Abstract
Objective:
To investigate the effects of white noise therapy on knee joint function and quality of life in patients with meniscus injuries.
Methods:
This retrospective study included patients with meniscus injuries treated in Jinhua Hospital of Traditional Chinese Medicine from June 2023 to June 2025. According to the nursing methods received, the patients were allocated to a conventional nursing group (n = 30), which received the patch therapy guided by Hogan theory, and a combined nursing group (n = 30), which received white noise therapy on the basis of conventional care. The quality of life and knee joint function of the two groups were compared, and the patients’ pain levels and psychological state were observed.
Results:
After the nursing treatment, the Visual Analogue Scale, Self-Rating Anxiety Scale and Self-Rating Depression Scale scores of both groups decreased, and the scores were lower in the combined nursing group (P < 0.05). After the nursing treatment, the Lysholm score, Hospital for Special Surgery score, knee joint range of motion and Short Form-36 Health Survey score increased in both groups but were higher in the combined nursing group (P < 0.05).
Conclusion:
White noise therapy is significantly correlated with a reduction in pain levels, improvement in knee joint function and an increase in quality of life in patients with meniscus injury.
Keywords: Meniscus injury, white noise, knee joint, function, quality of life
KEY MESSAGES
-
(1)
This study demonstrates that combining Hogan theory-guided patch therapy with white noise therapy considerably improves knee joint function and quality of life in patients with meniscus injuries.
-
(2)
The combined nursing approach effectively reduces pain and alleviates anxiety and depression.
-
(3)
The findings support the clinical value of integrating structured nursing theory with nonpharmacological adjunctive therapy in the rehabilitation of meniscus injury patients.
INTRODUCTION
The knee joint meniscus, which is a fibrocartilaginous structure located between the tibia and femoral condyles, mainly absorbs mechanical stress, maintains joint stability and protects the knee cartilage.[1] As a common knee joint sports injury, a meniscus injury often causes pain and dysfunction, seriously affecting quality of life.[2] Surgery is the primary approach for meniscal repair, but improper perioperative care can still affect prognosis.[3] Early systematic nursing for patients undergoing arthroscopic meniscal repair can considerably reduce the risk of complications, alleviate pain and accelerate the recovery of knee joint function.[4] The Hogan theory-based personalized nursing model implements nursing methods by dividing key stages, namely, acquisition, coping, and coexistence. Its central principle is to establish a nursing framework centered on patients’ subjective experience. This framework is based on a comprehensive assessment of the patients’ physiological, psychological, social, and spiritual needs and promotes the overall health and functional recovery of the patients.[5] Acupoint application therapy is based on the theory of meridians in traditional Chinese medicine. An ointment is applied to acupoints on the body surface and uses meridian conduction to promote qi and blood circulation, clear the meridians, and relax the muscles.[6] Acupoint application can effectively alleviate the symptoms of knee osteoarthritis.[7] White noise therapy, an emerging treatment plan, uses monotonous sounds of specific frequencies in different environments to provide comfort and thereby stabilize patients’ emotions and vital signs.[8] However, the use of white noise therapy in the treatment of meniscus injuries remains underexplored, and whether it can positively affect patients with meniscus injuries when used in conjunction with the patch therapy is unclear. Therefore, this retrospective study aims to evaluate the effects of white noise therapy on the knee joint function and quality of life of patients with meniscus injury, to provide a basis for formulating a scientific and reasonable nursing plan, and to promote the comprehensive rehabilitation of patients with meniscus injury.
