Perioperative Mindfulness Training Does Not Improve Sleep Quality in Patients Undergoing Total Knee Arthroplasty.
Jessica L H Phillips, Makenna R Hemmerle, Roseann M Johnson, Hayley E Ennis, Jason J Jennings
Arthroplasty today February 2026 DOI: 10.1016/j.artd.2025.101918 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 282 |
| Population | Patients undergoing primary unilateral total knee arthroplasty |
| Intervention | Mindfulness meditation |
| Dose | 15-minute mindfulness meditation video |
| Duration | Meditation sessions at the preoperative visit, the day before surgery, 3 days postoperatively, and 2 weeks postoperatively; follow-up at 2, 6, and 12 weeks |
| Measures | Pittsburgh Sleep Quality Index (PSQI) |
| Topics | Meditation |
| Keywords | Sleep Total knee arthroplasty |
| Key findings | Mindfulness meditation did not improve sleep quality after total knee arthroplasty at 2, 6, or 12 weeks; PSQI scores were similar across control, preoperative meditation, and perioperative meditation groups at every time point (for example, 10.7 vs 10.8 vs 9.9 at 2 weeks). Sleep worsened after surgery and returned to preoperative levels by 12 weeks. |
Abstract
Sleep quality declines in the immediate postoperative period following total knee arthroplasty (TKA). No prior study has prospectively analyzed the impact of mindfulness meditation (MM) on sleep quality following TKA. The purpose of this study was to determine whether MM administered in conjunction with TKA results in any improvement in Pittsburgh Sleep Quality Index (PSQI) at 2, 6, or 12 weeks postoperatively. Patients undergoing primary unilateral TKA were prospectively enrolled and randomized into 3 cohorts. The perioperative MM cohort received MM at the preoperative visit, the day preceding surgery, 3 days postoperatively, and 2 weeks postoperatively. The preoperative MM group only received MM at the preoperative visit. Controls received no MM. MM consisted of a video of 2 licensed professional psychologists guiding viewers through a 15-minute MM. Demographic data were collected and questionnaires completed at 2, 6, and 12 weeks postoperatively. Patients were excluded on the basis of prior alcohol/drug dependence and inability to present to in-person visits. An a priori analysis required 75 patients per cohort to achieve 80% power. Two hundred eighty-two patients were enrolled and randomized to 3 groups: control (n = 94), preoperative MM (n = 94), and perioperative MM (n = 94). There were no differences between cohorts in age (P = .24), sex (P = .77), body mass index (P = .18), American Society of Anesthesiologists (P = .17), or length of stay (P = .18). No differences between cohorts in preoperative PSQI scores were noted (8.4 ± 4.1 control, 7.9 ± 3.8 preoperative MM, 7.8 ± 4.3 perioperative MM; P = .58). Two weeks postoperatively, there remained no PSQI differences between groups (10.7 ± 4.3 control, 10.8 ± 4.4 preoperative MM, 9.9 ± 4.4 perioperative MM; P = .33). This persisted at 6 weeks (10.1 ± 4.2 control, 10.0 ± 3.9 preoperative MM, 9.5 ± 4.4 perioperative MM; P = .62). At 12 weeks, PSQI returned to preoperative levels and there remained no difference among cohorts (8.7 ± 4.4 control, 8.3 ± 4.2 preoperative MM, 7.8 ± 4.1 perioperative MM; P = .264). Mindfulness training did not improve postoperative sleep quality at any time point following TKA. Further studies are warranted, as improving sleep quality may enhance TKA rehabilitation. Therapeutic Level II.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cites 3
- The effect of mindfulness meditation on sleep quality: a systematic review and meta‐analysis of randomized controlled trials Annals of the New York Academy of Sciences December 21, 2018
- Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances JAMA Internal Medicine February 16, 2015
- Brief Mindfulness-Based Cognitive Behavioral Therapy is Associated with Faster Recovery in Patients Undergoing Total Knee Arthroplasty: A Pilot Clinical Trial. Pain Medicine June 1, 2023