University of Bristol, and Musculoskeletal Research Unit, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
Arthritis Care Res (Hoboken). 2011 Feb;63(2):286-92. doi: 10.1002/acr.20360.
To gain insight into patients' experiences of adjustment to chronic pain following recovery from total knee replacement (TKR) surgery.
Participants were purposively sampled and comprised 28 individuals, 18 women and 10 men, ages 57-87 years, who had undergone a TKR between 2 and 5 years previously. Semistructured interviews explored participants' perceptions of their condition and its impact, including its causes and consequences. Thematic analysis, using the constant comparison technique, was used to identify and analyze patterns and themes from the transcripts.
Although some individuals expressed acceptance of their continuing pain, others reported that it caused them considerable distress. Variation in expressed acceptance and distress was not related to self-reported pain severity. Various factors relating to adjustment emerged, including perceived improvement or deterioration in circumstances since TKR, surgeon input pre- and postsurgery, and beliefs about pain in the context of an individual's life. Participants described a sense of abandonment following TKR and discussed the support they felt they should have received.
The data suggest that adjustment to chronic pain following recovery from TKR surgery is influenced by biomedical and psychosocial factors, including an individual's pain-related illness cognitions, beliefs, and their perceptions of their condition in a social context. Patient care could be improved by clinicians utilizing a biopsychosocial framework to acknowledge the impact of osteoarthritis of the knee as a multidimensional health condition.
深入了解全膝关节置换 (TKR) 手术后慢性疼痛康复患者的调整体验。
采用目的性抽样，选取 28 名参与者，其中女性 18 名，男性 10 名，年龄 57-87 岁，TKR 术后 2-5 年。半结构化访谈探讨了参与者对自身状况及其影响的看法，包括其原因和后果。使用恒定比较技术的主题分析用于从转录本中识别和分析模式和主题。
尽管一些人表示接受他们持续的疼痛，但其他人报告说这给他们带来了相当大的痛苦。表达接受和痛苦的变化与自我报告的疼痛严重程度无关。与调整相关的各种因素出现，包括 TKR 后环境改善或恶化、手术前后医生的意见以及个体生活背景下对疼痛的信念。参与者描述了 TKR 后被抛弃的感觉，并讨论了他们认为应该得到的支持。
数据表明，TKR 手术后慢性疼痛的调整受到生物医学和心理社会因素的影响，包括个体的疼痛相关疾病认知、信念以及他们在社会背景下对自身状况的看法。临床医生可以通过利用生物心理社会框架来承认膝关节骨关节炎作为一种多维健康状况的影响，从而改善患者护理。
