Abstract
Postoperative rehabilitation is essential for orthopedic patients to restore physical function (PF), relieve pain, and improve overall quality of life. This study explores the effects of integrating acupuncture and massage therapy into postoperative care for orthopedic surgery patients, aiming to evaluate its impact on recovery outcomes and psychological well-being. A retrospective cohort analysis was conducted involving 110 patients who underwent orthopedic surgery between January 2023 and June 2024. Based on differences in their rehabilitation methods, participants were grouped into 2 categories: one receiving standard rehabilitation care (n = 54) and the other receiving a combination of acupuncture and massage therapy alongside routine rehabilitation (n = 56). Recovery indicators such as duration of hospital stay, joint stiffness, and chronic pain were compared between the 2 groups. Functional and psychological outcomes were assessed using the SF-36 health survey, Barthel index (BI), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) at both 1 week and 1 month after surgery. The group treated with acupuncture and massage demonstrated significantly enhanced postoperative recovery. Their average hospital stay was shorter (6.18 ± 2.11 days) compared to the conventional group (7.23 ± 2.31 days, P = .015). Furthermore, the incidence of joint stiffness (3.6% vs 16.7%, P = .035) and chronic pain (7.1% vs 22.2%, P = .045) was notably reduced. Assessments using the SF-36 and BI showed greater improvements in quality of life and daily functioning at both evaluation points (P < .05). Additionally, the acupuncture and massage group exhibited significantly lower levels of anxiety and depression 1 month post-surgery (P < .05). Incorporating acupuncture and massage therapy into postoperative rehabilitation for orthopedic patients can yield meaningful benefits in terms of faster recovery, improved joint function, reduced pain, and enhanced psychological health. These findings support the clinical value of integrative approaches in orthopedic postoperative care.
Keywords: acupuncture, massage therapy, mental health, orthopedic surgery, postoperative recovery, quality of life
1. Introduction
Orthopedic surgery is a widely used treatment for bone and joint disorders, including traumatic fractures, joint replacements, and spinal surgeries. These procedures are effective in alleviating orthopedic symptoms, enhancing patients’ quality of life, and restoring normal body functions. As the global population ages and sports injuries increase, the demand for orthopedic surgeries continues to rise each year.[1] However, while surgery effectively addresses the primary orthopedic issue, the postoperative rehabilitation process often involves pain, functional impairment, and a significant decline in quality of life, causing both physical and psychological distress to patients.[2] Post-surgical challenges such as pain management, delayed recovery of motor function, and restricted activities not only impact daily life but also adversely affect mental health (MH).[3] Consequently, improving postoperative rehabilitation, reducing pain, and enhancing quality of life have become critical areas of focus in contemporary orthopedic research.
Traditional rehabilitation methods, including physical therapy, medication, and physiotherapy, can aid in recovery to some extent, but they have notable limitations. For instance, medications may cause side effects, physiotherapy can be effective yet difficult for patients to maintain over the long term, and most of these approaches primarily address symptoms rather than underlying pathological issues.[4] Consequently, identifying and developing new treatments that offer a more comprehensive and effective postoperative rehabilitation strategy has become a key focus in clinical medical research.
Recently, the use of acupuncture and massage, traditional Chinese medicine treatments, in orthopedic postoperative rehabilitation has garnered increasing attention. Numerous clinical and experimental studies have demonstrated that these therapies significantly enhance postoperative recovery, alleviate pain, improve functional outcomes, and boost quality of life across multiple dimensions.[5] Acupuncture and massage enhance local blood circulation, reduce muscle stiffness, alleviate pain, and promote functional recovery by regulating the body’s qi, blood, and meridians. As a result, they have increasingly become essential adjuncts to postoperative rehabilitation in orthopedic patients.[6]
Acupuncture and moxibustion are traditionally understood to regulate the flow of qi and blood, unblock meridians, and restore balance between yin and yang. From a modern medical perspective, acupuncture stimulates specific points on the body, which can modulate the neuroendocrine system, enhance microcirculation, and increase the release of endogenous pain-relieving substances such as endorphins. These physiological changes help alleviate pain, reduce inflammation, and promote faster healing by improving blood flow to the affected areas.[7] In postoperative orthopedic rehabilitation, acupuncture not only reduces pain and promotes muscle relaxation and joint mobility but also accelerates soft tissue healing and improves functional recovery.[8] For instance, studies have demonstrated that acupuncture significantly alleviates pain and enhances joint mobility in joint replacement patients, effectively reducing postoperative complications and improving quality of life.[9] Moreover, acupuncture’s analgesic effects are crucial for managing both acute and chronic postoperative pain, reducing patients’ reliance on medications and minimizing the risk of drug side effects.[10]
