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Drużbicki M, Kitrys Ł, Jabłoński J, Filip D, Perenc L, Guzik A. Return to Work after Primary Total Knee Arthroplasty: The First Polish Pilot Retrospective Study. J Clin Med 2024; 13:1902. [PMID: 38610666 PMCID: PMC11012819 DOI: 10.3390/jcm13071902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/02/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Total knee arthroplasty (TKA) performed on working-age patients significantly affects the participation of such patients in social life. A retrospective study was conducted to determine the return to work (RTW) rate after TKA. The goal of this study was to provide reference data for the Polish population and identify the factors impacting patients' decisions to return to or resign from work, relative to their functional performance. (2) Methods: This retrospective study involved 48 patients. An interview related to RTW was carried out to identify the factors impacting a patient's decision to return to or resign from work. Functional performance was assessed using the Knee Outcome Survey-Activities of Daily Living (KOS-ADL) scale. (3) Results: Before TKA, 15 individuals (31.25%) qualified for the study did not work and were receiving welfare benefits. After the surgery, 23 individuals (47.9% of those working prior to TKA) did not return to work. The number of those who did not work after TKA increased to 38 (79.17%), which was a significant change. The mean level of functional performance after TKA assessed using KOS-ADL was 75.89. (4) Conclusions: The findings show that the rate of RTW after TKA in Poland is significantly lower than that in other countries. The reasons for this situation, as shown in the study, may be related to the lack of an occupational rehabilitation system, resulting in a paucity of information about the possibility to return to work and about opportunities for retraining.
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Affiliation(s)
| | | | | | | | | | - Agnieszka Guzik
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (M.D.); (Ł.K.); (J.J.); (L.P.)
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Morriss NJ, Kim BI, Poehlein E, Park CN, Lentz TA, Green CL, Lau BC. Association Between Preoperative Multidimensional Psychological Distress and Physical Function After Surgery for Sports-Related Injury. Orthop J Sports Med 2023; 11:23259671231163854. [PMID: 37113137 PMCID: PMC10126611 DOI: 10.1177/23259671231163854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background Psychological distress after orthopaedic surgery can lead to worse outcomes, including higher levels of disability and pain and lower quality of life. The 10-item Optimal Screening for Prediction for Referral and Outcome-Yellow Flag (OSPRO-YF) survey screens for multiple psychological constructs relevant to recovery from orthopaedic injury and may be useful to preoperatively identify patients who may require further psychological assessment and possible intervention after surgery. Purpose/Hypothesis To determine the association between the OSPRO-YF and physiological patient-reported outcomes (PROs). It was hypothesized that higher OSPRO-YF scores (indicating worse psychological distress) would be associated with worse PRO scores at time of return to sport. Study Design Case series; Level of evidence, 4. Methods This study evaluated 107 patients at a single, academic health center who were assessed at a sports orthopaedics clinic and ultimately treated surgically for injuries to the knee, shoulder, foot, or ankle. Preoperatively, patients completed the OSPRO-YF survey as well as the following PRO measures: Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, numeric rating scale for pain; American Shoulder and Elbow Surgeons standardized shoulder assessment form for patients with shoulder injuries, the International Knee Documentation Committee score (for patients with knee injuries), and the Foot and Ankle Ability Measure (FAAM; for patients with foot or ankle injuries). At the time of anticipated full recovery and/or return to sport, patients again completed the same PRO surveys. Multivariable regression was used to evaluate the association between total OSPRO-YF score at baseline and PRO scores at the time of functional recovery. Results The baseline OSPRO-YF score predicted postoperative PROMIS Physical Function and FAAM Sports scores only. A 1-unit increase in the OSPRO-YF was associated with a 0.55-point reduction in PROMIS Physical Function (95% CI, -1.05 to -0.04; P = .033) indicating worse outcomes. Among patients who underwent ankle surgery, a 1-unit increase in OSPRO-YF was associated with a 6.45-point reduction in FAAM Sports (95% CI, -12.0 to -0.87; P = .023). Conclusion The study findings demonstrated that the OSPRO-YF survey predicts certain long-term PRO scores at the time of expected return to sport, independent of baseline scores.
