Behavioral Activation for Orthopedic Trauma Patients After Discharge: A Case Series Report of an Open-Label, Prospective Observational Pilot Study

Patients discharged after surgery for orthopedic trauma are at high risk for depression and posttraumatic distress, but are underreached in terms of recovery-oriented mental health interventions. Behavioral activation (BA) is appropriate, given that maintaining self-reinforcing physical activity is congruent with physical and mental recovery among postsurgical patients. We report on a prospective observational pilot study evaluating the feasibility, acceptability, and efficacy of an adapted BA protocol developed as a preventative intervention to reduce the risk of depression among surgical patients with traumatic limb injury. We used a mixed-methods case series design to depict the population-specific adaptations made to Lejuez et al.'s (2011) brief BA protocol, as well as quantitative and qualitative outcomes among treatment completers (n = 5; all female; rangeage = 43-65 years). Completers reported either unchanged or modest improvements in global physical and mental health, and depressive and posttraumatic stress symptoms. Completers' postintervention qualitative responses corroborated these observations, emphasizing positive aspects of the intervention and perceived benefits for mental health and physical recovery. Overall, completers viewed the intervention as acceptable and feasible, and offered concrete suggestions for intervention delivery refinement. Our adapted BA protocol for orthopedic trauma surgical recovery appears acceptable, feasible, and preliminarily efficacious. Future trials should include a control group, and consider delivery by non-specialists.