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

Effects of Music Listening and Emotional Freedom Techniques on Fall Risk, Kinesiophobia, and Pain Following Knee Arthroscopy

This study aims to evaluate whether listening to music and using Emotional Freedom Techniques (EFT) can help patients recover better after knee arthroscopy. After this type of surgery, many patients experience pain, fear of movement (kinesiophobia), balance problems, and an increased risk of falling.

In this study, patients will receive music listening and EFT as supportive, non-drug interventions during the postoperative period. The goal is to determine whether these simple and safe methods can reduce pain, decrease fear of movement, and lower fall risk, ultimately improving recovery.

The findings of this study may help healthcare professionals, especially nurses, provide more holistic and patient-centered care after knee surgery.

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Pain; Knee Surgery; Arthroscopic Surgery; Kinesiophobia (Fear of Movement)
• Intervention / Treatment: Behavioral: listening music; Behavioral: Emotional Freedom Techniques

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 85
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: arzum çelik bekleviç; Phone Number: +90-545-292-21-61; Email: aezzum@gmail.com
• Study Contact Backup: Name: dilek aygin; Email: daygin@sakarya.edu.tr

Study Locations

• Turkey (Türkiye)
  • Zonguldak, Turkey (Türkiye), 67600
    • Zonguldak Bulent Ecevit University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged between 18 and 65 years
• Scheduled for elective knee arthroscopy
• Anxiety-fear intensity score ≥2 on the Subjective Units of Distress (SUD) scale
• No hearing or speech problems that would prevent communication
• No cognitive or mental impairments
• No psychiatric disorders
• No pain, tenderness, or wounds at the meridian points where Emotional Freedom Techniques (EFT) will be applied
• Have not received prior training in coping with anxiety or fear
• Have not previously attended courses related to energy therapy
• Agree to participate in the study

Exclusion Criteria:

• Currently using psychiatric medications
• Receiving active psychological therapy
• Experiencing postoperative surgical complications
• Having traumatic lower extremity fractures
• Undergoing simultaneous bilateral knee arthroscopy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm 1: Music Group Description; Participants will listen to relaxing music during the postoperative recovery period after knee arthroscopy. This intervention aims to reduce pain, anxiety, and kinesiophobia.	Behavioral: listening music; Participants will listen to any music of their choice during recovery sessions, guided by study personnel. Each session lasts approximately 30-35 minutes per sesession, during the preoperative and postoperative periods. This intervention is designed to alleviate pain, anxiety and fear of movement (kinesiphobia) associated with knee arthroscopy recovery.
Experimental: Arm 2: EFT Group; Participants will receive Emotional Freedom Techniques (EFT) during the postoperative recovery period after knee arthroscopy. The intervention focuses on reducing pain, anxiety, and fear of movement.	Behavioral: Emotional Freedom Techniques; EFT is a structured psychological relaxation technique applied during the preoperative and postoperative periods for patients undergoing knee arthroscopy. Participants tap on specific acupressure points while focusing on their pain or anxiety, guided by a trained practitioner. Each session consists of at least 3 consecutive repetitions and lasts approximately 30-35 minutes. The intervention aims to reduce pain, anxiety, and fear of movement (kinesiophobia) associated with the surgical recovery process.; Other Names: EFT
No Intervention: Arm 3: Control Group; Participants will receive standard postoperative care without additional interventions. This group serves as a baseline to compare the effects of music listening and EFT.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in postoperative pain after knee arthroscopy with perioperative Music Listening and EFT interventions (measured by VAS)	The perioperative effects of listening to music and Emotional Freedom Techniques (EFT) on postoperative pain, kinesiophobia (fear of movement), and the risk of falling in patients who have undergone knee arthroscopy will be evaluated. - For pain, the measurement tool used is the Visual Analogue Scale (VAS) pain scale (0 indicates no pain; 10 indicates unbearable severe pain);	Preoperative, Postoperative Day 1, Postoperative Day 3

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in fall risk after knee arthroscopy (ITAKI FALL RISK SCALE)	For fall risk, the Itaki Fall Risk Scale (scores below 5 indicate low risk; scores above 5 indicate high risk) will be used. Fall risk will be determined using the ITAKI Fall Risk Scale, a reliable measurement method validated in Turkey; multidimensional risk factors such as age, level of consciousness, history of falls, mobility and balance, visual status, medication use, neurological and orthopedic issues, toileting needs, and environmental factors will be taken into account. Patients will undergo a risk assessment using this scale on the day of surgery. After the music listening intervention is administered to the music listening group, the postoperative risk status will be evaluated. The situation is similar for the EFT group. The patient's fall risk will be determined during the preoperative period, and the effect of EFT on fall risk during the postoperative period will be evaluated using the scale.	Preoperative, Postoperative Day 1, Postoperative Day 3

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Additional Postoperative Outcomes: Kinesiophobia	For kinesophobia, the Tampa Kinesophobia Scale (scores range from 17 to 68, with higher scores indicating greater kinesophobia); EFT and music listening will be compared to a control group in patients undergoing knee arthroscopy surgery who have been randomly assigned to either the music listening or EFT group. In addition to pain and risk of falling, patients' fear of movement will be measured using the TAMPA KINESIOPHOBIA SCALE. The scale consists of 17 items. The possible score range is 17-68. A high score will be interpreted as indicating a fear of movement. The aim of this study is to evaluate the effect of EFT and music listening on fear of movement.	Postoperative Day 1 - Postoperative Day 3

Collaborators and Investigators

• Sponsor: Arzum ÇELİK BEKLEVİÇ
• Investigators: Study Chair: Dilek AYGİN, Professor, Sakarya University

Study record dates

Study Major Dates

• Study Start (Estimated): March 30, 2026
• Primary Completion (Estimated): December 25, 2026
• Study Completion (Estimated): January 28, 2027

Study Registration Dates

• First Submitted: March 27, 2026
• First Submitted That Met QC Criteria: April 10, 2026
• First Posted (Actual): April 15, 2026

Study Record Updates

• Last Update Posted (Actual): April 15, 2026
• Last Update Submitted That Met QC Criteria: April 10, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: knee surgery; postoperative pain; arthroscopy; kinesiophobia; listening to music; Emotional Freedom Techniques
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Mental Disorders; Postoperative Complications; Pathologic Processes; Phobic Disorders; Anxiety Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Kinesiophobia; Pain, Postoperative
• Other Study ID Numbers: 2025-85

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: All individual participant data collected during the trial, including pain scores, kinesiophobia scores, anxiety, and hospital stay duration, will not be shared publicly due to privacy concerns. Decisions regarding future sharing of de-identified data have not yet been finalized

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No