Dhurve Kunal, Scholes Corey, El-Tawil Sherif, Shaikh Aseem, Weng Lai Kah, Levin Kumbelin, Fritsch Brett, Parker David, Coolican Myles
Sydney Orthopaedic Research Institute, L1, 445 Victoria Avenue, Chatswood, NSW 2067, Australia.
Knee. 2017 Aug;24(4):856-862. doi: 10.1016/j.knee.2017.04.005. Epub 2017 May 24.
The aims of this study were to identify the prevalence and causes of dissatisfaction in a cohort of private practice patients, and to compare the psychological characteristics of dissatisfied patients to matched, satisfied controls.
Unilateral TKR patients were evaluated to identify those dissatisfied with their TKR. Dissatisfied and satisfied patients were matched in terms of age, gender, follow-up duration and body mass index (BMI). Psychological evaluation was performed using the Pain Catastrophizing Scale (PCS), Depression, Anxiety and Stress Scale (DASS) and the Multidimensional Health Locus of Control (MHLC) scale. The preoperative grade of osteoarthritis, prevalence of comorbidities, and postoperative functional outcomes, were also compared.
A cohort comprised 301 patients (response rate 71%), with 24 patients (eight percent) dissatisfied at a mean follow-up of 37months (range eight to 74months). Persistent pain was the most common reason for dissatisfaction (n=10). Dissatisfied patients reported a significantly higher mean PCS score (P=0.03), higher depression component of the DASS (P=0.02) and lower internal locus of control (P=0.02). The dissatisfied group exhibited reduced improvement (P<0.05) in the Oxford Knee Score (OKS) and range of motion (ROM), as well as a lower preoperative grade of osteoarthritis compared to satisfied patients.
Dissatisfied patients exhibit an altered psychological profile to matched satisfied controls. In addition, they have lesser improvements in the OKS and ROM. Thus, both physical as well as psychological factors contribute to dissatisfaction. Identification of these factors may help in planning focused interventions to address dissatisfaction.
本研究旨在确定一组私人诊所患者中不满意情况的发生率及原因，并将不满意患者与匹配的满意对照组的心理特征进行比较。
对单侧全膝关节置换术（TKR）患者进行评估，以确定那些对其TKR不满意的患者。根据年龄、性别、随访时间和体重指数（BMI）对不满意和满意的患者进行匹配。使用疼痛灾难化量表（PCS）、抑郁、焦虑和压力量表（DASS）以及多维健康控制点（MHLC）量表进行心理评估。还比较了术前骨关节炎的分级、合并症的发生率以及术后功能结果。
该队列包括301名患者（应答率71%），在平均37个月（范围8至74个月）的随访中有24名患者（8%）不满意。持续疼痛是最常见的不满意原因（n = 10）。不满意患者报告的平均PCS得分显著更高（P = 0.03），DASS的抑郁分量更高（P = 0.02），而内控点更低（P = 0.02）。与满意患者相比，不满意组在牛津膝关节评分（OKS）和活动范围（ROM）方面的改善较小（P < 0.05），且术前骨关节炎分级较低。
与匹配的满意对照组相比，不满意患者表现出不同的心理特征。此外，他们在OKS和ROM方面的改善较小。因此，身体和心理因素均导致不满意。识别这些因素可能有助于规划针对性的干预措施以解决不满意问题。