Massage therapy, a traditional manipulation technique, is thought to regulate the flow of qi and blood, relax muscles, and relieve pain. Modern studies suggest that massage improves blood circulation and lymphatic drainage, reduces muscle tension, and enhances joint mobility. It also helps to reduce postoperative swelling by promoting the movement of fluids in the body, and regulates muscle tone, which contributes to improved functional recovery.[11] Particularly in the rehabilitation following spinal and joint replacement surgeries, massage can significantly aid in restoring joint mobility, relieving muscle spasms, reducing edema, and enhancing functional recovery.[12] Studies have shown that massage facilitates joint flexibility and function by loosening soft tissue adhesions around the joints, providing considerable therapeutic value in reducing pain and promoting motor function recovery, especially in the early postoperative stages.[13] Furthermore, massage contributes to both physical and mental relaxation, alleviates negative emotions like anxiety and depression, and enhances psychological well-being, thereby improving overall postoperative rehabilitation outcomes.[14]
Although acupuncture and massage have demonstrated some effectiveness in postoperative orthopedic rehabilitation, current studies still have notable limitations. Most existing research primarily evaluates the impact of single treatment modalities, often with small sample sizes and a lack of large-scale, high-quality randomized controlled trials. However, many high-quality studies have already explored the role of acupuncture and massage in postoperative rehabilitation. Compared to these studies, our research provides additional insights into the combined effects of acupuncture and massage therapy across different types of orthopedic surgeries. While previous studies often focus on individual therapies or specific patient populations, this study evaluates the synergistic benefits of combining acupuncture and massage in a broader range of orthopedic patients, offering potentially more generalized insights for clinical practice. Additionally, many studies focus on specific disease types or patient groups, with limited comprehensive comparisons of treatment outcomes across various orthopedic surgery patients (e.g., joint replacement, traumatic fractures). While there may be variations in the effectiveness of acupuncture and massage for different types of postoperative orthopedic patients, this has not been thoroughly explored. Furthermore, the combined effect of acupuncture and massage has not been sufficiently evaluated, with most studies concentrating on individual treatments and failing to fully explore the potential synergistic benefits of combined therapies.
Moreover, the treatment protocols, timing, and duration of acupuncture and massage have yet to be standardized. Current studies lack a thorough analysis of patients’ individualized needs, with limited exploration of treatment timing and adjustments during the course of therapy. Therefore, further multicenter, large-sample studies are essential to systematically assess the effects of combined acupuncture and massage therapy following various types of orthopedic surgery.
The aim of this study is to evaluate the effect of combined acupuncture and massage. This study aims to evaluate the impact of combined acupuncture and massage therapy on functional recovery and quality of life in postoperative orthopedic patients through a retrospective cohort analysis. Specifically, it will assess the effects of this combined treatment across multiple dimensions, including pain relief, joint mobility restoration, muscle strength enhancement, quality of life, and psychological well-being. The innovation of this study lies in its first-time systematic review of combined acupuncture and massage therapies across various orthopedic surgeries, exploring the differences in their effects among different patient populations. Through this research, we aim to provide a scientific foundation for the rehabilitation of postoperative orthopedic patients, promote the clinical application of acupuncture and massage, and offer theoretical support for the development of individualized treatment plans.
2. Methodology and analyses
2.1. Study design
This study was approved by the Ethics Committee of Changzhou Hospital of Traditional Chinese Medicine, approval number 20243-0812-k254. This study employed a retrospective cohort design to evaluate the effects of acupuncture and massage treatments on postoperative functional recovery and quality of life. Data were collected from patients who underwent surgery in the Department of Orthopaedics at our hospital between January 2023 and June 2024. The study was reviewed and approved by the Ethics Committee of our hospital, and all patient data were anonymized to protect confidentiality and ensure participant privacy.
2.2. Study subjects
2.2.1. Inclusion criteria
Aged between 18 and 80 years, and undergoing orthopedic surgical treatment;
Patients who were followed for at least 3 months post-surgery, with complete electronic medical records and relevant assessment data;
Surgical procedures include common orthopedic surgeries such as hip replacement, knee replacement, and lower limb fracture repair;
The affected area is a unilateral lower limb;
Patients in good preoperative health, excluding those with severe systemic conditions such as advanced heart disease, renal failure, or malignant tumors.
2.2.2. Exclusion criteria
Patients with <3 months of postoperative follow-up;
Patients with missing follow-up data or those unable to provide valid information;
Patients with multiple fractures, upper limb fractures, or bilateral lower limb fractures;
Patients with severe preoperative limb deformities, muscle atrophy, or other conditions that may affect postoperative rehabilitation;
Patients with mental disorders or those with impaired self-reporting ability.
2.3. Treatment methods
2.3.1. Acupuncture and massage group
Patients began receiving acupuncture and massage treatments on the first day after surgery, with a total treatment duration of 8 weeks. The treatments were administered by experienced acupuncturists and massage practitioners, with the treatment plan tailored to each patient’s postoperative recovery needs.
