SMART Embedded Intervention for Military Postsurgical Engagement Readiness (SEMPER)

  • End date
    Oct 26, 2025
  • participants needed
  • sponsor
    University of Utah
Updated on 4 October 2022


The overarching objective of this proposal is to conduct a multi-site Sequential Multiple Assignment Randomized Trial (SMART) across multiple Military Health System (MHS) sites to optimize the sequencing and integration of two intervention strategies in total knee arthoplasty (TKA) patients: a single-session mindfulness-based intervention (MBI) and an intensive 8-week MBI-Mindfulness-Oriented Recovery Enhancement (MORE) designed to simultaneously reduce prolonged pain and chronic opioid use by enhancing self-regulation. Aim

  1. Evaluate the extent to which a brief preoperative MBI improves TKA patients' postoperative musculoskeletal health and reduces chronic opioid use. Aim 2: Evaluate the extent to which an intensive MBI (MORE) improves musculoskeletal health and reduces chronic opioid use among patients non-responsive to preoperative intervention. Aim 3: (A) Determine patient baseline characteristics that moderate MBI treatment responses. (B) Quantify the degree to which the impact of Phase 1 and 2 MBIs on musculoskeletal health and opioid dose are mediated by changes in mechanistic autonomic marker of self-regulation: heart-rate variability (HRV).

Condition Knee Pain Chronic
Treatment Standard Care, Mindfulness-Oriented Recovery Enhancement (MORE), Brief Mindfulness
Clinical Study IdentifierNCT05050409
SponsorUniversity of Utah
Last Modified on4 October 2022


Yes No Not Sure

Inclusion Criteria

Scheduled to undergo unilateral total TKA at one of the study sites
TRICARE beneficiary
Facility with the English language that is adequate to complete study procedures

Exclusion Criteria

Cognitive impairment preventing completion of study procedures
Formal mindfulness training (e.g., MBSR, MBCT)
Severe, active suicidality
Contralateral TKA in the past 3 months or planned contralateral TKA during the study
Current cancer diagnoses
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