Abstract

Psychological factors, including pain catastrophizing, depression, and anxiety are factors that influence chronic pain and physical function after total knee  arthroplasty (TKA). Previous studies have shown that exercise and psychological interventions improve psychological factors. However, the level of evidence on the effect of the combined exercise and psychological interventions on psychological factors after TKA is unclear. The purpose of this study was to  determine whether the combined exercise and psychological interventions for patients who underwent TKA improves psychological factors compared to  exercise alone or psychological intervention alone, and to determine the quality of the evidence. Moreover, to identify interventions with a high level of  evidence that improve psychological factors in patients who underwent TKA. Randomized controlled trials (RCTs) were researched in PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database (PEDro), and Igaku Chuo Zasshi. The PEDro scale was  used for assessing the risk of bias. This study included seven RCTs. Combined exercise and cognitive behavioral therapy may be more effective than exercise intervention alone in improving pain catastrophizing in patients who underwent TKA. Additionally, combined exercise and auditory or visual intervention may be more effective than exercise intervention alone in improving depression in patients who underwent TKA.