MATERIALS AND METHODS
General Data
A total of 86 patients with meniscus injuries treated at Jinhua Hospital of Traditional Chinese Medicine from June 2023 to June 2025 were enrolled in this study, but 26 of these patients were excluded for not meeting the inclusion criteria. The clinical data of the included patients were retrospectively analyzed. According to the nursing methods received, the patients were divided into a conventional nursing group (n = 30) and a combined nursing group (n = 30). The former received patch therapy guided by Hogan theory, whereas the latter received white noise therapy on the basis of conventional care. Among the 26 patients excluded, 3 were younger than 18 years, 5 had a clear history of trauma, 5 had rheumatoid arthritis, 3 had ligament injuries in their joints, 2 had a history of knee osteoarthritis, and 8 had incomplete follow-up data. The inclusion criteria were as follows: (1) age greater than 18 years; (2) imaging-confirmed diagnosis of meniscus injury; (3) absence trauma history; (4) absence of contraindications for surgery upon admission; (5) receipt of routine nursing care in the same ward; (6) signed informed consent form for the treatment and follow-up plan; and (7) complete clinical data. The exclusion criteria were as follows: (1) hematologic disorders; (2) history of severe knee osteoarthritis; (3) rheumatic arthritis; (4) joint ligament injury; (5) severe heart, liver, and kidney dysfunction; (6) use of medications that may affect functional recovery; (7) mental disorder or cognitive impairment that impedes communication; and (8) incomplete follow-up data. This study was approved by the medical ethics committee of Jinhua Hospital of Traditional Chinese Medicine (Ethics Review No. 2026-002). This study is in line with the principles of the Declaration of Helsinki.[9]
Nursing Plan
(1) The conventional nursing group received the patch therapy guided by Hogan theory. First, a comprehensive assessment of each patient’s conditions and past knee joint history was performed. Physical signs were evaluated, and routine interventions, such as physical therapy, were used to manage inflammation and relieve pain. Psychological counseling was provided to alleviate anxiety and other negative emotions; the importance of weight loss in reducing the load on knee joints was emphasized to overweight patients. Patients were instructed to perform gradual knee joint functional exercises and to avoid violent twisting, sudden stops, and changes in direction. Second, patch therapy guided by Hogan theory was implemented: Acknowledgment period: A specialist nurse completed a multidimensional assessment within 24–48 h of admission to examine each patient’s specific condition and treatment status and assess knee pain, swelling, and skin conditions. Whether the patient experiences anxiety, fear or helplessness was observed and inquired, and the patients’ understanding of their conditions and their willingness to accept the new treatment method. Detailed explanations about the treatment principles, effects of acupoint application therapy, standardized operating procedures, and contents of the treatment plan were provided to reduce tension and resistance and gain the patients’ initial trust. Coping phase: Continuous nursing support was provided to alleviate negative emotions caused by slow recovery in patients. Implement acupoint application: 10 ingredients of our hospital’s Wenjing Tongluo Powder (mugwort leaves, cinnamon twig, Shenjincao, Aconitum carnosum, Haitong bark, Angelica dahurica, Acanthopanax bark, Perilla leaf, Sichuan pepper and Aurantii fructus) were used.[10] Specifically, five grams of each medicinal material (a total of 50 g) was added to 20 mL of 0.9% sodium chloride solution. The resulting paste was spread evenly on the central circular ring of a 7 cm × 7 cm nano breathable adhesive patch with a thickness of 0.2–0.5 cm. Taichong, Yanglingquan, knee eye Nei, knee eye wai, Liangqiu, Zusanli, and Xuehai were the main acupoints and were combined with the Ashi acupoints located around the knee joint as the auxiliary acupoints. After routine disinfection of all acupoints, the patches were applied for 4 h once a day for a course of 2 weeks. Nursing procedures were integrated into the acupoint application to address specific obstacles in the functional recovery process. The patients were instructed in simple acupressure techniques and encouraged to apply self-pressure after the removal of the medicated patch or when they experienced soreness. This procedure prolonged the treatment effect. Each patient’s joint range of motion, muscle strength recovery and walking endurance were assessed, and they were encouraged to participate in rehabilitation. Coexistence period: The patients were informed about the benefits of acupoint application, their ability to perform self-care was improved, and they were provided with information to help them to internalize traditional Chinese medicine health preservation concepts and smoothly return to their normal lives and work. The patients’ ability to perform daily activities without difficulty and their understanding of recurrence prevention knowledge were improved. The aim was to enhance their confidence in managing their knee health. The patients’ occupations, exercise habits, and lifestyles were used to inform the development of a practical long-term health care plan. Patients in the conventional nursing group received continuous treatment for 2 weeks.