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Affiliation(s)
- Nicholas J. Morriss
- Duke University School of Medicine,
Durham, North Carolina, USA
- Nicholas J. Morriss, BA,
Duke University School of Medicine, Duke University Medical Center, 200 Trent
Drive, Durham, NC 27710, USA (
)
| | - Billy I. Kim
- Duke University School of Medicine,
Durham, North Carolina, USA
| | - Emily Poehlein
- Department of Biostatistics and
Bioinformatics, Duke University School of Medicine Durham, North Carolina,
USA
| | - Caroline N. Park
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
| | - Trevor A. Lentz
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke
University, Durham, North Carolina, USA
| | - Cynthia L. Green
- Department of Biostatistics and
Bioinformatics, Duke University School of Medicine Durham, North Carolina,
USA
- Duke Clinical Research Institute, Duke
University, Durham, North Carolina, USA
| | - Brian C. Lau
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
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Sergooris A, Verbrugghe J, De Baets L, Meeus M, Roussel N, Smeets RJEM, Bogaerts K, Timmermans A. Are contextual factors associated with activities and participation after total hip arthroplasty? A systematic review. Ann Phys Rehabil Med 2023; 66:101712. [PMID: 36680879 DOI: 10.1016/j.rehab.2022.101712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/12/2022] [Accepted: 10/07/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES After total hip arthroplasty (THA), over 30% of individuals report activity limitations and participation restrictions. This systematic review aimed to determine the association between contextual factors and outcomes in the activity and participation domain after THA for hip osteoarthritis (OA). METHODS This systematic review was developed according to the PRISMA guidelines for systematic reviews. PubMed, Web of Science, Embase and Scopus were searched until August 2022. Risk of bias was assessed with the Quality in Prognosis Studies tool (QUIPS). RESULTS Twenty-nine articles were included. Eighteen had a high risk of bias, 3 had a low risk of bias, and 8 had a moderate risk of bias. Anxiety was only investigated in studies with high risk of bias but showed a consistent negative association with activities and participation after THA across multiple studies. Evidence was inconsistent regarding the associations between depression, trait anxiety, sense of coherence, big 5 personality traits, educational level, marital status, employment status, job position, expectations and social support, and the activity and participation domain. Optimism, general self-efficacy, cognitive appraisal processes, illness perception, ethnicity, and positive life events were associated with activities and participation but were only investigated in 1 study. No associations were identified across multiple studies for living or smoking status. Control beliefs, kinesiophobia, race, discharge location, level of poverty in neighbourhood, negative life events and occupational factors, were not associated with the activity and participation domain but were only investigated in 1 study. CONCLUSION Methodological quality of the included studies was low. Anxiety was the only factor consistently associated with worse outcomes in the activity and participation domain after THA but was only investigated in studies with high risk of bias. Further research is needed to confirm relationships between other contextual factors and activities and participation after THA. REGISTRATION PROSPERO CRD42020199070.
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Affiliation(s)
- Abner Sergooris
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium.
| | - Jonas Verbrugghe
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium
| | - Liesbet De Baets
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group (PAIN), Belgium
| | - Mira Meeus
- Department Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium; Pain in Motion Research Group (PAIN), Belgium
| | - Nathalie Roussel
- Department Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium; Pain in Motion Research Group (PAIN), Belgium
| | - Rob J E M Smeets
- Department Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Research School CAPHRI and CIR Revalidatie, Eindhoven, the Netherlands; Pain in Motion Research Group (PAIN), Belgium
| | - Katleen Bogaerts
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium; Department Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium
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Kondo Y, Higuchi D, Miki T, Watanabe Y, Takebayashi T. Influence of Pain Self-Efficacy and Gender on Disability in Postoperative Cervical Myelopathy. Pain Manag Nurs 2023; 24:335-341. [PMID: 36621459 DOI: 10.1016/j.pmn.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 12/03/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pain self-efficacy and gender may influence disability in patients with musculoskeletal disorders. The direct and interactive influence of pain self-efficacy and gender on postoperative disability with degenerative cervical myelopathy (DCM) is unclear. AIM This study aimed to determine the effects of age, pain, and pain self-efficacy on disability postoperatively in patients with DCM, and explore whether these effects differ by gender. METHOD A total of 180 participants who underwent DCM surgery were consecutively recruited. The following were evaluated: (1) demographic/descriptive data (age, gender, diagnosis, surgery date, procedure); (2) numerical rating scale pain and dysesthesia intensity; (3) Neck Disability Index; and (4) Pain Self-Efficacy Questionnaire. Hierarchical multiple regression analysis and simple slope analysis determined the effect of patients' biologic and psychosocial factors, and their interaction in terms of disability. RESULTS The responses of 82 participants were analyzed. The hierarchical multiple regression final model analysis determined 57.1% participant disability variance; gender (B = 3.388; p < .01); pain (B = 3.574; p < .01); pain self-efficacy (B = -0.229; p < .01); age and gender (B = -0.201; p < .05); pain and gender (B = -3.749; p < .01); pain self-efficacy and gender (B = -0.304; p < .01) were significantly associated with disability. Simple slope test indicated that women showed weaker pain associations and stronger age and pain self-efficacy associations with disability than men. CONCLUSIONS Pain self-efficacy improvement should be focused on after surgery in patients with DCM, especially women.
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Affiliation(s)
- Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan.
| | - Daisuke Higuchi
- Department of Physical Therapy, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Yuta Watanabe
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
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Hardwick-Morris M, Carlton S, Twiggs J, Miles B, Liu D. Pre- and postoperative physiotherapy using a digital application decreases length of stay without reducing patient outcomes following total knee arthroplasty. ARTHROPLASTY 2022; 4:30. [PMID: 35915464 PMCID: PMC9344731 DOI: 10.1186/s42836-022-00133-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/05/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Total Knee Arthroplasty (TKA) for both patients and the surgical team is a journey spanning many months, rather than purely a hospital episode of care. To improve patient outcomes and reduce costs in TKA, greater emphasis should be placed on the pre- and postoperative periods as, historically, innovation has focused on the intraoperative execution of the surgery. The purpose of this study was to determine if a pre- and postoperative physiotherapy program delivered via a digital application could reduce hospital length of stay (LOS) without compromising patient outcomes. Methods A retrospective series of 294 patients who underwent TKA from a single-surgeon in a single-centre was examined. This included 232 patients who underwent a pre- and postoperative physiotherapist-led program delivered via a digital application and 62 patients who underwent a conventional pre- and postoperative protocol. 2:1 nearest neighbour propensity score matching was performed to establish covariate balance between the cohorts. Data collected included pre- and postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS for Joint Replacement (KOOS, JR), and acute, rehabilitation, and total LOS. Results No significant difference in KOOS or KOOS, JR scores was observed at 12-month follow-up. A significantly reduced rehabilitation (P = 0.014) and total LOS (P = 0.015) was observed in the patients who received the digital physiotherapy program. Conclusions There may be significant economic benefits to a pre- and postoperative physiotherapy program delivered via a digital application. Our results suggest that a digital physiotherapist-led patient program may reduce the need for inpatient rehabilitation services without compromising patient outcomes.
