Lingard Elizabeth A, Riddle Daniel L
Department of Orthopaedics, Level 7, Room 134, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, United Kingdom.
J Bone Joint Surg Am. 2007 Jun;89(6):1161-9. doi: 10.2106/JBJS.F.00914.
Preoperative psychological distress has been reported to be an important risk factor for poor outcome following lower-extremity arthroplasty. We determined the independent impact of preoperative psychological distress on three, twelve, and twenty-four-month WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain and function scores and on change scores over those time periods.
Data were obtained from an international group of 952 patients in thirteen centers participating in the Kinemax Outcomes Study. Patients completed the WOMAC and Short Form-36 (SF-36) questionnaires. The mental health (MH) scale of the SF-36 was used to quantify the impact of psychological distress on WOMAC pain and function scores. We also dichotomized patients into groups with and without psychological distress on the basis of evidence-based cut-points. Repeated-measures models were used to derive mean preoperative and three, twelve, and twenty-four-month WOMAC pain and function scores and general linear models were used to derive change scores for patients with and without psychological distress after adjustment for covariates.
Psychological distress, when examined on a continuous scale, was found to predict pain and function at all time-points. WOMAC pain scores for psychologically distressed patients were 3 to 5 points lower, depending on the time-frame, than the scores for the non-distressed patients, after adjustment for covariates. WOMAC function scores did not differ significantly between the two groups following surgery. The changes in the WOMAC pain and function scores for the psychologically distressed patients were not significantly different from those for the non-distressed patients.
Many patients with psychological distress demonstrate a substantial decrease in that distress following surgery. Patients who are distressed have slightly worse pain preoperatively and for up to two years following knee arthroplasty as compared with patients with no psychological distress. With the exception of preoperative scores, these differences are not likely to be measurable at the individual patient level. WOMAC pain and function change scores do not differ between patients with and without distress after adjustment for covariates.
Prognostic Level I.
据报道，术前心理困扰是下肢关节置换术后预后不良的重要危险因素。我们确定了术前心理困扰对3个月、12个月和24个月的WOMAC（西安大略和麦克马斯特大学骨关节炎指数）疼痛和功能评分以及这些时间段内变化评分的独立影响。
数据来自参与Kinemax结果研究的13个中心的952名国际患者。患者完成了WOMAC和简短健康调查问卷（SF-36）。SF-36的心理健康（MH）量表用于量化心理困扰对WOMAC疼痛和功能评分的影响。我们还根据循证切点将患者分为有心理困扰和无心理困扰两组。重复测量模型用于得出术前、3个月、12个月和24个月的WOMAC疼痛和功能评分均值，一般线性模型用于得出在对协变量进行调整后有心理困扰和无心理困扰患者的变化评分。
当以连续量表进行检查时，发现心理困扰可预测所有时间点的疼痛和功能。在对协变量进行调整后，根据时间框架不同，有心理困扰患者的WOMAC疼痛评分比无心理困扰患者低3至5分。两组术后WOMAC功能评分无显著差异。有心理困扰患者的WOMAC疼痛和功能评分变化与无心理困扰患者的变化无显著差异。
许多有心理困扰的患者术后该困扰会大幅减轻。与无心理困扰的患者相比，有心理困扰的患者术前及膝关节置换术后长达两年的疼痛稍重。除术前评分外，这些差异在个体患者层面可能无法测量。在对协变量进行调整后，有心理困扰和无心理困扰患者的WOMAC疼痛和功能变化评分无差异。
预后I级。
