Risk Stratification and Targeted Psychiatric Intervention in Orthopaedic Surgery: A Randomised Controlled Trial Examining Depression, Anxiety, Pain Catastrophizing, Fear-Avoidance, and Kinesiophobia as Modifiable Factors for Improved Surgical Outcomes
Rabhya Juneja1, Aditya Verma2*
1Department of Psychiatry, MM Institute of Medical Sciences and Research, Mullana, Ambala, India.
2Department of Orthopaedics, Whiston Hospital, MWL NHS Trust, United Kingdom.
*Corresponding Author: Aditya Verma, Department of Orthopaedics, Whiston Hospital, MWL NHS Trust, United Kingdom.
https://doi.org/10.58624/SVOAOR.2026.06.002
Received: December 22, 2025
Published: January 14, 2026
Citation: Juneja R, Verma A. Risk Stratification and Targeted Psychiatric Intervention in Orthopaedic Surgery: A Randomised Controlled Trial Examining Depression, Anxiety, Pain Catastrophizing, Fear-Avoidance, and Kinesiophobia as Modifiable Factors for Improved Surgical Outcomes. SVOA Orthopaedics 2026, 6:1, 11-19. doi: 10.58624/SVOAOR.2026.06.002
Abstract
Background: Depression, anxiety, and maladaptive pain-related cognitions predict poor outcomes following orthopaedic surgery. However, evidence for modifying these factors preoperatively through targeted psychiatric intervention remains limited.
Objective: To evaluate whether preoperative psychiatric intervention targeting depression, anxiety, pain catastrophizing, fear-avoidance beliefs, and kinesiophobia improves functional outcomes and reduces complications in high-risk orthopaedic patients.
Methods: Multicentre prospective randomised controlled trial across three orthopaedic centres. Patients (n=200) undergoing joint arthroplasty or spinal surgery were risk-stratified using baseline psychiatric screening. High-risk patients (elevated scores on ≥2 psychological measures) were randomised to targeted psychiatric intervention (8 sessions of cognitive-behavioural therapy, ≥60 days preoperatively) or standard care. Primary outcomes were functional disability (Oxford/Oswestry scores) at 6 months. Secondary outcomes included psychological metrics, pain, complications, and satisfaction.
Results: Intervention group (n=91) demonstrated significantly greater reductions in depression (mean difference: 2.23 points, 95% CI 1.12–3.34, p=0.001), anxiety (3.07 points, p<0.001), catastrophizing (5.90 points, p<0.001), and fear-avoidance (11.20 points, p<0.001) at 6 months compared to control (n=109). Functional disability improved more in intervention versus control groups (10.8-point difference, p<0.001). Pain scores were lower in the intervention group (1.48 points lower, p=0.002). Postoperative complications occurred in 15.4% of intervention versus 19.3% of control patients (p=0.38). Patient satisfaction was significantly higher in the intervention group (7.69 vs 6.30, p<0.001).
Conclusion: Targeted preoperative psychiatric intervention significantly improves psychological outcomes and functional recovery in high-risk orthopaedic patients. This approach represents a modifiable, cost-effective strategy to optimise surgical outcomes through addressing psychiatric risk factors.
Keywords: Orthopaedic Surgery, Depression, Anxiety, Pain Catastrophizing, Kinesiophobia, Cognitive-Behavioural Therapy, Randomised Controlled Trial, Psychiatric Intervention, Surgical Outcomes