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

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