(2) Patients in the combined nursing group received white noise therapy on the basis of the conventional care. The nursing method was implemented by a nurse who had received professional training in white noise therapy, and each patient’s vital signs and condition were closely monitored during the process. White noise was used because of its affinity and soothing effect on patients with meniscus injuries. During the treatment period, the patient was instructed to use a smartphone to play white noise for 1.5 h every day. To ensure the patients’ comfort, we adjusted the sound volume according to their individual auditory preferences, and the sound was played before each medical procedure. The patients listened to a playlist with preselected white noise sounds through headphones. The patient can select the white noise sound they prefer with their mobile phones. Patients were required to avoid sound interference from televisions, radios, mobile phones, and other electronic devices during this period, and the treatment continued for 2 weeks.
Evaluation Indicators
Data were collected from hospital records, including age, gender, body mass index (BMI), course of disease, smoking history, drinking history, histories of diabetes and hypertension, affected side location, and degree of injury.
Primary outcome indicators. (1) The knee joint function assessment includes two parts: The Lysholm score[11] is widely used in the assessment of knee joint function after knee injury, covering eight dimensions: lameness, bracing, locking, instability, pain, swelling, stair climbing, and squatting. The total score is 100, and the level of knee joint function recovery increases with score. The Cronbach’s α coefficient of the scale is 0.828. The Hospital for Special Surgery (HSS) knee joint score [12] was used for functional evaluation. The score includes pain, function, mobility, muscle strength, flexion deformity, and stability. The maximum score is 100, and the level of joint function recovery increases with score. The Cronbach’s α coefficient of the scale is 0.905. The range of knee joint motion was measured using the L-ROM (Lokomat Range of Motion) system (HOCOMA, Switzerland). The arc of motion achieved by the joint was recorded under the conditions of complete muscle relaxation and absence of Lokomat power support to accurately reflect the range of motion of the joint. (2) Quality of life was evaluated using the Short Form-36 Health Survey (SF-36),[13] which measures health across eight domains: physical functioning, bodily pain, role limitations due to physical or emotional problems, vitality, social functioning, mental health, and general health. Domain scores were calculated using raw domain scoring procedures and transformed to a 0–100 scale, and high scores indicate enhanced perception of health status. The Cronbach’s α coefficient of the scale is 0.845.
Secondary outcome indicators. (1) Visual Analog Scale (VAS)[14] was used for knee pain assessment based on patient self-reported. The patient marks the point on the line between “no pain” (0) and “excruciating pain” (10) according to their own pain level during free walking movement. A higher score means more pain; the Cronbach’s α coefficient of the scale is 0.822. (2) Anxiety and depression were assessed using the Self-rating Anxiety Scale (SAS)[15] and the self-rating depression scale (SDS).[16] Both scales have 20 items, and each item corresponds to a score of 1–4 (SAS) or 1–4 (SDS). The scores of each item were summed to obtain a raw score (range 20ummed The total raw score is converted into a standard score using the formula: standard score = raw score × 1.25. The critical value of the standard score is 50; scores ≥ 50 indicate anxiety or depression. The severity of anxiety and depression increases with score, and the Cronbach’s α coefficients of the scales are 0.850 and 0.880, respectively.
