Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA.
Division of Biology and Medicine, Brown University, Providence, RI, USA.
Hip Int. 2022 Sep;32(5):641-647. doi: 10.1177/1120700021992318. Epub 2021 Mar 7.
Despite improving diagnostic and surgical techniques, some patients do not respond as well as others following hip arthroscopy. In most musculoskeletal studies, predictors for surgical outcomes focus solely on physical health prior to surgery. However, there likely exists a relationship between a patient's mental health and their postoperative patient-reported outcome measures (PROMs).
40 patients who met indications for hip arthroscopy were enrolled in this prospective cohort study. All patients completed a baseline Brief Resilience Scale (BRS) and 4validated PROMs: modified Harris Hip Score (mHHS), visual analogue scale for pain (VAS), Hip Outcomes Score for Activities of Daily Living (HOS-Daily), and Hip Outcomes Score for Sports-Related Activities (HOS-Sport). For a secondary measure of psychometric evaluation, past medical histories of anxiety/depression were recorded. Patients were stratified into Low Resilience (LR < 21), Normal Resilience (NR 22-24), and High Resilience (HR > 25) by tertile to determine differences in PROMs. Comparisons and correlations of pre- and postoperative outcomes between resilience groups were performed.
In comparing the LR and HR groups, there was a significant relationship between resilience and all PROMs both preoperatively and 6 months postoperatively ( < 0.05), with the exception of the HOS-Sports. Pearson Correlation Coefficients confirmed this trend in the mHHS and the HOS-Daily. Additionally, there were sixteen patients who were discharged prior to 6-month follow-up with an average resilience above the mean of total population ( < 0.0001). Resilience was associated with return to activity ( = 0.017). A past history of anxiety/depression was associated with lower resilience ( = 0.039).
This study showed that HR hip arthroscopy patients had better PROMs than LR patients both preoperatively and postoperatively. HR patients were able to return to activity earlier and had lower rates of preoperative anxiety/depression. The BRS is a simple in-office screening tool, which may help guide patient and doctor communication and expectations.
尽管髋关节镜检查的诊断和手术技术不断提高，但仍有一些患者的术后效果不如其他患者。在大多数肌肉骨骼研究中，手术结果的预测因素仅关注手术前的身体健康。然而，患者的心理健康与他们术后的患者报告结局测量（PROMs）之间可能存在关系。
本前瞻性队列研究纳入了 40 名符合髋关节镜检查适应证的患者。所有患者均完成基线简明韧性量表（BRS）和 4 项经过验证的 PROMs：改良 Harris 髋关节评分（mHHS）、疼痛视觉模拟评分（VAS）、日常生活活动髋关节结局评分（HOS-Daily）和与运动相关活动髋关节结局评分（HOS-Sport）。作为心理测量评估的次要指标，记录了焦虑/抑郁的既往病史。患者按三分位法分为低韧性（LR<21）、正常韧性（NR 22-24）和高韧性（HR>25），以确定 PROMs 的差异。比较韧性组之间术前和术后的结果，并进行相关性分析。
LR 组和 HR 组比较，韧性与所有 PROMs（术前和术后 6 个月）均有显著相关性（ <0.05），除了 HOS-Sports。Pearson 相关系数在 mHHS 和 HOS-Daily 中证实了这一趋势。此外，有 16 名患者在 6 个月随访前出院，其平均韧性高于总人群的平均值（ <0.0001）。韧性与恢复活动相关（ =0.017）。焦虑/抑郁的既往史与韧性降低相关（ =0.039）。
本研究表明，HR 髋关节镜检查患者的 PROMs 无论是术前还是术后均优于 LR 患者。HR 患者能够更早地恢复活动，术前焦虑/抑郁的发生率较低。BRS 是一种简单的门诊筛查工具，可帮助指导医患沟通和期望。