Acupuncture treatment: Acupuncture sessions were conducted 3 times a week, starting on the first day after surgery, with each session lasting 30 minutes. Acupuncture points were selected based on the patient’s surgical site and symptoms. Commonly used points included Ahshi, Knee Eye, Guanyuan, Huizhong, and Foot Sanli, aimed at improving local blood circulation, alleviating postoperative pain, and promoting recovery. Millimeter needles were used, with needling depth adjusted according to the patient’s constitution and tolerance. Needle retention lasted 20 to 30 minutes, and electro-acupuncture was applied when necessary.
Massage therapy: Starting on the first day after surgery, massage therapy was performed 3 times a week, with each session lasting 40 minutes. The techniques applied, including pushing, holding, pressing, moistening, and pinching, were tailored to each patient’s individual needs. These techniques aimed to alleviate postoperative muscle tension, enhance blood circulation, promote lymphatic drainage, reduce swelling, and restore joint mobility and muscle strength. The focus was primarily on the affected limbs, including the muscles and soft tissues around the joints.
Patients in this group received conventional rehabilitation therapy in addition to acupuncture and massage. Throughout the treatment, the duration and intensity of acupuncture and massage were adjusted based on the patient’s feedback and tolerance, ensuring both safety and effectiveness.
2.3.2. Conventional rehabilitation group
Patients received treatment based on the conventional orthopedic postoperative rehabilitation program, which primarily included physical therapy, functional training, and medication. Starting on the first day after surgery, physical therapy sessions were held twice a week, each lasting 30 minutes. These treatments included low-frequency electrotherapy and hot/cold compresses to reduce postoperative pain and swelling. As the patient’s recovery progressed, the intensity of physiotherapy was gradually increased to improve blood circulation and alleviate discomfort. Medications such as pain relievers, anti-inflammatory drugs, and muscle relaxants were administered based on the patient’s symptoms to manage pain, inflammation, and muscle spasms. From the first day post-surgery, rehabilitation physicians guided patients through joint mobility exercises and muscle strength recovery training. Initially, training focused on joint flexion and extension, gradually increasing the intensity and volume of exercises to restore joint mobility and muscle strength. As recovery advanced, weight-bearing and gait training were incorporated to help patients resume normal daily activities as soon as possible.
Patient adherence to acupuncture and massage therapy was monitored through regular follow-up visits, where patients were asked about their compliance with the prescribed treatment regimen. Additionally, the number of treatment sessions attended by each patient was recorded, and any deviations from the prescribed treatment plan were documented and taken into account in the analysis.
2.4. Data sources
The data for this study were primarily collected from the hospital’s electronic medical records, nursing records, and patient-completed assessment scales. To ensure data reliability and maintain patient confidentiality, all information was de-identified.
2.5. Study variables
Independent variables: Postoperative patients received either acupuncture and massage therapy or conventional rehabilitation.
Dependent variables: Postoperative recovery, including time to first stand and walk after surgery, time to hospital discharge, postoperative short- and long-term complications, pain (measured by the VAS scale), swelling of the affected limb (graded from 0 to 3), and muscle strength (graded 1–5). Swelling severity is classified as: Grade 0 – no swelling or minimal swelling without discomfort; Grade 1 – minor localized swelling without significant dysfunction or tenderness; Grade 2 – noticeable swelling with partial movement limitation, mild tenderness, or discomfort; Grade 3 – severe swelling with significant functional impairment, possibly accompanied by skin tightness, rupture, or ulceration. Quality of life, assessed using the SF-36 brief health status questionnaire, which evaluates physical function (PF), role function limitations (RP), body pain (BP), general health (GH), vitality (VT), social functioning (SF), emotional role restrictions (RE), and MH. Barthel index (BI) for activities of daily living. MH indicators, including scores from the self-rating anxiety scale (SAS) and self-rating depression scale (SDS).
2.6. Methods of statistical analysis
Data analysis was conducted using SPSS statistical software (version 26.0). The process involved the following steps:
Descriptive statistics were applied to summarize the basic characteristics of the patients (e.g., age, gender), presented as mean ± standard deviation (mean ± SD) or as frequency (n) and percentage (%).
Between-group comparisons: For continuous variables (e.g., age, BMI), an independent samples t-test was used to assess differences between the 2 groups. For categorical variables (e.g., gender, comorbidities), a chi-square test (χ2 test) was employed to analyze differences. The Mann–Whitney U-test was used for non-parametric comparisons of non-normally distributed data.
Significance level: A P-value of <.05 was considered statistically significant.
3. Results
3.1. Baseline characteristics
A total of 110 orthopedic surgery patients were included in this study and randomly assigned to either the acupuncture and acupressure group (n = 56) or the conventional rehabilitation group (n = 54). There were no significant differences between the 2 groups in terms of age, gender, BMI, comorbidities, smoking, alcohol consumption, disease type, surgery type, or surgery duration (P > .05), ensuring baseline comparability. For further details, refer to Table 1.
Table 1.