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Hall A, Dandu N, Sonnier JH, Rao S, Holston K, Liu J, Freedman K, Tjoumakaris F. The Influence of Psychosocial Factors on Hip Surgical Disorders and Outcomes After Hip Arthroscopy: A Systematic Review. Arthroscopy 2022; 38:3194-3206. [PMID: 35660519 DOI: 10.1016/j.arthro.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the associations between mental health and preoperative or postoperative outcomes of hip arthroscopy for femoroacetabular impingement. METHODS The literature search was conducted using the PubMed, EMBASE and PsychINFO databases following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. RESULTS Nine studies were identified that met the inclusion and exclusion criteria. All studies assessing patient-reported outcomes found significantly lower patient-reported outcomes (modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, and International Hip Outcome Tool scores) related to worse mental health functioning before surgery. Specifically, preoperative Hip Outcome Score-Activities of Daily Living and Hip Outcome Score-Sports-Specific Subscale were significantly greater in control patients than patients in the mental health group by 11.6 points (mean difference; 95% confidence interval 7.58-15.79, P < .001) and 10 points (95% confidence interval 5.14-14.87, P < .001), without significant heterogeneity between studies (I2 = 28.59, P = .25; I2 = 0, P = .93), respectively. Patients with lower mental health status also had lower rates of achieving a minimal clinically important difference in 5 studies included in this review. CONCLUSIONS This systematic review finds consistent evidence supporting the association between negative psychological function and worse preoperative and postoperative outcomes for patients with hip disorders. Understanding both the effect of mental health on surgical outcomes and the potential benefits of psychological intervention may represent an opportunity to improve patient outcomes following hip arthroscopy. LEVEL OF EVIDENCE IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Anya Hall
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Navya Dandu
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Somnath Rao
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kayla Holston
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - James Liu
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kevin Freedman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
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7
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Olsen U, Lindberg MF, Rose C, Denison E, Gay C, Aamodt A, Brox JI, Skare Ø, Furnes O, Lee K, Lerdal A. Factors Correlated With Physical Function 1 Year After Total Knee Arthroplasty in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2219636. [PMID: 35816307 PMCID: PMC9274324 DOI: 10.1001/jamanetworkopen.2022.19636] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE More than 1 in 5 patients do not experience improved physical function after total knee arthroplasty (TKA). Identification of factors associated with physical function may be warranted to improve outcomes in these patients. OBJECTIVE To identify preoperative and intraoperative factors associated with physical function at 12 months after TKA in a systematic review and meta-analysis. DATA SOURCES Data from January 2000 to October 2021 were searched in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Physiotherapy Evidence Database (PEDro). No language restrictions were applied. STUDY SELECTION Prospective observational studies or randomized clinical trials on factors associated with physical function after TKA in adult patients with osteoarthritis were selected. A prespecified peer-reviewed protocol was followed. DATA EXTRACTION AND SYNTHESIS Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline, 2 reviewers independently screened titles and abstracts and judged risk of bias using Quality in Prognosis Studies (QUIPS). Multivariate random-effects meta-analyses were performed to estimate mean correlations between factors and physical function with 95% CIs. Sensitivity analyses were conducted for each QUIPS domain. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO). MAIN OUTCOMES AND MEASURES The primary outcome was physical function 12 months after TKA. Secondary outcomes were physical function 3 and 6 months after TKA. All estimates are mean correlations between factors and postoperative function. Positive correlations correspond to better function. RESULTS Among 12 052 articles, 20 studies (including 11 317 patients and 37 factors) were analyzed. Mean correlation with higher BMI was estimated to be -0.15 (95% CI, -0.24 to -0.05; P = .33; moderate-certainty evidence), while mean correlation with better physical function was estimated to be 0.14 (95% CI, 0.02 to 0.26; P = .03; low-certainty evidence) and mean correlation with more severe osteoarthritis was estimated to be 0.10 (95% CI, 0.01 to 0.19; P = .17; high-certainty evidence). In sensitivity analyses, mean correlation with better physical function was estimated to be 0.20 (95% CI, 0.04 to 0.36; P = .02), and so perhaps a larger coefficient than in the main analysis, while mean correlations were estimated to be similar for other factors (BMI: -0.17; 95% CI, -0.28 to -0.06; P < .001; osteoarthritis severity: 0.10; 95% CI, -0.01 to 0.20; P = .05). CONCLUSIONS AND RELEVANCE This study found that higher presurgical BMI was correlated with worse physical function (with moderate certainty) and that better physical function (low certainty) and osteoarthritis severity (high certainty) were correlated with better physical function after TKA. These findings suggest that these factors should be included when testing predictive models of TKA outcomes.
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Affiliation(s)
- Unni Olsen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Maren Falch Lindberg
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Christopher Rose
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Eva Denison
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Caryl Gay
- Department of Family Health Care Nursing, University of California, San Francisco
- Department of Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Skare
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kathryn Lee
- Department of Family Health Care Nursing, University of California, San Francisco
| | - Anners Lerdal
- Department of Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Lane E, Magel JS, Thackeray A, Greene T, Fino NF, Puentedura EJ, Louw A, Maddox D, Fritz JM. Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial. Pain 2022; 163:852-860. [PMID: 34354017 PMCID: PMC8816964 DOI: 10.1097/j.pain.0000000000002436] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: -0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to -6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.