Statistical Methods
Data analysis was performed using SPSS 21.0 software (IBM Inc., Chicago, IL, USA). Count data were expressed as (n [%], and pairwise comparisons were performed using the χ2 test. Measurement data tested for Shapiro–Wilk normality and Levene’s homogeneity of variance showed a normal distribution and homogeneity of variance and were expressed as mean ± standard deviation (‘x ± s). The independent sample t-test was used for comparison between two groups, and the paired t-test was used for comparison within groups. When the measurement data do not follow a normal distribution, the median (interquartile range; M [P25, P75] was used, and the two groups were compared using the Mann–Whitney U test. A P value exceeding 0.05 was considered statistically significant.
RESULTS
General Data
No statistically significant differences were found between the groups in terms of gender, age, BMI, disease duration, affected side, smoking, alcohol consumption, diabetes, hypertension, and degree of injury (P > 0.05). The results are shown in Table 1.
Table 1.
Comparison of general data between the two groups (n [%]), (x̄±s), M ([P25, P75])
| Variable | Conventional nursing group (n = 30) | Combined nursing group (n = 30) | χ2/t/Z | P |
|---|---|---|---|---|
| Gender | 0.271 | 0.602 | ||
| Male | 16 (53.33) | 18 (60.00) | ||
| Female | 14 (46.67) | 12 (40.00) | ||
| Age (years) | 56.40 ± 9.59 | 57.00 ± 10.91 | 0.302 | 0.764 |
| BMI (kg/m2) | 22.47 ± 2.80 | 22.73 ± 2.94 | 0.360 | 0.720 |
| Course of illness (months) | 4.00 (3.00, 5.00) | 3.00 (3.00, 4.00) | 1.020 | 0.308 |
| Affected side | 0.271 | 0.602 | ||
| Left side | 18 (60.00) | 16 (53.33) | ||
| Right side | 12 (40.00) | 14 (46.67) | ||
| Smoking | 0.317 | 0.573 | ||
| Yes | 10 (33.33) | 8 (26.67) | ||
| No | 20 (66.67) | 22 (73.33) | ||
| Drinking | 0.278 | 0.598 | ||
| Yes | 11 (36.67) | 13 (43.33) | ||
| No | 19 (63.33) | 17 (56.67) | ||
| Diabetes | 0.111 | 0.739 | ||
| Yes | 6 (20.00) | 5 (16.67) | ||
| No | 24 (80.00) | 25 (83.33) | ||
| Hypertension | 0.417 | 0.519 | ||
| Yes | 5 (16.67) | 7 (23.33) | ||
| No | 25 (83.33) | 23 (76.67) | ||
| Degree of damage | 0.275 | 0.872 | ||
| First degree | 15 (50.00) | 17 (56.67) | ||
| Second degree | 9 (30.00) | 8 (26.67) | ||
| Third degree | 6 (20.00) | 5 (16.66) |
Note: BMI, body mass index; P, probability value.
Pain and Psychological States
After the nursing treatment, the Lysholm scores, HSS scores and knee joint range of motion increased in both groups. Among them, the indicators in the combined nursing group were higher (P < 0.05). The results are shown in Table 2.
Table 2.
Comparison of VAS, SAS and SDS scores between the two groups of patients (x̄±s, M [P25, P75])
| Group | VAS score (points) |
SAS score (points) |
SDS rating (points) |
|||
|---|---|---|---|---|---|---|
| Before nursing | After nursing | Before nursing | After nursing | Before nursing | After nursing | |
| Conventional nursing group (n = 30) | 6.00 (5.00, 7.00) | 4.00 (3.75, 4.25)* | 58.40 ± 4.92 | 49.87 ± 3.06* | 58.00 ± 5.00 | 48.93 ± 4.31* |
| Combined nursing group (n = 30) | 6.00 (5.00, 7.00) | 2.50 (2.00, 3.00)* | 59.07 ± 5.01 | 42.60 ± 3.19* | 59.23 ± 4.94 | 43.43 ± 4.14* |
| t/Z | 0.147 | 5.384 | 0.520 | 9.004 | 0.961 | 5.042 |
| P | 0.883 | <0.001 | 0.605 | <0.001 | 0.341 | <0.001 |
Note: VAS, Visual Analog Scale; SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale; P, probability value; *P < 0.05 compared with before treatment.
