Filardo G, Merli G, Roffi A, Marcacci T, Berti Ceroni F, Raboni D, Bortolotti B, Kon E, Marcacci M
Laboratory of Biomechanics and Technology Innovation/Ist Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna University, Via di Barbiano 1/10, Bologna, Italy.
Laboratory of NanoBiotechnology (NABI), Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, Italy.
Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3417-3423. doi: 10.1007/s00167-016-4201-3. Epub 2016 Jun 21.
To evaluate the effects of kinesiophobia on the outcomes of total knee arthroplasty (TKA), and to investigate whether kinesiophobia represents an independent factor influencing the surgery success or whether the observed effects are driven by other physical or psychological aspects such as anxiety and depression.
Two hundred patients were evaluated prospectively (mean age 65.7 ± 9.1 years, 134 women and 66 men) at 12 months after TKA. Kinesiophobia was assessed with the Tampa Scale for kinesiophobia (TSK: Activity Avoidance-TSK1 and Harm-TSK2 subscales); anxiety and depression were assessed with STAI and BDI, respectively, and preoperative pain and function, sex, age, BMI, education level, number of painful joints and years of symptoms' duration before surgery were documented as well. Results were evaluated with pain and function on 0-10 numeric rating scales, while the overall clinical outcome was documented with WOMAC and SF-12 (Physical and Mental subscales) scores.
TSK1 was correlated with WOMAC results at 12 months (p = 0.005, ρ = 0.197). STAI (p = 0.002, ρ = 0.222), BDI (p < 0.0005, ρ = 0.307), and sex (p = 0.004) also influenced the outcome after TKA, while other parameters, such as age, BMI, education level, and number of painful joints and years of symptoms' duration before surgery, did not correlate with the clinical outcome. The multivariate analysis confirmed the role of BDI (p = 0.006, partial η = 0.038), TSK1 (p = 0.011, partial η = 0.033), and sex (p = 0.048, partial η = 0.020), and a synergic interaction of BDI and TSK1, which together presented an even stronger correlation (p < 0.0005, partial η = 0.111) with WOMAC at 12-month follow-up.
Kinesiophobia is a factor influencing the outcome after TKA independently from other psychological and physical variables. This risk factor may affect TKA results, especially in women, and shows a further synergic interaction with depression in terms of lower surgical outcome. These findings are of clinical relevance because they show the impact of psychological factors such as kinesiophobia, and suggest the possibility of adopting co-interventions to overcome the fear of physical activity, and in the end improve patient recovery and final outcome after TKA.
IV.
评估运动恐惧对全膝关节置换术（TKA）结局的影响，并调查运动恐惧是否是影响手术成功的独立因素，或者观察到的影响是否由焦虑和抑郁等其他生理或心理因素驱动。
前瞻性评估200例TKA术后12个月的患者（平均年龄65.7±9.1岁，女性134例，男性66例）。使用坦帕运动恐惧量表（TSK：活动回避-TSK1和伤害-TSK2分量表）评估运动恐惧；分别使用状态特质焦虑量表（STAI）和贝克抑郁量表（BDI）评估焦虑和抑郁，并记录术前疼痛和功能、性别、年龄、体重指数（BMI）、教育水平、疼痛关节数量以及术前症状持续时间。采用0-10数字评分量表评估疼痛和功能结果，同时使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和简明健康状况调查量表（SF-12，生理和心理分量表）评分记录总体临床结局。
TSK1与12个月时的WOMAC结果相关（p = 0.005，ρ = 0.197）。STAI（p = 0.002，ρ = 0.222）、BDI（p < 0.0005，ρ = 0.307）和性别（p = 0.004）也影响TKA术后结局，而其他参数，如年龄、BMI、教育水平、疼痛关节数量以及术前症状持续时间，与临床结局无关。多变量分析证实了BDI（p = 0.006，偏η² = 0.038）、TSK1（p = 0.011，偏η² = 0.033）和性别（p = 0.048，偏η² = 0.020）的作用，以及BDI和TSK1的协同相互作用，在12个月随访时，它们与WOMAC的相关性更强（p < 0.0005，偏η² = 0.111）。
运动恐惧是独立于其他心理和生理变量影响TKA术后结局的一个因素。这个危险因素可能影响TKA结果，尤其是在女性中，并且在手术结局较低方面显示出与抑郁的进一步协同相互作用。这些发现具有临床相关性，因为它们显示了运动恐惧等心理因素的影响，并提示了采取联合干预措施以克服对身体活动的恐惧，最终改善TKA术后患者恢复情况和最终结局的可能性。
IV级。
