Objectives:
Mindfulness is a proven therapeutic practice for reducing anxiety, depression, and chronic pain, which are factors that influence the success of hip/knee replacement surgery. The present study aimed to investigate the effect of mindfulness bibliotherapy in rehabilitation on anxiety, depression, and health status. The objective was to determine whether there is a connection between the level of mindfulness before rehabilitation and the health status after rehabilitation.

Method:
Ninety-three patients (M age = 63.34, SD = 10.49) from an outpatient rehabilitation clinic participated in the study. Forty-three patients were included in the mindfulness bibliotherapy group, and 45 were included in the waitlist control group. Anxiety, depression (both measured with the Hospital Anxiety and Depression Scale), quality of life (measured with the SF-36), and walking ability (measured with the Timed “Up and Go”-Test), as well as orthopedic measurements and dispositional mindfulness, were measured before and after the intervention. A follow-up measurement was carried out 4 weeks after the end of rehabilitation.

Results:
A significant interaction effect between test time (pre- and post-test) and group (mindfulness bibliotherapy and waitlist control group) was detected for the measurement of Anxiety. The Anxiety score decreased in the intervention group from the pre-test to the post-test and the follow-up. In addition, the five subscales of dispositional mindfulness, age, and gender predicted mental health status (measured with the mental health scale of the SF-36) at the end of rehabilitation, F(7, 85) = 2.52, p = 0.021, even though no individual predictor reached significance.

Conclusions:
Mindfulness diary practice can be a helpful therapy approach to support patients and to regain the goal of full capacity for working life and everyday life after surgery. Further studies need to investigate more intensively the relationships between the mode of action of mindfulness interventions in the setting of orthopedic rehabilitation.