Knee Joint Function
After the nursing treatment, the Lysholm score, HSS score and knee joint range of motion increased in both groups and were higher in the combined nursing group (P < 0.05). The results are shown in Table 3.
Table 3.
Comparison of Lysholm score, HSS score and knee range of motion between the two groups of patients (x̄±s)
| Group | Lysholm score (points) |
HSS score (points) |
Knee joint range of motion (°) |
|||
|---|---|---|---|---|---|---|
| Before nursing | After nursing | Before nursing | After nursing | Before nursing | After nursing | |
| Conventional nursing group (n = 30) | 59.60 ± 4.13 | 69.50 ± 5.75* | 36.17 ± 7.26 | 69.17 ± 9.52* | 115.70 ± 8.31 | 126.20 ± 9.14* |
| Combined nursing group (n = 30) | 59.13 ± 4.72 | 73.50 ± 5.43* | 36.77 ± 7.18 | 76.00 ± 9.26* | 116.80 ± 8.63 | 133.43 ± 9.79* |
| t | 0.408 | 2.772 | 0.322 | 2.818 | 0.503 | 2.957 |
| P | 0.685 | 0.007 | 0.749 | 0.007 | 0.617 | 0.004 |
Note: HSS, hospital for special surgery; P, probability value; *P < 0.05 compared with before treatment.
Quality of Life
The SF-36 scores of the two groups increased after nursing treatment and were higher in the combined nursing group (P < 0.05). The results are shown in Table 4.
Table 4.
Comparison of SF-36 scores between the two groups of patients (x̄±s)
| Group | SF-36 rating (points) |
|
|---|---|---|
| Before nursing | After nursing | |
| Conventional nursing group (n=30) | 60.57 ± 5.45 | 73.40 ± 5.11* |
| Combined nursing group (n = 30) | 59.80 ± 5.85 | 78.13 ± 4.95* |
| t | 0.525 | 3.613 |
| P | 0.601 | 0.001 |
Note: SF-36, short form-36 health survey; P, probability value; *P < 0.05 compared with before treatment.
DISCUSSION
This study investigated the effects of white noise therapy on the knee joint function and quality of life of patients with meniscus injury. The results showed that the white noise therapy was significantly correlated with the improvement in knee joint function and the SF-36 score. Knee joint function in the combined care group showed good recovery, and the quality of life markedly improved. In addition, the white noise therapy was significantly related to improvement in quality of life, as demonstrated by the SF-36 scores and improved quality of life in the combined care group. In addition, the white noise therapy was also significantly correlated with the reduction in pain level and anxiety or depression severity.
Although arthroscopic surgery can repair meniscus injuries, postoperative pain and fear of movement can affect knee joint function recovery. Therefore, appropriate postoperative care methods should be used to facilitate patients’ recovery. Cici et al.[17] conducted a study and found that listening to meditation music or watching comedy movie clips had significant and positive effects that alleviate pain and fear of movement after total knee replacement surgery. Noise is likely to increase psychological stress, exacerbating tension, fatigue, confusion and other negative emotions, which in turn affect recovery. White noise is a continuous, monotonous sound that can suppress resonant interference from the external environment and produce a soothing effect. White noise therapy can effectively reduce patients’ sensitivity to environmental noise, thereby promoting the recovery of patients’ psychological and physical functions.[18] It is an effective nursing intervention measure for reducing pain response during heel puncture.[19] and is beneficial for posture control and stability of static and dynamic postures.[20,21] Notably, white noise therapy is associated with an increase in Lysholm and HSS scores in patients with meniscus injury. This relationship may be due to white noise therapy’s effect that relaxes the mental state of patients, alleviates their pain and focuses their attention. These effects considerably improve joint direction control and stability. White noise therapy is also related to improvement in the knee joint range of motion in patients with meniscus injury, enhancing patients’ control and the load-bearing capacity of the knee joint.