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Affiliation(s)
- Elizabeth Lane
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - John S. Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Tom Greene
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
- Population Health, Research Study Design and Biostatistics Center, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Nora F. Fino
- Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Adriaan Louw
- Department of Physical Therapy, Evidence in Motion, San Antonio, TX, United States
| | - Daniel Maddox
- Department of Physical Therapy, Brenau University, Gainesville, GA, United States
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- College of Health, University of Utah, Salt Lake City, UT, United States
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9
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FitzGerald J, Wells YD, Ellis JM. Psychosocial modification of general self-efficacy in older adults: A restricted review. Australas J Ageing 2022; 41:e210-e226. [PMID: 35235249 PMCID: PMC9545063 DOI: 10.1111/ajag.13052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In recent years, the concept of general self-efficacy has increased in popularity. General self-efficacy is positively associated with quality of life and has the potential to act as a psychological buffer against adverse events and circumstances. However, due to the long-term influences that are said to shape general self-efficacy beliefs, they may be resistant to intervention, particularly within the older population. This restricted review aimed to explore whether psychosocial interventions could improve the general self-efficacy of older adults. Aspects of intervention design associated with improvements were also investigated. METHODS A restricted review was undertaken. This included a keyword search of four major health databases (PubMed, CINAHL, PsycINFO and AgeLine). Search terms focused on general self-efficacy and the commonly used measures of this concept and were limited to the older adult population. RESULTS In total, 848 articles were screened, with 20 studies proceeding to data extraction. The modification of general self-efficacy in older adults appears possible, with 7 out of the 20 included studies reporting improvements postintervention. Despite issues relating to the quality of included studies and the generalisability of their results, several aspects of intervention design coincided with intervention success, including intervention duration, and employing sufficiently-qualified staff. CONCLUSIONS Future research must address the generalisability issues identified in this review. Studies comparing the effectiveness of individual- and group-based interventions, the efficacy of remote delivery platforms and the possibility for long-term transfer of any improvements are needed to contribute the high-quality data required for policy and practice decisions in this area.
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Affiliation(s)
- Jarrah FitzGerald
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne D Wells
- Lincoln Centre for Research on Ageing, Australian Institute for Primary Care & Ageing, La Trobe University, Melbourne, Victoria, Australia
| | - Julie M Ellis
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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10
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Hiraga Y, Babazono A, Hara R, Nomiyama K, Hirakawa Y. Rehabilitation interventions incorporating self-management improve psychological factors: A non-randomized controlled trial of patients after total Knee arthroplasty. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2033468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Yuki Hiraga
- Department of Occupational Therapy, Faculty of Health Science, International University of Health and Welfare, Okawa, Japan
- Department of Health Sciences, International University of Health and Welfare Graduate School, Okawa, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Kyushu University, Fukuoka, Japan
| | - Ryusei Hara
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka, Japan
| | - Katsuhiro Nomiyama
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka, Japan
| | - Yoshiyuki Hirakawa
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka, Japan
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11
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Vu PH, Tran DV, Dao TTH, Dong OT, Nguyen TT, Nguyen TH. Patients' Active Participation in Postoperative Pain Management in an Urban Hospital of Vietnam: Implications for Patient Empowerment. Hosp Top 2021; 101:227-234. [PMID: 34904528 DOI: 10.1080/00185868.2021.2014767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Active participation in pain management is vital to improve postoperative pain outcomes. However, this issue has not been fully examined in Vietnam. This study aimed to examine the active participation of patients in pain management after surgery, as well as explore its effect on acute postoperative pain. A hospital-based survey on 245 patients after surgery was conducted. Information about demographic and clinical characteristics, pain intensity and active participation in pain management was collected. Multivariate regression models were utilized to determine the associations. 53.9% of patients reported that they were informed about the postoperative pain relief method before surgery. One-third (33.5%) of patients selected preferred pain relief methods; 46.1% reported that they asked physicians when feeling pain immediately after surgery; 49.8% asked physicians when pain was not relieved after taking medications, and 52.2% asked physicians for their current pain in the time of interview. Age and occupation were found to be positively associated with active participation score. Patients being informed about the postoperative pain relief method before surgery had 0.87 points higher than those not receiving explanation (Coef. = 0.87; 95%CI = 0.49-1.26). Patients with high active participation scores were more likely to have pain improvement (OR = 3.41, 95%CI = 2.37-4.92). This study highlights a low level of active participation in postoperative pain management among Vietnamese patients. Routinely providing information about pain control before surgery, and encouraging patients to actively participate in pain management are essential to improve postoperative pain outcomes.