Basic information of patients (x ± s, n/%).
| Acupuncture and massage (n = 56) | Routine rehabilitation (n = 54) | t/χ2 | P-value | |
|---|---|---|---|---|
| Age | 50.69 ± 16.83 | 52.33 ± 15.97 | 0.52 | .60 |
| Sex | ||||
| Male | 25 (44.6%) | 27 (50%) | 0.49 | .63 |
| Female | 31 (55.4%) | 27 (50%) | ||
| BMI | 22.34 ± 4.11 | 21.94 ± 4.45 | 0.49 | .63 |
| Complication | ||||
| Diabetes | 6 (10.7%) | 5 (9.3%) | 0.68 | .92 |
| Hypertension | 14 (25%) | 11 (20.4%) | ||
| Coronary heart disease | 8 (14.3%) | 5 (9.3%) | ||
| COPD | 3 (5.4%) | 4 (7.4%) | ||
| Other | 8 (14.3%) | 12 (22.2%) | ||
| None | 17 (30.4%) | 17 (31.5%) | ||
| Smoking | ||||
| Yes | 22 (39.3%) | 25 (46.3%) | 2.95 | .40 |
| No | 34 (60.7%) | 29 (53.7%) | ||
| Drink alcohol | ||||
| Yes | 27 (48.2%) | 29 (53.7%) | 0.40 | .94 |
| No | 29 (51.8%) | 25 (46.3%) | ||
| Type of disease | ||||
| Hip/knee arthritis | 8 (14.3%) | 9 (16.7%) | 0.05 | .98 |
| Open fractures | 15 (26.8%) | 12 (22.2%) | ||
| Closed fractures | 31 (55.4%) | 32 (59.3%) | ||
| Tumors | 2 (3.6%) | 1 (1.9%) | ||
| Type of surgery | ||||
| Joint replacement | 11 (19.6%) | 13 (24.1%) | 0.08 | .097 |
| Fracture reduction and internal fixation | 25 (44.6%) | 18 (33.3%) | ||
| Closed reduction and internal fixation of fracture | 7 (12.5%) | 9 (16.7%) | ||
| Fracture external fixation | 13 (23.2%) | 14 (25.9%) | ||
| Length of surgery | 2.78 ± 1.21 | 2.98 ± 1.37 | 0.81 | .42 |
BMI = body mass index, COPD = chronic obstructive pulmonary disease.
3.2. Postoperative recovery
No significant differences in postoperative pain, limb swelling, or muscle strength were observed between the acupuncture and massage group and the conventional rehabilitation group during the first 3 days after surgery. However, by the end of the first week postoperatively, patients in the acupuncture and massage group showed better recovery in all 3 aspects compared to those in the conventional rehabilitation group. While there was no significant difference in early postoperative activity times between the 2 groups, a statistically significant difference was observed in time to discharge. Patients in the acupuncture and massage group (6.18 ± 2.11 days) were discharged earlier than those in the conventional rehabilitation group (7.23 ± 2.31 days). Regarding short-term complications, no significant differences were found in the incidence of lower extremity venous thrombosis, pneumonia, wound infection, or sleep disorders between the 2 groups. In terms of long-term complications, the rates of joint stiffness (16.7%) and chronic pain (22.2%) were significantly higher in the conventional rehabilitation group compared to the acupuncture and massage group (3.6% and 7.1%, respectively). No significant differences were observed in the incidence of bone atrophy or muscle atrophy between the 2 groups. For more details, refer to Tables 2 and 3.
Table 2.
Postoperative recovery1.
| The day after surgery | 3 d after surgery | 1 wk after surgery | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Acupuncture and massage | Routine rehabilitation | t/χ2 | P-value | Acupuncture and massage | Routine rehabilitation | t/χ2 | P-value | Acupuncture and massage | Routine rehabilitation | t/χ2 | P-value | ||
| Soreness | 7.81 ± 1.11 | 7.69 ± 1.25 | 0.53 | .60 | 6.23 ± 2.02 | 6.47 ± 2.28 | 0.58 | .56 | 4.33 ± 2.55 | 5.32 ± 2.18 | 2.19 | .031 | |
| Internal bruising | |||||||||||||
| Level 0 | 0 | 0 | 0.003 | .95 | 0 | 0 | 0.46 | .79 | 7 | 2 | 9.8 | .02 | |
| Level 1 | 0 | 0 | 5 | 7 | 22 | 11 | |||||||
| Level 2 | 36 | 35 | 35 | 32 | 23 | 32 | |||||||
| Level 3 | 20 | 19 | 16 | 15 | 4 | 9 | |||||||
| Muscle power | |||||||||||||
| Level 1 | 8 | 9 | 0.27 | .97 | 2 | 5 | 5.26 | .26 | 0 | 1 | 10.93 | .027 | |
| Level 2 | 11 | 9 | 4 | 9 | 2 | 5 | |||||||
| Level 3 | 25 | 25 | 31 | 27 | 9 | 19 | |||||||
| Level 4 | 12 | 11 | 18 | 13 | 33 | 25 | |||||||
| Level 5 | 0 | 0 | 1 | 0 | 12 | 4 | |||||||
Table 3.
