Cognitive Behavioural Therapy to Optimize Post-Operative Fracture Recovery (COPE): a randomized controlled trial.
Jason W Busse, Randi E McCabe, Matilda Nowakowski et al.
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In 30 seconds
This multicentre randomized controlled trial tested whether app-based cognitive behavioural therapy (CBT) reduced persistent postsurgical pain in adults with operatively treated extremity fractures at 11 hospitals in the United States and Canada. Among 1009 participants, CBT did not reduce moderate-to-severe persistent pain over 12 months compared with usual care: 30.8% versus 30.3% (adjusted relative risk 1.02, 95% confidence interval 0.89 to 1.16). Fewer than half of those assigned to CBT completed all seven modules. Most secondary outcomes also did not differ significantly between groups.
Key findings
- Persistent postsurgical pain occurred in 30.8% with app-based CBT and 30.3% with usual care (adjusted relative risk 1.02, 95% confidence interval 0.89 to 1.16).
- Only 237/506 patients (46.8%) assigned to CBT completed all 7 modules.
- The 365-day probability of returning to leisure activities without restrictions was 29.0% with CBT and 22.4% with usual care (hazard ratio 1.33, 95% CI 1.00 to 1.77).
Why it matters
Persistent pain after fracture surgery is associated with long-term morbidity, making effective supportive interventions clinically important. In this trial, the app-based CBT program did not lower persistent pain risk, and adherence was modest. These findings help clarify that this particular delivery approach did not demonstrate the intended pain benefit, while leaving open whether other CBT formats or supportive interventions may be effective.
What to keep in mind
Adherence to the app-based program was modest, with fewer than half of participants completing all seven modules; the findings therefore concern this intervention and its uptake.