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Affiliation(s)
- Phuong Hoang Vu
- Hanoi Medical University Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
| | | | | | - Oanh Tu Dong
- Hanoi Medical University Hospital, Hanoi, Vietnam
| | | | - Tu Huu Nguyen
- Hanoi Medical University Hospital, Hanoi, Vietnam
- Hanoi Medical University, Hanoi, Vietnam
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12
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Beischer S, Hamrin Senorski E, Thomeé P, Thomeé R. Validation of an 18-item version of the Swedish Knee Self-Efficacy Scale for patients after ACL injury and ACL reconstruction. J Exp Orthop 2021; 8:96. [PMID: 34693487 PMCID: PMC8542523 DOI: 10.1186/s40634-021-00414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the measurement properties of a new version of the Swedish Knee Self-Efficacy Scale (K-SES) in samples of individuals with an anterior cruciate ligament (ACL) injury and after ACL reconstruction. A secondary aim was to translate the new version of K-SES into English in order to prepare for future complete cross-cultural adaptation. Methods The reliability, structural validity, internal consistency and construct validity of the new, 18-item version of the K-SES (K-SES18) were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for evaluating methodological quality. The Swedish version of the K-SES18 was translated to English using recommended guidelines. Results The test-retest reliability for the K-SES18 subscale present and the K-SES18 subscale future showed an Interclass Correlation Coefficient (ICC) = 0.92. In addition, the K-SES18 had a Cronbach’s α ranging from 0.93 to 0.96 for the K-SES18 subscale present and from 0.81 to 0.91 for the K-SES18 subscale future. No floor and ceiling effects were identified for the subscale present or the subscale future of the K-SES18. A factor analysis produced 2 factors of importance; K-SES18present and K-SES18future. Seven predefined hypotheses were confirmed. Conclusion The K-SES18 has acceptable reliability and validity to assess knee self-efficacy in patients up to 18 months after ACL injury and reconstruction. Level of evidence IV. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00414-2.
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Affiliation(s)
- S Beischer
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30, Gothenburg, Sweden. .,Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden.
| | - E Hamrin Senorski
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30, Gothenburg, Sweden.,Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - P Thomeé
- Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden
| | - R Thomeé
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, SE-405 30, Gothenburg, Sweden.,Sportrehab Sports Medicine Clinic, Stampgatan 14, SE-411 01, Gothenburg, Sweden
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13
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Are Psychosocial Factors Predictors of Pain and Functional Outcomes After Knee Arthroplasty at 6 and 12 Months After Surgery? A Systematic Review. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Björk M, Niklasson J, Westerdahl E, Sagerfors M. Self-efficacy corresponds to wrist function after combined plating of distal radius fractures. J Hand Ther 2021; 33:314-319. [PMID: 32088082 DOI: 10.1016/j.jht.2020.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/06/2019] [Accepted: 01/12/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A prospective cohort single-center study. INTRODUCTION Self-efficacy (SE) refers to beliefs in ones capabilities to organize and execute the courses of action required to produce given goals. High SE is an important factor for recovery from injury/illness; people who believe in their capability will more likely reach a good outcome. PURPOSE OF THE STUDY The aim of this study was to examine if SE has an effect to physical functioning, pain and patient-rated wrist function three months postoperatively in patients undergoing plating due to a distal radius fracture. METHODS Sixty-seven patients undergoing plating for a distal radius fracture rated SE at the first appointment with the physiotherapist. At the three-month follow-up, the following assessments were administered: Patient-Rated Wrist Evaluation (PRWE), pain-scores, hand grip strength, and range of motion. RESULTS The group with a high SE showed significantly better range of motion for flexion (P = .046) and supination (P = .045), hand grip strength (P = .001) and PRWE scores (P = .04). The NRS pain during activity was lower, although not significantly lower (P = .09). Using Spearman's rank correlation coefficient, there was a moderate correlation between SE and pain during activity, wrist flexion, and PRWE score. DISCUSSION SE corresponds to wrist function after combined plating of distal radius fractures. CONCLUSION Measurement of SE could possibly be useful to identify patients in special need of support during the postoperative rehabilitation.
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Affiliation(s)
- Marie Björk
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden
| | - Johan Niklasson
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden
| | - Elisabeth Westerdahl
- Faculty of Medicine and Health, Department of Physiotherapy, Örebro University, Örebro, Sweden
| | - Marcus Sagerfors
- Faculty of Medicine and Health, Department of Hand Surgery, Örebro University, Örebro, Sweden.
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15
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López-Bravo MD, Zamarrón-Cassinello MD, Touche RL, Muñoz-Plata R, Cuenca-Martínez F, Ramos-Toro M. Psychological Factors Associated with Functional Disability in Patients with Hip and Knee Osteoarthritis. Behav Med 2021; 47:285-295. [PMID: 32910744 DOI: 10.1080/08964289.2020.1813682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several studies have shown an association between psychosocial variables and functional capacity in chronic pain processes such as osteoarthritis. The aim of this study was to test a structural equations model that shows the predictive weight of certain variables such as catastrophizing, self-efficacy and kinesiophobia on functional pain and WOMAC subscales scores of pain and physical function of older patients diagnosed with hip and knee osteoarthritis. We also assessed the specific weight of age in terms of the factors. The study was conducted on a sample of 170 patients (142 women and 28 men mean age, 74.44 years range, 50-96 years). The main variables evaluated were WOMAC subscales scores of pain and physical function, self-efficacy, catastrophizing and kinesiophobia. To assess these variables, we used the Spanish validated version of the Western Ontario and McMaster Universities questionnaire, the Chronic Pain Self-Efficacy Scale, the Pain Catastrophizing Scale and the Tampa Scale for Kinesiophobia, respectively. We tested a structural equations model (IBM SPSS Amos version 22). The results showed the predominant predictive weight (both direct and indirect) of catastrophizing while simultaneously ruling out the relevance of age as a predictor of WOMAC subscales scores of pain and physical function. This study provides data of interest on the explanatory mechanisms that underlie the direct and inverse relationships between the studied psychological variables.
