Department of Psychology, McGill University, Montreal, QC, Canada Department of Surgery, McGill University, Montreal, QC, Canada Department of Surgery, Dalhousie University, Halifax, NS, Canada.
Pain. 2011 Oct;152(10):2287-2293. doi: 10.1016/j.pain.2011.06.014. Epub 2011 Jul 18.
The present study examined the prospective value of response expectancies (ie, pain, sleep) and behavioral outcome expectancies (ie, return to function) in the prediction of pain severity and functional limitations 12 months after total knee arthroplasty (TKA). The study sample consisted of 120 individuals (73 women, 47 men) with osteoarthritis of the knee who were scheduled for TKA. Measures of expectancies, pain severity, pain catastrophizing, pain-related fears of movement, and depression were completed prior to surgery. Participants also completed measures of pain severity and functional limitations 12 months following surgery. Analyses revealed that behavioral outcome expectancies were stronger predictors of follow-up pain and functional limitations than response expectancies. Consistent with previous research, analyses also revealed that pain catastrophizing, pain-related fear of movement, and depression predicted follow-up pain and function. In a multivariate analysis, only pain catastrophizing contributed significant unique variance to the prediction of follow-up pain and function. Behavioral outcome expectancies partially mediated the relation between catastrophizing and follow-up pain and function. The relation between catastrophizing and follow-up pain severity and functional limitations remained significant even when controlling for behavioral outcome expectancies. The results suggest that interventions designed to specifically target behavioral outcome expectancies and catastrophizing might improve post-surgical outcomes.
本研究考察了在全膝关节置换术（TKA）后 12 个月时，反应预期（即疼痛、睡眠）和行为结果预期（即恢复功能）对疼痛严重程度和功能限制的预测价值。研究样本包括 120 名膝关节骨关节炎患者（73 名女性，47 名男性），他们计划接受 TKA。在手术前完成了对预期、疼痛严重程度、疼痛灾难化、与运动相关的疼痛恐惧和抑郁的测量。参与者还在手术后 12 个月完成了疼痛严重程度和功能限制的测量。分析表明，行为结果预期比反应预期更能预测术后疼痛和功能限制。与之前的研究一致，分析还表明，疼痛灾难化、与运动相关的疼痛恐惧和抑郁预测了术后疼痛和功能。在多元分析中，只有疼痛灾难化对随访疼痛和功能的预测有显著的独特差异。行为结果预期部分中介了灾难化与随访疼痛和功能之间的关系。即使控制了行为结果预期，灾难化与随访疼痛严重程度和功能限制之间的关系仍然显著。结果表明，专门针对行为结果预期和灾难化的干预措施可能会改善术后结局。
