Belford Kathryn, Gallagher Nicola, Dempster Martin, Wolfenden Melanie, Hill Janet, Blaney Janine, O'Brien Seamus, Smit Anne-Marie, Botha Pieter, Molloy Dennis, Beverland David
School of Behavioural Sciences, Queens University Belfast, David Keir Building, 18-30 Malone Road, Belfast BT9 5BN, Northern Ireland.
Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast BT9 7JB, Northern Ireland.
Knee. 2020 Jun;27(3):1028-1034. doi: 10.1016/j.knee.2020.03.006. Epub 2020 Apr 13.
Total knee arthroplasty (TKA) aims to relieve pain and improve physical functioning of the knee, however, some patients continue to experience pain and impaired function following TKA which cannot be explained by surgical and implant factors. Psychological factors may influence the outcomes of TKA. The aim of this prospective study was to examine the psychosocial factors that predicted pain, stiffness and physical functioning up to one year following TKA.
One hundred and two patients completed pre-operative and one-year questionnaires which assessed a wide range of psychosocial and sociodemographic factors prior to surgery. The Oxford Knee Score (OKS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Stiffness and Physical Functioning subscales were used as outcome measures. Pearson correlation analysis and multiple linear regression were conducted to examine relationships between predictor and outcome variables.
Regression analysis showed that regarding variance in WOMAC outcome measures post TKA, our model predicted 31% for physical functioning, 25% for pain and 29% for stiffness at one year. Regarding variance in OKS post TKA, the model predicted 36% at one year. Greater levels of depressive symptoms and neuroticism and worse pre-operative scores significantly predicted poorer outcomes.
The findings indicate that pre-operative psychosocial factors are important in understanding outcomes of TKA. Psychosocial factors could be considered during pre-operative assessment. Further research conducted on psychological interventions is needed within this population to determine whether early and one-year outcomes can be improved.
全膝关节置换术（TKA）旨在缓解疼痛并改善膝关节的身体功能，然而，一些患者在TKA后仍持续经历疼痛和功能受损，而这无法通过手术和植入因素来解释。心理因素可能会影响TKA的结果。这项前瞻性研究的目的是检查在TKA后长达一年预测疼痛、僵硬和身体功能的心理社会因素。
102名患者完成了术前和一年期问卷调查，这些问卷在手术前评估了广泛的心理社会和社会人口学因素。牛津膝关节评分（OKS）以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛、僵硬和身体功能分量表被用作结局指标。进行了Pearson相关性分析和多元线性回归，以检查预测变量和结局变量之间的关系。
回归分析表明，关于TKA后WOMAC结局指标的方差，我们的模型在一年时预测身体功能的方差为31%，疼痛为25%，僵硬为29%。关于TKA后OKS的方差，该模型在一年时预测为36%。更高水平的抑郁症状和神经质以及更差的术前评分显著预测了更差的结局。
研究结果表明，术前心理社会因素对于理解TKA的结果很重要。在术前评估时可考虑心理社会因素。需要对该人群进行关于心理干预的进一步研究，以确定是否可以改善早期和一年期的结局。