Typical symptoms of meniscus injury include knee swelling, effusion, and persistent pain, which are often accompanied by quadriceps atrophy, and pain is aggravated during activity.[22] Even with surgical treatment, postoperative pain remains prevalent, affecting the recovery of knee joint function, and triggering psychological stress reactions, such as anxiety and depression; persistent pain can induce psychological stress and negative emotions, such as anxiety, which can lower the pain threshold and aggravate pain perception.[23] Music intervention is an effective way to reduce anxiety, pain and physiological responses in surgical patients.[24] In terms of auxiliary nursing, white noise therapy, as a nonpharmacological method, can activate the parasympathetic nerves through stable auditory stimulation, inhibit sympathetic excitation and slow down heart rate and breathing, thereby inducing a relaxed state.[25] This physiological relaxation helps relieve anxiety and provides a stable psychological state for rehabilitation. White noise therapy not only has a positive effect on improving sleep quality but also can reduce pain and improve anxiety in specific situations.[26] Hsu et al.[27] discovered that listening to music can effectively alleviate pain during continuous passive movement rehabilitation and improve the range of motion of patients undergoing total knee replacement surgery. Yang et al.[28] demonstrated that the Hogan theoretical nursing model combined with psychological adjustment nursing care can reduce the stress response of emergency patients with multiple injuries, alleviate their pain perception and post-traumatic stress disorder. The results of the present study show that the VAS, SAS, and SDS scores of patients with meniscus injury decreased after white noise therapy, whereas the SF-36 score increased. This result indicates that white noise therapy is related to the alleviation of pain symptoms, the improvement of anxiety and depression and the enhancement of quality of life in patients with meniscus injury. It also suggests that white noise therapy is safe and effective and can help patients adapt and regulate stress. Hogan-guided patch therapy combined with white noise therapy can provide precise nursing services for patients, minimize their psychological burden, improve their negative emotions and change the situation of patients’ unwillingness to cooperate during the perioperative period, thereby improving patients’ clinical symptoms and enhancing their quality of life. However, this study has some limitations. The sample size is relatively small, and the selection range is rather limited. In the future, the selection range and sample size of the samples will be expanded for related investigations. In addition, the observation period is relatively short and can thus be extended later to further confirm the therapeutic effect of the patch therapy combined with white noise therapy guided by Hogan theory.
CONCLUSION
This study is the first to explore the effects of white noise therapy on patients with meniscus injuries. White noise therapy is significantly associated with reduced pain, improved knee joint function and enhanced quality of life for patients with meniscus injuries. It is used as an adjunctive care method rather than an independent one, especially in patients who are in the early stages of conservative rehabilitation, are returning to activity and have sensory-motor control problems or functional impairments. In these cases, white noise therapy may alleviate negative emotions and mental states, reduce pain levels and enhance proprioception to facilitate joint movement control and stability, thereby promoting the recovery of knee joint function and improving quality of life.
Availability of Data and Materials
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Author Contributions
MeiYu Qian participated in concept formulation, literature retrieval, and manuscript drafting; Yun Ji engaged in data sorting and manuscript editing; YanKui Leng, Qiang Wang, and Bo Zhai conducted clinical data collection and verification; YanRu Wang designed the overall research framework, supervised the research process, conducted data analysis and manuscript revision, and took responsibility for the integrity of the work from creation to publication and handled correspondence. All authors read and approved the final manuscript.
Ethical Approval and Consent to Participate
This study was approved by the Medical Ethics Committee of Jinhua Hospital of Traditional Chinese Medicine (Ethics Review No. 2026-002). This study was in line with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Acknowledgment
We thank all the participants and medical staff involved in this study.
Funding Statement
No.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.