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Affiliation(s)
- María Dolores López-Bravo
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Dolores Zamarrón-Cassinello
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid Ciudad Universitaria de Cantoblanco, Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Rosa Muñoz-Plata
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mónica Ramos-Toro
- Instituto de Gerontología y Servicios Sociales (INGESS), Madrid, Spain
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16
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Fonseca-Rodrigues D, Rodrigues A, Martins T, Pinto J, Amorim D, Almeida A, Pinto-Ribeiro F. Correlation between pain severity and levels of anxiety and depression in osteoarthritis patients: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 61:53-75. [PMID: 34152386 DOI: 10.1093/rheumatology/keab512] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Osteoarthritis (OA) is a chronic degenerative musculoskeletal disease that causes articular damage and chronic pain, with a prevalence of up to 50% in individuals >60 years of age. Patients suffering from chronic painful conditions, including OA, also frequently report anxiety or depression. A systematic review and meta-analysis were performed to assess the correlation between pain severity and depressive and anxious symptomatology in OA patients. METHODS A systematic search was conducted using four databases (PubMed, Medline, Scopus, and Web of Science) from inception up to 14th January of 2020. We included original articles evaluating pain severity and anxiety and/or depression severity in OA-diagnosed patients. Detailed data were extracted from each study, including patients' characteristics and pain, anxiety, and depression severity. When available, the Pearson correlation coefficient between pain and depression severity and pain and anxiety severity was collected and a meta-analysis of random effects was applied. RESULTS This systematic review included 121 studies, with a total of 38085 participants. The mean age was 64.3 years old and subjects were predominantly female (63%). The most used scale to evaluate pain severity was the Western Ontario and the McMaster Universities Osteoarthritis Index, while for anxiety and depression, the Hospital Anxiety and Depression Scale was the most used. The meta-analysis showed a moderate positive correlation between pain severity and both anxious (r = 0.31, p < 0.001) and depressive symptomatology (r = 0.36, p < 0.001). CONCLUSIONS Our results demonstrate a significant correlation between pain and depression/anxiety severity in OA patients, highlighting the need for its routine evaluation by clinicians.
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Affiliation(s)
- Diana Fonseca-Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - André Rodrigues
- School of Medicine, University of Minho, Braga, Portugal.,Anesthesiology Department, Coimbra Hospital and Universitary Centre (CHUC), Praceta Prof. Mota Pinto, Coimbra, Portugal
| | - Teresa Martins
- School of Medicine, University of Minho, Braga, Portugal
| | - Joana Pinto
- School of Medicine, University of Minho, Braga, Portugal
| | - Diana Amorim
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,School of Medicine, University of Minho, Braga, Portugal
| | - Filipa Pinto-Ribeiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,School of Medicine, University of Minho, Braga, Portugal
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17
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Nishigami T, Tanaka S, Mibu A, Imai R, Wand BM. Knee-related disability was largely influenced by cognitive factors and disturbed body perception in knee osteoarthritis. Sci Rep 2021; 11:5835. [PMID: 33712725 PMCID: PMC7970993 DOI: 10.1038/s41598-021-85307-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to explore the existence of subgroups in a cohort of people with knee osteoarthritis (OA) based upon data from multiple pain-related variables and to profile identified clusters according to levels of pain intensity and knee-related disability. Three hundred and three people with knee OA were recruited. Latent profile analysis was used to confirm the optimal number of knee OA subgroups. Body mass index, radiographic knee OA severity, pain catastrophizing, pain related self-efficacy, and knee specific self-perception, were incorporated into the model. Cluster, demographic and clinical variables were compared between the resulting classes. Four distinct classes were identified. Cluster 1 (28.7%) represented early radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 2 (18.8%) showed advanced radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 3 (34.3%) represented various levels of radiographic OA, and the lowest pain intensity, disability and cognitive and perceptual dysfunction. Cluster 4 (18.1%) represented various levels of radiographic OA, the highest disability and cognitive and perceptual dysfunction. Considering cognitive factors and disturbed body perception may help to explain the phenomenon of the discrepancy between the knee-related disability and the severity of radiographic knee OA.
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Affiliation(s)
- Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-tyou, Mihara, Hiroshima, 723-0053, Japan.
| | - So Tanaka
- Department of Rehabilitation, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagikawachi, Minami-ku, Fukuoka, Fukuoka, 815-0063, Japan
| | - Akira Mibu
- Department of Physical Therapy, Konan Women's University, 6-2-23 Morikita-machi, Higashinada-ku, Kobe, Hyogo, 658-0001, Japan
| | - Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka, Osaka, 597-0104, Japan
| | - Benedict Martin Wand
- School of Physiotherapy, The University of Notre Dame Australia, 32 Mouat St, Fremantle, WA, 6160, Australia
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18
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Pogatzki-Zahn E. [Prediction and prevention of chronic postoperative pain]. Schmerz 2021; 35:30-43. [PMID: 33471209 DOI: 10.1007/s00482-020-00525-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
Chronic postoperative pain has been identified as a major medical and socioeconomic problem. A prevention of the chronification processes is potentially possible and preventive treatment could start early (e.g. preoperatively). So far, however, evidence for the effectiveness of preventive strategies is basically low. Important reasons for this dilemma are the lack of appropriate risk assessment as well as effective and mechanism-based preventive (procedure-sepcific) strategies for the chronification process, a lack of stratification of treatment approaches and a so far barely investigated combination of various treatment approaches. In this review article recent findings on the appropriate identification of patients at risk for developing postoperative chronic pain are presented, predictive models for the valid estimation of the individual risk of patients are assessed and studies on pharmaceutical and regional analgesia techniques influencing the pain chronification process are discussed. As a chronification process is, however, extremely complex and dynamic and also necessitates adaptation of the prevention during the course of the process, only combinations of treatment, interdisciplinary and if necessary even longer term approaches might be successful. Future studies are needed to address with which preventive treatment strategies and in which patients chronic pain after surgery can effectively be prevented.
