Singh J A, O'Byrne M M, Colligan R C, Lewallen D G
University of Alabama, Birmingham, Alabama 35294, USA.
J Bone Joint Surg Br. 2010 Jun;92(6):799-806. doi: 10.1302/0301-620X.92B6.23114.
Seligman's theory of causal attribution predicts that patients with a pessimistic explanatory style will have less favourable health outcomes. We identified 702 patients who had undergone 894 primary total knee replacements between 1993 and 2005, who responded to follow-up surveys at two (n = 783 knee replacements) and/or five years (n = 443 knee replacements) and had also completed the Minnesota Multiphasic Personality Inventory long before the joint replacement (median = 16.6 and 14.5 years for two- and five-year cohorts, respectively). Scores from the Minnesota Multiphasic Personality Inventory Optimism-Pessimism scale were used to categorise patients as pessimistic (t-score > 60) or non-pessimistic (t-score < or = 60). Multivariate logistic regression models assessing the effect of pessimistic explanatory style on pain or improvement in knee function were adjusted for gender, age, distance from the place of treatment and depression score. Pessimists reported (a) significantly more moderate or severe pain at two years with odds ratio 2.21 (95% confidence interval (CI) 1.12 to 4.35; p = 0.02), but not at five years when the odds ratio was 1.21 (95% CI 0.51 to 2.83; p = 0.67); and (b) less improvement in knee function at two years when the odds ratio was 0.53 (95% CI 0.30 to 0.96; p = 0.04), but not at five years when the odds ratio was 1.26 (95% CI 0.57 to 2.77; p = 0.57). No significant associations with moderate or severe limitation of activity were seen at two or five years. We conclude that a pessimistic explanatory style is associated with worse pain and functional outcomes two years after total knee replacement.
塞利格曼的因果归因理论预测，具有悲观解释风格的患者健康结局较差。我们确定了702例在1993年至2005年间接受了894次初次全膝关节置换术的患者，他们在两年（n = 783例膝关节置换术）和/或五年（n = 443例膝关节置换术）时回复了随访调查，并且在关节置换术之前很久就完成了明尼苏达多相人格调查表（两年和五年队列的中位数分别为16.6年和14.5年）。明尼苏达多相人格调查表乐观-悲观量表的得分用于将患者分类为悲观（t评分> 60）或非悲观（t评分<或= 60）。评估悲观解释风格对疼痛或膝关节功能改善影响的多变量逻辑回归模型针对性别、年龄、距治疗地点的距离和抑郁评分进行了调整。悲观者报告：（a）两年时中度或重度疼痛明显更多，优势比为2.21（95%置信区间（CI）1.12至4.35；p = 0.02），但五年时未出现，此时优势比为1.21（95%CI 0.51至2.83；p = 0.67）；以及（b）两年时膝关节功能改善较少，优势比为0.53（95%CI 0.30至0.96；p = 0.04），但五年时未出现，此时优势比为1.26（95%CI 0.57至2.77；p = 0.57）。在两年或五年时未发现与中度或重度活动受限有显著关联。我们得出结论，悲观解释风格与全膝关节置换术后两年时更差的疼痛和功能结局相关。
