School of Medical Sciences .
Disabil Rehabil. 2013;35(23):2000-7. doi: 10.3109/09638288.2013.770082. Epub 2013 Mar 13.
Control cognitions have been directly related to positive engagement with rehabilitation regimes. The impact of such cognitions on recovery following surgery is not well understood.
To assess whether perceived control cognitions predict function 9-12 months following total hip replacement (THR).
Prospective cohort study performed as part of a randomised controlled trial. Behavioural cognitions (BC) (recovery locus of control (RLOC); perceived external behavioural control (PEBC))) and subjective functional outcome measures (Oxford hip score (OHS) and a reduced version of the Western Ontario and McMasters University Osteoarthritis Function scale (rWOMAC PF)) were administered pre-operatively and up to 12 months post-operatively to 50 patients randomised to home-based progressive resistance training (N = 26) or standard rehabilitation (N = 24), post-THR. Regression analysis investigated variance in functional scores.
Group randomisation had no effect on BC. RLOC and OHS (6 months) correlated significantly with 12-month OHS, with 6-month OHS predicting 62.3% of the variance in 12-month OHS. 12-month rWOMAC PF was determined by each of its three previous assessments (pre-operative 8.8%, 6 weeks 17.8% and 6 months 67.3%). Variance in functional gain at 12 months (OHS and rWOMAC PF) was explained by pre-operative OHS and rWOMAC PF (63.7% and 63.8%, respectively).
BC had no impact on functional outcome in this population. Subjectively assessed function at 12 months, as well as the levels of functional gain over time, was best explained by the patients' earlier functional status. Implications for Rehabilitation It is important to assess psychological factors such as poor pre-operative mental health and pain catastrophising in patients undergoing joint replacement surgery as these factors have an adverse effect on subjective patient outcomes. Pre-operative behavioural cognitions appear to have no impact on subjective functional outcome at 12 months post-THR. The pre-existing functional status of the patient appears to be most predictive of subjective function at 12 months post-THR, implying that perhaps earlier surgery may be optimal before the onset of a decline in function.
控制认知与积极参与康复治疗方案直接相关。这些认知对手术后恢复的影响尚不清楚。
评估全髋关节置换术后 9-12 个月时，感知控制认知是否可预测功能。
前瞻性队列研究，作为随机对照试验的一部分进行。行为认知（BC）（康复控制源（RLOC）；感知外部行为控制（PEBC））和主观功能结果测量（牛津髋关节评分（OHS）和简化版的西部安大略省和麦克马斯特大学骨关节炎功能量表（rWOMAC PF））在术前和术后 12 个月内对 50 名随机分配至家庭渐进式抗阻训练（n=26）或标准康复（n=24）的患者进行评估。回归分析调查了功能评分的方差。
组随机化对 BC 没有影响。RLOC 和 OHS（6 个月）与 12 个月的 OHS 显著相关，6 个月的 OHS 预测了 12 个月的 OHS 的 62.3%。12 个月 rWOMAC PF 由其前三次评估（术前 8.8%，6 周 17.8%和 6 个月 67.3%）决定。12 个月时功能增益的方差（OHS 和 rWOMAC PF）由术前 OHS 和 rWOMAC PF 解释（分别为 63.7%和 63.8%）。
在该人群中，BC 对功能结果没有影响。12 个月时的主观功能以及随时间推移的功能增益水平，最好由患者的早期功能状态来解释。
评估接受关节置换手术的患者的心理因素（如术前心理健康状况不佳和疼痛灾难化）非常重要，因为这些因素对患者的主观结果有不利影响。术前行为认知似乎对 THR 后 12 个月的主观功能没有影响。患者的初始功能状态似乎是 THR 后 12 个月主观功能的最主要预测因素，这意味着在功能下降之前，早期手术可能是最佳选择。