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Affiliation(s)
- Esther Pogatzki-Zahn
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
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19
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Hawker GA, Conner-Spady BL, Bohm E, Dunbar MJ, Jones CA, Ravi B, Noseworthy T, Woodhouse LJ, Peter F, Dick D, Powell J, Paul P, Marshall DA. The Relationship between Patient-Reported Readiness for Total Knee Arthroplasty and Likelihood of a Good Outcome at One Year. Arthritis Care Res (Hoboken) 2021; 74:1374-1383. [PMID: 33460528 DOI: 10.1002/acr.24562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 01/12/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the relationship between patients' pre-operative readiness for total knee arthroplasty (TKA) and surgical outcome at one-year. METHODS This prospective cohort study recruited knee osteoarthritis (OA) patients aged 30+ years referred for TKA at two hip/knee surgery centers in Alberta, Canada. Those who received primary, unilateral TKA completed questionnaires pre-TKA to assess WOMAC-pain, KOOS-physical function, Perceived Arthritis Coping Efficacy, General Self-Efficacy, PHQ-8, BMI, comorbidities and TKA readiness (Patient Acceptable Symptom State; willingness to undergo TKA), and one-year post-TKA to assess outcomes. A good TKA outcome was defined as improved knee symptoms (OARSI-OMERACT responder criteria) AND overall satisfaction with results. Poisson regression with robust error estimation was used to estimate relative risk of a good outcome for exposures, before and after controlling for covariates. RESULTS Of 1,272 TKA recipients assessed at one year, 1,053 with data for our outcome were included (mean age 66.9 years (SD 8.8); 58.6% female). Most (87.8%) were definitely willing to undergo TKA and had 'unacceptable' knee symptoms (79.7%). 78.1% achieved a good TKA outcome. Controlling for pre-TKA OA-related disability, arthritis coping efficacy, comorbid hip symptoms and depressed mood, definite willingness to undergo TKA and unacceptable knee symptoms were associated with greater likelihood of a good TKA outcome (adjusted RRs 1.18, 95% CI 1.04-1.35, and 1.14, 95% CI 1.02-1.27, respectively). CONCLUSION Among TKA recipients for knee OA, patients' psychological readiness and willingness for TKA were associated greater likelihood of a good outcome. Incorporation of these factors in TKA decision-making may enhance patient outcomes and appropriate use of TKA.
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Affiliation(s)
- Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Eric Bohm
- Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tom Noseworthy
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.,School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia
| | - Faris Peter
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Donald Dick
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - James Powell
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paulose Paul
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Niederstrasser NG, Cook S. Investigating the True Effect of Psychological Variables Measured Prior to Arthroplastic Surgery on Postsurgical Outcomes: A P-Curve Analysis. THE JOURNAL OF PAIN 2020; 22:400-414. [PMID: 33098977 DOI: 10.1016/j.jpain.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 07/02/2020] [Accepted: 07/31/2020] [Indexed: 12/27/2022]
Abstract
Patients' presurgical psychological profiles have been posited to predict pain and function following arthroplastic surgery of the hip and knee. Nevertheless, findings are conflicting, and this may be rooted in biased reporting that makes the determination of evidential value difficult. This ambiguity may have negative consequences for researchers and governmental agencies, as these rely on findings to accurately reflect reality. P-Curve analyses were used to establish the presence of evidential value and selective reporting in a sample of studies examining the effect of presurgical psychological predictors on outcomes following knee and hip arthroplastic surgery. A systematic search of the literature revealed 26 relevant studies. The examined sets of studies indicate that there is evidential value for the effect of depression on pain intensity and function, anxiety on pain intensity and function, pain catastrophizing on pain intensity, as well as the combined effects of all psychological predictors on pain intensity and function. The presence of evidential value was inconclusive for the effect of optimism on pain intensity. There were no signs that any results were influenced by biased reporting. The results highlight the importance of patients' psychological profiles in predicting surgical outcomes, which represent a promising avenue for future treatment approaches. PERSPECTIVE: The effects of P-hacking are difficult to detect and might be at the root of conflicting findings pertaining to the predictive properties of presurgical psychological variables on postsurgical outcomes. P-Curve analysis allows the determination of evidential value underlying these relationships and detection of P-hacking to ensure that findings are not the result of selective reporting.