Postoperative recovery2.
| Acupuncture and massagen (n = 56) | Routine rehabilitation (n = 54) | t/χ2 | P-value | |
|---|---|---|---|---|
| First postoperative walking time (hr) | 25.63 ± 6.24 | 26.18 ± 6.53 | 0.45 | .65 |
| First postoperative walking time (hr) | 46.51 ± 8.21 | 48.68 ± 8.92 | 1.33 | .18 |
| Time to discharge from hospital (d) | 6.18 ± 2.11 | 7.23 ± 2.31 | 2.48 | .015 |
| Postoperative complications (short-term) | ||||
| Lower extremity venous thrombosis | 7 (12.5%) | 13 (24.1%) | 1.8 | .18 |
| Pneumonia | 3 (5.4%) | 5 (9.3%) | 0.5 | .48 |
| Wound infection | 3 (5.4%) | 2 (3.7%) | 0.2 | .65 |
| Sleep disorders | 9 (16.1%) | 19 (35.2%) | 3.57 | .059 |
| Postoperative complications (long term) | ||||
| Joint stiffness | 2 (3.6%) | 9 (16.7%) | 4.45 | .035 |
| Muscle atrophy | 8 (14.3%) | 12 (22.2%) | 0.8 | .37 |
| Bone atrophy | 2 (3.6%) | 1 (18.5%) | 0.33 | .56 |
| Chronic pain | 4 (7.1%) | 12 (22.2%) | 4 | .045 |
3.3. Quality of life assessment (SF-36)
At 1 day post-surgery, there were no significant differences between the 2 groups in SF-36 dimensions (P > .05). However, at 1 week postoperatively, the acupuncture and massage group had significantly higher scores than the conventional rehabilitation group in physical functioning, role limitations, physical pain, GH, and VT. No significant differences were observed in SF, emotional role limitations, or MH. At 1 month post-surgery, the acupuncture and massage group outperformed the conventional rehabilitation group in all SF-36 dimensions (P < .01), indicating an overall improvement in quality of life. For further details, refer to Table 4.
Table 4.
SF-36 concise health status questionnaire.
| Acupuncture and massage (n = 56) | Routine rehabilitation (n = 54) | t-value | P-value | |
|---|---|---|---|---|
| The day after surgery | ||||
| PF | 56.25 ± 5.23 | 56.71 ± 5.66 | 0.44 | .66 |
| RP | 52.42 ± 6.51 | 53.21 ± 6.37 | 0.64 | .52 |
| BP | 53.47 ± 8.11 | 52.25 ± 7.89 | 0.80 | .43 |
| GH | 56.01 ± 5.81 | 56.21 ± 6.21 | 0.17 | .86 |
| VT | 51.11 ± 5.23 | 50.91 ± 5.18 | 0.20 | .84 |
| SF | 53.01 ± 5.21 | 52.33 ± 5.29 | 0.68 | .50 |
| RE | 55.02 ± 5.37 | 55.41 ± 5.54 | 0.37 | .71 |
| MH | 56.77 ± 6.25 | 56.34 ± 6.39 | 0.36 | .72 |
| 1 wk after surgery | ||||
| PF | 62.35 ± 5.02 | 59.79 ± 5.18 | 2.63 | .01 |
| RP | 55.21 ± 5.79 | 52.81 ± 5.11 | 2.31 | .02 |
| BP | 60.98 ± 6.13 | 55.32 ± 6.16 | 4.83 | <.01 |
| GH | 62.90 ± 6.37 | 60.46 ± 6.23 | 2.03 | .04 |
| VT | 58.63 ± 4.19 | 55.12 ± 5.02 | 3.97 | <.01 |
| SF | 55.16 ± 3.88 | 54.77 ± 4.01 | 0.52 | .61 |
| RE | 63.33 ± 4.47 | 62..35 ± 4.62 | 1.54 | .12 |
| MH | 61.58 ± 6.39 | 60.21 ± 6.02 | 1.16 | .25 |
| 1 mo after surgery | ||||
| PF | 71.51 ± 4.32 | 65.99 ± 5.13 | 6.09 | <.01 |
| RP | 67.25 ± 6.60 | 61.28 ± 5.11 | 5.32 | <.01 |
| BP | 75.12 ± 6.56 | 67.32 ± 5.38 | 6.83 | <.01 |
| GH | 71.38 ± 5.41 | 68.30 ± 5.39 | 2.99 | <.01 |
| VT | 76.36 ± 7.23 | 69.22 ± 6.91 | 5.3 | <.01 |
| SF | 73.37 ± 5.33 | 64.19 ± 5.42 | 8.95 | <.01 |
| RE | 72.31 ± 5.68 | 66.33 ± 5.24 | 5.74 | <.01 |
| MH | 73.36 ± 6.23 | 66.21 ± 6.32 | 5.97 | <.01 |
BP = body pain, GH = general health, MH = mental health, RE = role-emotional, RP = role-physical, PF = physical function, SF = social functioning, VT = vitality.
