Balck Friedrich, Jeszenszky Csilla, Günther Klaus-Peter, Kirschner Stephan, Linke Maike
Psychosocial Medicine and Development Neuroscience, University Hospital Dresden, Germany.
Clinic of Psychiatry, University Hospital Dresden, Dresden, Germany.
J Psychosom Res. 2022 Apr;155:110749. doi: 10.1016/j.jpsychores.2022.110749. Epub 2022 Feb 5.
According to the Common Sense Model (CSM), cognitive and emotional representations influence recovery. We used groups of individuals grouping multiple cognitive representations (schemas) to predict the recovery process after total hip arthroplasty (THR).
The aim of this prospective cohort study with three collection time points was to examine the significance of these schemas for functionality three and six months after THR. We assessed illness perception with the Illness Perception Questionnaire-Revised and the functionality with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were collected four weeks before (n = 317), three (n = 268), and six months after (n = 292) primary THR. Groups of individuals with the same schemas were identified using a two-step cluster analysis across cognitive representations. Controlling for WOMAC variables (functionality, stiffness, pain, and activities of daily living) before THR, we calculated the regression of schemas and emotional representations before THR on WOMAC variables after THR.
Before THR, two cognitive schemes were found: Schema One: medium identity, long duration, many consequences, low personal and treatment control, and low coherence; Schema Two: low identity, short timeline, low consequences, and high personal and treatment control. Patients with Schema Two had better functionality and lower pain and stiffness three months after surgery compared to those with Schema One. After three months, the influence of cognitive schemas was stronger on functionality than that of emotional representation (f: 0.04 /0.02).
Further study is needed to determine whether a psychological intervention can change Schema One.
根据常识模型（CSM），认知和情感表征会影响康复。我们使用对多种认知表征（图式）进行分组的个体群体来预测全髋关节置换术（THR）后的康复过程。
这项具有三个收集时间点的前瞻性队列研究的目的是检验这些图式对THR后三个月和六个月功能的重要性。我们使用修订后的疾病认知问卷评估疾病认知，并使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评估功能。在初次THR前四周（n = 317）、三个月（n = 268）和六个月（n = 292）收集数据。通过对认知表征进行两步聚类分析，确定具有相同图式的个体群体。在控制THR前的WOMAC变量（功能、僵硬、疼痛和日常生活活动）的情况下，我们计算了THR前的图式和情感表征对THR后的WOMAC变量的回归。
在THR前，发现了两种认知方案：方案一：中等认同度、持续时间长、后果多、个人和治疗控制低、连贯性低；方案二：认同度低、时间线短、后果少、个人和治疗控制高。与方案一的患者相比，方案二的患者在术后三个月功能更好，疼痛和僵硬程度更低。三个月后，认知图式对功能的影响比情感表征更强（F：0.04/0.02）。
需要进一步研究以确定心理干预是否可以改变方案一。
