Khatib Yasser, Madan Aman, Naylor Justine M, Harris Ian A
Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, UNSW, 1 Campbell Street, Liverpool, NSW, 2170, Australia,
Clin Orthop Relat Res. 2015 Aug;473(8):2630-8. doi: 10.1007/s11999-015-4234-9. Epub 2015 Mar 20.
A subgroup of patients undergoing TKA is unhappy with the outcome of surgery and preoperative psychological factors may play a role in their dissatisfaction.
QUESTIONS/PURPOSES: We asked whether (1) psychological factors, as measured by preoperative self-reported questionnaires, predicted poor outcome after TKA, and (2) whether certain psychological factors examined predicted poor outcome better than others.
We performed a systematic review and meta-analysis of prospective observational studies published in MEDLINE, CINAHL®, EMBASE™, and PsycINFO® databases from their date of inception to October 2013, augmented with a manual search of bibliographies. Study eligibility was performed according to an a priori protocol. Included studies were assessed for quality according to the Newcastle-Ottawa scale. Two reviewers independently performed the search, identified eligible studies, assessed their methodologic quality, and extracted data. Outcomes of interest included postoperative dissatisfaction, pain, or limited function of the patients.
A total of 19 studies (17 cohort studies and two cross-sectional surveys) containing data on 9046 TKAs performed in 8704 adult patients were included in the review. Mean patient age was 68 years and followup ranged from 6 to 60 months (mean study followup, 14 months). Clinical and methodologic heterogeneity in study design prevented the statistical pooling of data and subsequent meta-analysis. Dissatisfaction rates with TKA ranged from 7.5% to 28.3%. Psychological health was deemed a significant predictor of satisfaction, pain, or function at a minimum of 6 months after TKA in 16 studies. The remaining three studies did not find this relationship. Baseline mental health factors may affect patient satisfaction, their long-term perception of pain, and their motivation to return to the desired level of function. We were unable to determine the most relevant psychological states or the most appropriate way to assess them with our systematic review.
The preoperative psychological state of a patient may affect the outcome after a TKA. A comprehensive psychological assessment of patients is required to examine the long-term effect of such psychological factors on the eventual outcomes of TKA once the recovery phase is complete and to assess the effect that treatment for these psychological conditions may have on decreasing the dissatisfaction rate with TKA in this population.
接受全膝关节置换术（TKA）的患者中有一部分对手术结果不满意，术前心理因素可能在其不满中起作用。
问题/目的：我们探讨了（1）通过术前自我报告问卷测量的心理因素是否能预测TKA术后效果不佳，以及（2）某些被研究的心理因素是否比其他因素能更好地预测不良结果。
我们对MEDLINE、CINAHL®、EMBASE™和PsycINFO®数据库中从建库至2013年10月发表的前瞻性观察性研究进行了系统评价和荟萃分析，并通过手工检索参考文献进行补充。根据预先制定的方案进行研究纳入。根据纽卡斯尔-渥太华量表对纳入研究的质量进行评估。两名评价者独立进行检索、确定符合条件的研究、评估其方法学质量并提取数据。感兴趣的结局包括患者术后不满意、疼痛或功能受限。
本评价纳入了19项研究（17项队列研究和2项横断面调查），这些研究包含了8704例成年患者进行的9046例TKA的数据。患者平均年龄为68岁，随访时间为6至60个月（研究平均随访时间为14个月）。研究设计中的临床和方法学异质性妨碍了数据的统计合并及后续的荟萃分析。TKA的不满意率在7.5%至28.3%之间。16项研究认为心理健康是TKA术后至少6个月时满意度、疼痛或功能的重要预测因素。其余三项研究未发现这种关系。基线心理健康因素可能影响患者满意度、其对疼痛的长期感知以及恢复到期望功能水平的动力。通过我们的系统评价，我们无法确定最相关的心理状态或评估它们的最合适方法。
患者的术前心理状态可能影响TKA术后的结果。需要对患者进行全面的心理评估，以研究这些心理因素在恢复阶段完成后对TKA最终结果的长期影响，并评估针对这些心理状况的治疗对降低该人群对TKA的不满意率可能产生的效果。