3.4. Ability to perform activities of daily living
BI assessments revealed no significant difference in mobility between the 2 groups on the day after surgery. However, at 1 week and 1 month postoperatively, the acupuncture and massage group showed significantly higher scores compared to the conventional rehabilitation group (66.44 ± 6.87 vs 63.21 ± 7.10, P = .017; 75.33 ± 6.21 vs 70.31 ± 6.86, P < .01), indicating a better recovery in the ability to perform activities of daily living in the acupuncture and massage group. For further details, refer to Table 5.
Table 5.
Assessment of ability to perform activities of daily living.
| The day after surgery | 1 wk after surgery | 1 mo after surgery | |
|---|---|---|---|
| Acupuncture and massage = 56 | 59.34 ± 7.34 | 66.44 ± 6.87 | 75.33 ± 6.21 |
| Routine rehabilitation = 54 | 58.23 ± 8.01 | 63.21 ± 7.10 | 70.31 ± 6.86 |
| t-value | 0.76 | 2.42 | 3.34 |
| P-value | .45 | .017 | <.01 |
3.5. Assessment of psychological status
There were no significant differences between the 2 groups in psychological assessments on the day of surgery and 1 week postoperatively. However, at 1 month post-surgery, patients in the acupuncture and massage group exhibited significantly better anxiety and depression levels compared to those in the conventional rehabilitation group, with a number of patients in the conventional rehabilitation group still experiencing MH issues. For further details, refer to Table 6.
Table 6.
Assessment of psychological status.
| Acupuncture and massage (n = 56) | Routine rehabilitation (n = 54) | χ2 | P-value | |
|---|---|---|---|---|
| The day after surgery | ||||
| SAS | ||||
| <50 points (normal) | 4 | 6 | 0.78 | .86 |
| 50–59 points (mild anxiety) | 15 | 16 | ||
| 60–69 points (moderate anxiety) | 26 | 22 | ||
| >70 (severe anxiety) | 11 | 10 | ||
| SDS | ||||
| <53 points (normal) | 16 | 14 | 0.96 | .81 |
| 53–62 points (mild depression) | 26 | 22 | ||
| 63–72 points (moderate depression) | 9 | 11 | ||
| >72 points (severe depression) | 5 | 7 | ||
| 1 wk after surgery | ||||
| SAS | 5.78 | .12 | ||
| <50 points (normal) | 25 | 13 | ||
| 50–59 points (mild anxiety) | 15 | 17 | ||
| 60–69 points (moderate anxiety) | 12 | 16 | ||
| >70 (severe anxiety) | 4 | 8 | ||
| SDS | ||||
| <53 points (normal) | 28 | 18 | 5.01 | .16 |
| 53–62 points (mild depression) | 23 | 24 | ||
| 63–72 points (moderate depression) | 3 | 8 | ||
| >72 points (severe depression) | 2 | 4 | ||
| 1 mo after surgery | ||||
| SAS | ||||
| <50 points (normal) | 44 | 30 | 8.10 | .044 |
| 50–59 points (mild anxiety) | 11 | 18 | ||
| 60–69 points (moderate anxiety) | 1 | 4 | ||
| >70 (severe anxiety) | 0 | 2 | ||
| SDS | ||||
| <53 points (normal) | 45 | 31 | 7.91 | .048 |
| 53–62 points (mild depression) | 9 | 16 | ||
| 63–72 points (moderate depression) | 2 | 6 | ||
| >72 points (severe depression) | 0 | 1 | ||
SAS = self-rating anxiety scale, SDS = self-rating depression scale.
4. Discussion
With the aging population and the rise in sports injuries, orthopedic surgery has increasingly become a crucial method for treating bone and joint conditions, including hip arthroplasty, knee arthroplasty, spinal surgery, and traumatic fracture repair.[15] These procedures play a vital role in alleviating disease symptoms, slowing disease progression, and significantly improving patients’ quality of life, particularly by reducing pain and restoring joint function.[16] However, despite the success of these surgeries in symptom relief, postoperative rehabilitation remains a complex challenge. Specifically, patients often encounter a range of surgery-related complications and adverse effects during the recovery process, which not only impact their physical health but also have a significant influence on their psychological well-being.[17]
Postoperative pain is a prevalent complication among orthopedic patients, often extending beyond the surgical site to other areas due to factors such as muscle atrophy and restricted joint movement.[18] Many patients experience prolonged difficulty managing pain after surgery, with pain fluctuating between persistent and intermittent episodes, hindering their ability to perform routine daily activities. In addition to pain, muscle atrophy and limited joint mobility are common challenges during postoperative rehabilitation. The mobility of patients is frequently compromised, and many require extensive physical therapy to gradually regain limb flexibility and strength. This recovery process is often slow, significantly impacting the patients’ quality of life.[19]
Muscle atrophy and joint stiffness often lead to reduced motor function and limited mobility, causing some patients to experience anxiety and frustration about their recovery. More critically, prolonged impairment of motor function not only impacts physical health but also negatively affects psychological well-being.[20] Many patients develop mood disorders, such as anxiety and depression, which further complicate the rehabilitation process. During extended hospitalizations or rehabilitation periods, patients may experience feelings of loneliness, helplessness, and concerns about their future recovery, leading to unstable psychological states. These emotional challenges can undermine treatment adherence and hinder the overall rehabilitation process.[21]
Rehabilitation after orthopedic surgery presents not only a physical challenge but also a psychological and emotional one. Effectively managing postoperative pain, restoring function, reducing muscle atrophy, enhancing joint mobility, and improving psychological well-being have become pressing concerns in orthopedic rehabilitation. Addressing these issues requires a holistic approach that considers factors such as medication, physical therapy, and psychological support to develop a personalized rehabilitation plan aimed at helping patients regain function and enhance their quality of life.
