Effects of Music Listening and Relaxation Interventions on Postoperative Recovery After Knee Surgery

Arthroscopy is a method used in orthopedics for diagnostic and therapeutic purposes by entering the joint through an endoscopic technique to obtain visualization. Knee arthroscopy (KA) is one of the most commonly performed surgical procedures worldwide. Although it is most frequently preferred for the repair of meniscal tears, it is also used to relieve pain, improve knee function, and delay total knee arthroplasty in patients with anterior and posterior cruciate ligament injuries, cartilage lesions, synovial pathologies, knee locking (inability to fully extend or flex the knee), patellar problems, infections, and osteoarthritis (OA).

Knee joint diseases lead to cartilage loss due to intra-articular degenerative changes, resulting in severe pain. In particular, cartilage loss caused by osteoarthritis leads to joint instability and functional impairment along with pain. Therefore, knee arthroscopy is often considered a first-line option before prosthetic surgery in patients with knee osteoarthritis, depending on the degree of degeneration.

Approximately 20% of patients report experiencing moderate to severe pain even one year after knee surgery. Although knee arthroscopy is a minimally invasive surgical technique, the literature indicates that a significant proportion of patients experience varying levels of postoperative pain, and opioid use is frequently preferred. Studies examining pain-related factors in patients undergoing arthroscopic surgery have shown that preoperative pain experience, duration of tourniquet use during surgery, and the complexity of the procedure are associated with increased postoperative pain.

Uncontrolled postoperative pain can trigger physiological stress and may lead to chronic pain. The response to pain is influenced by an interaction of emotional and cognitive factors. Therefore, in addition to surgical techniques and comorbidities, psychological factors play a crucial role in the recovery of patients undergoing knee surgery.

When patients experience pain, they generally respond in two ways:

1. confronting pain, leading to reduced fear and a return to normal activities, or
2. avoiding pain due to fear, resulting in increased pain and withdrawal from movement.

Patients who are unable to confront pain often develop a "fear-avoidance" model, in which they avoid movement due to the expectation of pain. As a result, avoidance of movement-considered a conservative coping strategy-leads to fear of exercise and reduced adherence to rehabilitation, negatively affecting postoperative recovery. However, postoperative exercise and rehabilitation play a critical role in improving knee function and reducing disability after knee arthroscopy.

Based on this, introduced the term "kinesiophobia," defined as an excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or re-injury. Kinesiophobia is defined as avoidance of physical activity due to pain-related fear. Patients undergoing knee surgery may develop kinesiophobia due to pain and balance loss, which can lead to disability characterized by cognitive and physical performance impairments. Studies have shown that kinesiophobia leads to movement restriction in patients undergoing knee surgery. Consequently, patients may enter a cycle of avoiding exercise due to pain, experiencing chronic pain due to inactivity, and delayed recovery.

A thesis study conducted in Türkiye evaluating pain, fall risk, and kinesiophobia in patients undergoing knee surgery reported a positive correlation between kinesiophobia and fall risk. Additionally, a study evaluating balance functions in patients undergoing arthroscopic meniscectomy due to anterior cruciate ligament reconstruction found that patients were at risk of falling for 3-6 months postoperatively.

In light of this information, postoperative pain, fall risk, and fear of movement are thought to delay recovery in patients undergoing knee surgery. Therefore, the use of non-pharmacological methods aimed at reducing pain and anxiety may accelerate recovery. In the literature, music listening and Emotional Freedom Techniques (EFT) are among the interventions used to reduce postoperative pain and anxiety.

Numerous studies have shown that listening to relaxing music has positive effects on pain reduction after surgery. For example, one study reported that allowing participants to listen to music of their choice significantly reduced pain levels regardless of the music type. Similarly, another study found that individuals with chronic pain experienced reduced pain perception through music listening. A study in the literature examining patients undergoing bypass surgery reported that music helped reduce perceived pain intensity.

Among various methods used for pain reduction, Emotional Freedom Techniques have also been highlighted. This method has been reported to reduce cognitive effects such as fear, pain, anxiety, and sleep disturbances. In patients scheduled for laparoscopic cholecystectomy, preoperative EFT was found to have positive effects on surgical fear. A systematic review including 16 studies on complementary methods (aromatherapy, acupressure, massage, EFT, and music therapy) used to control preoperative anxiety reported that EFT was effective in reducing anxiety and fear, although further research is needed. In another study evaluating patients undergoing knee arthroplasty over a 3-6 month follow-up period, EFT was associated with short-term improvements and reduced pain levels.

Although there are numerous studies on the effects of EFT on anxiety and fear, research specifically focusing on pain, fall risk, and fear of movement after knee surgery remains limited.

Accordingly, this study was designed to evaluate the effects of music listening and Emotional Freedom Techniques on postoperative pain and fear of movement in patients undergoing knee arthroscopy.