2.
21. Childs JD, Piva SR, Fritz JM. Responsiveness of the
numeric pain rating scale in patients with low back
pain. Spine (Phila Pa 1976). 2005; 30(11):1331–4.
22. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP.
Validity of four pain intensity rating scales. Pain.
2011; 152(10):2399–404.
23. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole
RM. Clinical importance of changes in chronic pain
intensity measured on an 11-point numerical pain
rating scale. Pain. 2001; 94(2):149–58.
24. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi
W. Minimal clinically important changes in chronic
musculoskeletal pain intensity measured on a
numerical rating scale. Eur J Pain. 2004; 8(4):283-91.
25. 25. Beck KR, Tan SM, Lum SS, Lim LE, Krishna LK.
Validation of the emotion thermometers and hospital
anxiety and depression scales in Singapore: Screening
cancer patients for distress, anxiety and depression.
Asia Pac J Clin Oncol. 2016; 12(2):241-9.
26. Singh M, Kohler L, Davies J. The effect of using guided
mental imagery for patients receiving knee or hip
replacement. J Patient-Centered Res Rev. 2014; 1:51.
27. Park ER, Traeger L, Willett J, Gerade B, Webster
A, Rastegar S, et al. A relaxation response training
for women undergoing breast biopsy: Exploring
integrated care. Breast. 2013; 22(5):799-805.