Medication is a common approach in postoperative rehabilitation; however, prolonged use can lead to side effects such as drug dependence, gastrointestinal discomfort, and liver or kidney damage.[22] While physical therapies like hot compresses and electrotherapy can be effective, patient adherence is often a challenge. Additionally, these treatments primarily address symptoms rather than the underlying pathological issues.[23] As a result, there is a growing focus in clinical research on discovering novel therapeutic methods to offer more comprehensive and effective rehabilitation options post-surgery.
Recently, acupuncture and massage have gained significant attention as traditional Chinese medicine therapies.[24] Numerous clinical studies have demonstrated that both treatments are effective in alleviating postoperative pain, enhancing functional recovery, and improving MH and quality of life.[25] Acupuncture and moxibustion stimulate meridians and acupoints, promoting the flow of qi and blood, relieving muscle stiffness, and improving circulation to accelerate recovery. From a modern medical perspective, acupuncture enhances neuroendocrine regulation, stimulates the release of pain-relieving endorphins, and improves microcirculation, which contributes to reduced pain and accelerated healing.[26] Massage, on the other hand, improves local blood circulation and lymphatic drainage through manual manipulation, relaxes muscles, alleviates muscle tension, and supports joint function recovery. These mechanisms combined may significantly enhance postoperative recovery.[27] When combined, acupuncture and massage produce a synergistic effect, making them a valuable adjunct to postoperative orthopedic rehabilitation.[28]
While preliminary evidence supports the effectiveness of acupuncture and massage in postoperative orthopedic rehabilitation, many studies still have significant limitations. Primarily, most research has focused on the effects of single treatment modalities, often with small sample sizes, and lacks high-quality, large-scale randomized controlled trials. Additionally, many studies have concentrated on specific disease types, with limited comprehensive research on patients undergoing different orthopedic surgeries.[29] In response, the current study aims to systematically assess the effects of combined acupuncture and massage therapy in patients undergoing a variety of orthopedic surgeries, addressing gaps in existing research and providing a scientific basis for clinical application.
The results of this study indicated that the acupuncture and massage group showed significant advantages over the conventional rehabilitation group in postoperative recovery, particularly in terms of discharge time, joint stiffness, and the incidence of chronic pain. The benefits may stem from acupuncture’s ability to enhance microcirculation and promote neuroendocrine regulation, while massage helps reduce muscle tension and improves blood flow, leading to faster recovery and reduced complications. Patients in the acupuncture and massage group were discharged significantly earlier, suggesting that this combined treatment can expedite postoperative recovery and reduce hospitalization duration. The benefits of acupuncture and massage may stem from mechanisms such as improving blood circulation, alleviating pain and muscle tension, and promoting soft tissue healing.[30] Additionally, acupuncture enhances microcirculation and supports the body’s self-repair processes by regulating the flow of qi and blood, clearing blockages in meridians, and fostering healing, while massage aids recovery by relaxing muscles and restoring joint function.[31]
In terms of long-term complications, the acupuncture and massage group showed a significantly lower incidence of joint stiffness (3.6%) and chronic pain (7.1%) compared to the conventional rehabilitation group (16.7% for joint stiffness and 22.2% for chronic pain). This indicates that acupuncture and massage effectively reduce the occurrence of joint stiffness and chronic pain in the early postoperative period, likely through mechanisms such as enhancing local blood circulation, improving joint mobility, and alleviating muscle stiffness. These findings align with existing literature, which suggests that acupuncture and massage can significantly promote joint function recovery and mitigate postoperative complications.
The SF-36 brief health status questionnaire results indicated that the acupuncture and massage group had significantly higher quality of life scores than the conventional rehabilitation group at both 1 week and 1 month postoperatively, particularly in the areas of PF, role limitations, BP, and VT. At 1 month postoperatively, the acupuncture and massage group demonstrated significant improvement across all dimensions (P < .01), suggesting that this combined treatment can enhance quality of life in multiple aspects. Acupuncture and massage notably improved PF by alleviating postoperative pain, boosting muscle strength, and promoting joint mobility. These effects can be attributed to acupuncture’s ability to stimulate the neuroendocrine system, reduce inflammation, and promote tissue healing, while massage improves blood circulation, relaxes muscles, and alleviates soft tissue adhesions, leading to improved joint mobility and muscle strength. Furthermore, these treatments significantly contributed to better psychological health, particularly in reducing symptoms of postoperative anxiety and depression.
