"The Effect of Mandala Art Therapy on Anxiety and Pain in Patients Undergoing Total Hip Replacement: A Randomized Controlled Study"

Hip arthroplasty is recognized as an effective method for adults suffering from significant pain and limited mobility due to hip joint damage. The rapid advancements in total hip arthroplasty technology, alongside the increasing average life expectancy, highlight the importance of this procedure for patients who have undergone it. However, any surgical intervention can be traumatic for patients. Experiencing surgical trauma often leads to pain, and approximately 60-80% of individuals exhibit anxiety prior to such procedures. Factors contributing to anxiety and pain are frequently linked to a person's emotional, psychological, behavioral, and socio-cultural background. Previous studies have emphasized that anxiety and pain behaviors, which can adversely affect individuals during surgical processes, are related to the perception of pain. Effective and planned nursing care can significantly reduce pre-operative anxiety, resulting in lower levels of pain and anxiety post-surgery. In patients undergoing total hip arthroplasty, it is essential to manage post-operative acute pain effectively. Successful pain management allows patients to mobilize more quickly and reduces hospital stay durations. Severe post-operative pain can discourage patients from engaging in necessary exercises. To control this acute pain, it is often recommended to administer analgesics every 4-6 hours, based on medical advice. Regular pain assessment, establishing therapeutic communication with patients, and employing patient-controlled analgesia, along with oral analgesics, are among the most effective pain management strategies. Additionally, non-pharmacological methods are suggested as alternatives to pharmacological approaches. Mandala art therapy represents an inward journey for individuals, helping them feel empowered and extraordinary. The mandala, depicting the blossoming of a flower at its center, symbolizes the spiritual self. While representing unity, the mandala forms a pattern that transitions from the micro to the macro, symbolizing the moment of existence and life. Jung utilized mandala art as a therapeutic method and since then, it has been applied across various fields as mandala therapy. The mandala activity has been associated with positive psychological effects, such as enhancing individual awareness, boosting self-esteem, and reducing feelings of guilt . Literature suggests that engaging with mandalas fosters conscious awareness and positively contributes to individuals. This engagement helps focus attention and distances individuals from negative thoughts, thereby alleviating anxiety. While no significant differences have been observed between mandala coloring and drawing in terms of anxiety reduction, mandala coloring may be preferred in the future for its cost-effectiveness and ease of implementation for adults . One study found that engaging in mandala activities for at least 30 minutes daily significantly reduced anxiety levels in patients, offering an adjunctive treatment option. Another study emphasized that performing mandala activities with focus could positively impact psychological and emotional well-being, thereby reducing anxiety. A systematic meta-analysis indicated that mandala activities significantly and positively affect state anxiety. Reducing pain and anxiety in patients who have undergone total hip replacement will enhance patient comfort and satisfaction. Therefore, this study aims to evaluate the effects of mandala art therapy on anxiety and pain in patients undergoing total hip replacement.