术前心理困扰会影响全膝关节置换术后的疼痛、功能和生活质量吗？
Does preoperative psychologic distress influence pain, function, and quality of life after TKA?
作者信息
Utrillas-Compaired Alfonso, De la Torre-Escuredo Basilio J, Tebar-Martínez Ana J, Asúnsolo-Del Barco Ángel
机构信息
Orthopaedics and Traumatology Department, Guadalajara University Hospital, 19002, Guadalajara, Spain,
出版信息
Clin Orthop Relat Res. 2014 Aug;472(8):2457-65. doi: 10.1007/s11999-014-3570-5. Epub 2014 Mar 27.
BACKGROUND
Preoperative psychologic distress is considered to be a risk factor for clinical dissatisfaction stemming from persistent pain and physical limitations after elective orthopaedic procedures such as lower-extremity arthroplasty. However, the degree to which psychologic distress, specifically in the form of anxiety and depression, influences surgical results has been poorly characterized.
QUESTIONS/PURPOSES: We analyzed the effect of preoperative psychologic distress on changes in pain, function, and quality of life 1 year after elective TKA.
METHODS
In this prospective cohort study, we assessed patients who underwent TKAs in 2009 and 2010. Before surgery, patients completed the Folstein Mini Mental Test, the Hospital Anxiety and Depression Scale (HAD), The Knee Society Score(©), the WOMAC quality-of-life questionnaire, and the VAS for pain. The patients were divided into two groups based on the degree of psychologic distress on the HAD Scale, and the groups were compared in terms of the above-listed clinical outcomes tools 1 year after surgery using multivariate linear models. Two hundred sixty-three patients met the inclusion criteria, and 202 (77%) completed the study protocol.
RESULTS
The presence of preoperative psychologic distress did not influence 1-year postoperative pain assessment (average reduction in pain, 40.33; 95% CI, 36.9-43.8; p = 0.18). The only factor influencing change in pain experienced by patients was the preoperative pain recorded (R(2) = 0.31; β = -0.82; p < 0.001). The patients experiencing preoperative psychologic distress obtained poorer outcomes in function (R(2) = 0.16; β = -5.62; p = 0.001) and quality of life (R(2) = 0.09; β = -0.46; p < 0.001) 1 year after receiving TKA.
CONCLUSIONS
The presence of preoperative psychologic distress is associated with worse 1-year outcomes for function and quality of life in patients undergoing TKA. Interventions designed to reduce psychologic distress may be indicated for patients to undergo this type of surgery, and incorporation of these data into discussions with patients may facilitate informed and shared decision making regarding the surgical treatment of knee osteoarthritis.
LEVEL OF EVIDENCE
Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
背景
术前心理困扰被认为是导致选择性骨科手术（如下肢关节置换术）后持续疼痛和身体功能受限而引起临床不满意的一个风险因素。然而，心理困扰，尤其是焦虑和抑郁形式的心理困扰对手术结果的影响程度，目前仍缺乏充分的描述。
问题/目的：我们分析了术前心理困扰对选择性全膝关节置换术（TKA）后1年疼痛、功能和生活质量变化的影响。
方法
在这项前瞻性队列研究中，我们评估了2009年和2010年接受TKA手术的患者。手术前，患者完成了简易精神状态检查表、医院焦虑抑郁量表（HAD）、膝关节协会评分（©）、WOMAC生活质量问卷以及疼痛视觉模拟评分法（VAS）。根据HAD量表上的心理困扰程度将患者分为两组，并使用多变量线性模型在术后1年根据上述临床结果工具对两组进行比较。263例患者符合纳入标准，202例（77%）完成了研究方案。
结果
术前存在心理困扰并不影响术后1年的疼痛评估（疼痛平均减轻40.33；95%可信区间，36.9 - 43.8；p = 0.18）。影响患者疼痛变化的唯一因素是术前记录的疼痛情况（R² = 0.31；β = -0.82；p < 0.001）。接受TKA术后1年，术前有心理困扰的患者在功能（R² = 0.16；β = -5.62；p = 0.001）和生活质量（R² = 0.09；β = -0.46；p < 0.001）方面的结果较差。
结论
术前存在心理困扰与接受TKA手术患者术后1年较差的功能和生活质量结果相关。对于接受此类手术的患者，可能需要采取旨在减轻心理困扰的干预措施，并且将这些数据纳入与患者的讨论中，可能有助于就膝关节骨关节炎的手术治疗做出明智且共同的决策。
证据水平
II级，治疗性研究。有关证据水平的完整描述，请参阅作者须知。
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