As patients progress in their recovery, improvements are seen across all quality of life dimensions, with notable gains in MH and SF. Acupuncture and massage aid in alleviating postoperative anxiety and depression, enhancing mental well-being by relaxing the body, stimulating blood circulation, and reducing pain. The treatment regimen of acupuncture and massage plays a crucial role in promoting the overall health of postoperative patients, aligning with existing research that demonstrates the benefits of acupuncture and massage not only in restoring physiological functions but also in significantly improving MH and quality of life.
The BI assessment revealed that the acupuncture and massage group demonstrated significantly better performance in activities of daily living compared to the conventional rehabilitation group at both 1 week and 1 month postoperatively. At 1 week postoperatively, the acupuncture and massage group scored 66.44 ± 6.87, while the conventional rehabilitation group scored 63.21 ± 7.10 (P = .017). At 1 month postoperatively, the scores were 75.33 ± 6.21 and 70.31 ± 6.86, respectively (P < .01). These findings suggest that acupuncture and massage notably enhance the recovery of daily living abilities, particularly in the early stages of postoperative rehabilitation. By improving joint mobility, reducing muscle atrophy, and increasing muscle strength, acupuncture and massage facilitate faster recovery of functional independence.
MH plays a vital role in the rehabilitation of postoperative orthopedic patients. Our study found that, at 1 month postoperatively, the acupuncture and massage group had SAS and SDS scores compared to the conventional rehabilitation group, with a notably reduced incidence of anxiety and depression. These results suggest that acupuncture and massage not only alleviate postoperative pain and facilitate functional recovery, but also improve patients’ MH by enhancing their psychological well-being. By promoting relaxation, relieving pain, and improving blood circulation and muscle function, acupuncture and massage help reduce negative emotions such as anxiety and depression, contributing to overall recovery. Previous studies have emphasized the close relationship between postoperative pain and psychological disorders, noting that patients with better pain management tend to show improved MH. Acupuncture and massage appear to serve a dual purpose, addressing both pain relief and psychological support.
While this study demonstrates the significant benefits of acupuncture and acupressure in postoperative orthopedic rehabilitation, it has several limitations. First, being a retrospective cohort study, it is subject to selection and information biases, as well as the influence of potential confounding factors. These confounding factors could affect the observed outcomes, and future research should confirm these findings through randomized controlled trials. Second, the study did not explore the specific mechanisms of acupuncture and massage, and further investigations should focus on understanding the physiological mechanisms and potential synergistic effects of these treatments. Additionally, the small sample size and single-center data limit the generalizability of the results. Larger, multicenter studies will be essential to validate these findings and support their broader clinical application.
Overall, acupuncture and massage play a significant role in enhancing functional recovery, quality of life, and psychological well-being in postoperative orthopedic patients. These therapies not only alleviate postoperative pain and promote joint mobility and muscle strength recovery, but also improve patients’ ability to perform daily activities and reduce symptoms of anxiety and depression. As research continues to advance, acupuncture and massage are poised to become crucial adjuncts in orthopedic postoperative rehabilitation, offering more evidence-based and personalized treatment options in clinical settings. Tailoring the treatment plans and timing of acupuncture and massage will enable more precise and effective rehabilitation, ultimately improving the overall treatment outcomes.
Author contributions
Conceptualization: Liqing Xue, Yichen Yan, Zhangmei Chen, Yu Hong.
Data curation: Liqing Xue, Yichen Yan, Zhangmei Chen, Yu Hong.
Formal analysis: Liqing Xue, Yichen Yan, Yu Hong.
Validation: Yu Hong.
Visualization: Yu Hong.
Writing – original draft: Liqing Xue, Yichen Yan, Yu Hong.
Writing – review & editing: Liqing Xue, Yichen Yan, Zhangmei Chen.
Abbreviations:
- BI
- Barthel index
- BP
- body pain,
- GH
- general health
- MH
- mental health
- PF
- physical function
- RE
- emotional role restrictions
- RP
- role function limitations
- SAS
- self-rating anxiety scale
- SDS
- self-rating depression scale
- SF
- social functioning
- VT
- vitality
General Project of Philosophy and Social Sciences Research in Colleges and Universities in 2024, Project Number 2024SJYB0973, Jiangsu Provincial Education Planning Project of 2024, Project Number: C/2024/01/97.
The authors have no conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Xue L, Yan Y, Chen Z, Hong Y. Acupuncture and massage therapy enhance postoperative recovery and quality of life in orthopedic patients. Medicine 2025;104:37(e44314).
Contributor Information
Liqing Xue, Email: 8000000922@czie.edu.cn.
Yichen Yan, Email: yanyichen2017@163.com.
Zhangmei Chen, Email: Chenzhangmei1962@163.com.
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