Abstract / Summary
Lower extremity surgical procedures including total knee arthroplasty, total hip arthroplasty, anterior cruciate ligament reconstruction, and traumatic fracture fixation are associated with persistent postoperative pain, impaired function, and psychosocial barriers to recovery. This systematic review and meta-analysis evaluated the efficacy of psychologically informed physical therapy (PIPT) on clinical and self-reported outcomes in this population. By targeting the psychosocial barriers that persist alongside tissue healing, PIPT is potentially relevant to these procedures, in which pain catastrophizing, kinesiophobia, and low self-efficacy are common drivers of poor postoperative recovery. A PRISMA-compliant search of five databases identified randomized controlled trials published between 2000 and 2025. Seven RCTs (n = 944) met inclusion criteria. Methodological quality was assessed using the PEDro scale. Random-effects meta-analyses were conducted for the Oxford Knee Score (OKS), Pain Catastrophizing Scale (PCS), and Tampa Scale for Kinesiophobia-11 (TSK-11). Remaining outcomes were narratively synthesized. All meta-analyses were performed in RStudio (version 1.2.5001) using the meta package. PEDro scores ranged from 4 to 9. Meta-analysis demonstrated significant improvements favoring PIPT in knee function (OKS: SMD = 1.72; 95% CI 1.33–2.11; p < 0.0001; I 2 = 0%), pain catastrophizing (PCS: SMD = 2.46; 95% CI 0.69–4.24; p = 0.007; I 2 = 91%), and kinesiophobia (TSK-11: SMD = 1.56; 95% CI 0.56–2.57; p = 0.002; I 2 = 93.7%). Narrative synthesis demonstrated significant benefits in ACL-RSI, Lysholm score, Brief Resilience Scale, and Knee Self-Efficacy Scale. No between-group differences were observed for KOOS, PROMIS Physical Function, WOMAC, or pain intensity measures. PIPT significantly reduces pain catastrophizing and kinesiophobia, improves knee function and psychological readiness for return to sport, and enhances resilience and self-efficacy. Benefits are most consistent in structured, multi-session, face-to-face programs targeting psychosocially high-risk patients. Standardized protocols and adequately powered trials are needed. However, because these findings derive from a small number of heterogeneous trials of variable (fair-to-strong) methodological quality, they should be interpreted as preliminary, and definitive conclusions cannot yet be drawn.