Duke University School of Medicine, Durham, NC, USA.
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Health Qual Life Outcomes. 2021 May 1;19(1):136. doi: 10.1186/s12955-021-01772-2.
Patients' psychological health may influence recovery and functional outcomes after total knee arthroplasty (TKA). Pain catastrophizing, known to be associated with poor function following TKA, encompasses rumination, magnification, and helplessness that patients feel toward their pain. Resilience, however, is an individual's ability to adapt to adversity and may be an important psychological construct that supersedes the relationship between pain catastrophizing and recovery. In this study we sought to identify whether pre-operative resilience is predictive of 3-month postoperative outcomes after adjusting for pain catastrophizing and other covariates.
Patients undergoing TKA between January 2019 and November 2019 were included in this longitudinal cohort study. Demographics and questionnaires [Brief Resilience Scale (BRS), Pain Catastrophizing Scale (PCS), Knee injury and Osteoarthritis Outcome Score, Junior (KOOS, JR.) and Patient-Reported Outcomes Measurement Information System Physical and Mental Health (PROMIS PH and MH, respectively)] were collected preoperatively and 3 months postoperatively. Multivariable regression was used to test associations of preoperative BRS with postoperative outcomes, adjusting for PCS and other patient-level sociodemographic and clinical characteristics.
The study cohort included 117 patients with a median age of 67.0 years (Q1-Q3: 59.0-72.0). Fifty-three percent of patients were women and 70.1% were white. Unadjusted analyses identified an association between resilience and post-operative outcomes and the relationship persisted for physical function after adjusting for PCS and other covariates; in multivariable linear regression analyses, higher baseline resilience was positively associated with better postoperative knee function (β = 0.24, p = 0.019) and better general physical health (β = 0.24, p = 0.013) but not general mental health (β = 0.04, p = 0.738).
Our prospective cohort study suggests that resilience predicts postoperative knee function and general physical health in patients undergoing TKA. Exploring interventions that address preoperative mental health and resilience more specifically may improve self-reported physical function outcomes of patients undergoing TKA.
患者的心理健康可能会影响全膝关节置换术（TKA）后的恢复和功能结果。疼痛灾难化是与 TKA 后功能不良相关的一种现象，它包含了患者对自身疼痛的反刍、放大和无助感。然而，韧性是个体适应逆境的能力，可能是一种重要的心理结构，它超越了疼痛灾难化与恢复之间的关系。在这项研究中，我们试图确定术前的韧性是否可以预测调整疼痛灾难化和其他协变量后 3 个月的术后结果。
本纵向队列研究纳入了 2019 年 1 月至 2019 年 11 月期间接受 TKA 的患者。收集了患者的人口统计学和问卷调查数据[简要韧性量表（BRS）、疼痛灾难化量表（PCS）、膝关节损伤和骨关节炎结局评分，青少年版（KOOS，JR.）和患者报告的测量信息系统身体和心理健康量表（PROMIS PH 和 MH，分别）]，分别在术前和术后 3 个月收集。多变量回归用于测试术前 BRS 与术后结果的关联，调整了 PCS 和其他患者层面的社会人口统计学和临床特征。
研究队列包括 117 名中位年龄为 67.0 岁（Q1-Q3：59.0-72.0）的患者。53%的患者为女性，70.1%为白人。未调整分析确定了韧性与术后结果之间的关联，并且在调整 PCS 和其他协变量后，这种关系在身体功能方面仍然存在；在多变量线性回归分析中，基线时较高的韧性与术后膝关节功能更好（β=0.24，p=0.019）和一般身体健康状况更好（β=0.24，p=0.013）呈正相关，但与一般心理健康状况无关（β=0.04，p=0.738）。
我们的前瞻性队列研究表明，韧性预测了接受 TKA 的患者的术后膝关节功能和一般身体健康状况。探索更具体地针对术前心理健康和韧性的干预措施可能会改善接受 TKA 的患者的自我报告身体功能结果。