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Affiliation(s)
| | - Stephanie Cook
- School of Applied Social Sciences, De Montfort University, Leicester, UK
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21
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Low Self-Efficacy and High Kinesiophobia Are Associated With Worse Function in Patients With Femoroacetabular Impingement Syndrome. J Sport Rehabil 2020; 30:445-451. [PMID: 33027764 DOI: 10.1123/jsr.2019-0498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/11/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Femoroacetabular impingement syndrome (FAIS) is a painfully debilitating hip condition disproportionately affecting active individuals. Mental health disorders are an important determinant of treatment outcomes for individuals with FAIS. Self-efficacy, kinesiophobia, and pain catastrophizing are psychosocial factors that have been linked to inferior outcomes for a variety of orthopedic conditions. However, these psychosocial factors and their relationships with mental health disorders, pain, and function have not been examined in individuals with FAIS. OBJECTIVE (1) To examine relationships between self-efficacy, kinesiophobia, pain catastrophizing, pain, and function in patients with FAIS and (2) to determine if these variables differ between patients with and without a self-reported depression and/or anxiety. DESIGN Cross-sectional. SETTING University health center. PARTICIPANTS Fifty-one individuals with FAIS (42 females/9 males; age 35.7 [11.6] y; body mass index 27.1 [4.9] kg/m2). MAIN OUTCOME MEASURES Participants completed the Pain Self-Efficacy Questionnaire, Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, visual analog scale for hip pain at rest and during activity, and the 12-item International Hip Outcome Tool. Self-reported depression and/or anxiety were recorded. The relationships between psychosocial factors, pain, and function were examined using Spearman rank-order correlations. Independent t tests and Mann-Whitney U tests were used to evaluate the effect of self-reported depression and/or anxiety on psychosocial factors, pain and function. RESULTS The 12-item International Hip Outcome Tool was correlated with pain during activity (ρ = -.57, P ≤ .001), Tampa Scale for Kinesiophobia (ρ = -.52, P ≤ .001), and Pain Self-Efficacy Questionnaire (ρ = .71, P ≤ .001). The Pain Self-Efficacy Questionnaire was also correlated with pain at rest (ρ = -.43, P = .002) and pain during activity (ρ = -.46, P = .001). Individuals with self-reported depression and/or anxiety (18/51; 35.3%) had worse self-efficacy and pain catastrophizing (P ≤ .01). CONCLUSION Self-reported depression and/or anxiety, low self-efficacy, and high kinesiophobia were associated with more hip pain and worse function for patients with FAIS. These findings warrant further examination including psychosocial treatment strategies to improve the likelihood of a successful clinical outcome for this at-risk population.
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22
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Management of nonarthritic meniscal tears: a qualitative, patient-centered assessment of decision making. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Ditton E, Johnson S, Hodyl N, Flynn T, Pollack M, Ribbons K, Walker FR, Nilsson M. Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors. Front Psychol 2020; 11:1061. [PMID: 32670136 PMCID: PMC7326061 DOI: 10.3389/fpsyg.2020.01061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/27/2020] [Indexed: 12/19/2022] Open
Abstract
Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centered outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centered TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centered TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centered outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarized, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilization of multivariate prediction models to inform individually tailored interventions targeting a range of health conditions.
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Affiliation(s)
- Elizabeth Ditton
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Sarah Johnson
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Electrical Engineering and Computing, The University of Newcastle, Callaghan, NSW, Australia
| | - Nicolette Hodyl
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Traci Flynn
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Humanities and Social Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Michael Pollack
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,John Hunter Hospital, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Karen Ribbons
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.,School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Helminen EE, Arokoski JP, Selander TA, Sinikallio SH. Multiple psychological factors predict pain and disability among community-dwelling knee osteoarthritis patients: a five-year prospective study. Clin Rehabil 2020; 34:404-415. [PMID: 31965830 DOI: 10.1177/0269215519900533] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify predictors of long-term pain and disability in knee osteoarthritis. DESIGN A longitudinal cohort study of five years. SETTING Primary care providers. SUBJECTS In all, 108 patients (mean age = 63.6 years, standard deviation (SD) = 7.2 years) with knee pain (⩾40 mm on a 100 mm visual analogue scale in the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index pain scale) and radiographic grading (Kellgren-Lawrence: 2-4) of knee osteoarthritis who participated in a randomized controlled trial. MAIN MEASURES Disease-specific pain and functioning were assessed using the corresponding WOMAC subscales. Generic functioning was assessed by the RAND-36 subscales for function and physical and mental component summary scores. Possible baseline predictors for these outcomes were (1) demographic and disease-related variables and (2) psychological variables of mood (anxiety, depression), pain-related cognitions (pain self-efficacy, pain catastrophizing, kinesiophobia), and positive resource factors (life satisfaction, sense of coherence). RESULTS Multivariate linear mixed model analyses revealed that minimal anxiety at baseline predicted significantly better results for pain (WOMAC, P = 0.019) and function (WOMAC, P = 0.001, RAND-36 function P = 0.001). High pain self-efficacy predicted significantly better scores in RAND-36 function (P = 0.006), physical (P = 0.004) and mental (P = 0.001) component summaries. Pain catastrophizing predicted higher pain (P = 0.015), whereas fear of movement predicted poorer functioning in RAND-36 physical (P = 0.016) and mental (P = 0.009) component summaries. Those satisfied with life reported higher scores in RAND-36 function (P = 0.002) and mental component summary (P = 0.041). A low number of comorbidities predicted significantly better results in pain (WOMAC P = 0.019) and function (WOMAC P = 0.033, RAND-36 P = 0.009). CONCLUSION Anxiety, pain-related cognitions, and psychological resources predict symptoms in knee osteoarthritis in the long term.
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Affiliation(s)
- Eeva-Eerika Helminen
- Mental Health and Substance Abuse, Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Jari Pa Arokoski
- Department of Physical Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Sanna H Sinikallio
- School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland
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Barroso J, Wakaizumi K, Reckziegel D, Pinto-Ramos J, Schnitzer T, Galhardo V, Apkarian AV. Prognostics for pain in osteoarthritis: Do clinical measures predict pain after total joint replacement? PLoS One 2020; 15:e0222370. [PMID: 31914126 PMCID: PMC6948829 DOI: 10.1371/journal.pone.0222370] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022] Open
Abstract
A significant proportion of osteoarthritis (OA) patients continue to experience moderate to severe pain after total joint replacement (TJR). Preoperative factors related to pain persistence are mainly studied using individual predictor variables and distinct pain outcomes, thus leading to a lack of consensus regarding the influence of preoperative parameters on post-TJR pain. In this prospective observational study, we evaluated knee and hip OA patients before, 3 and 6 months post-TJR searching for clinical predictors of pain persistence. We assessed multiple measures of quality, mood, affect, health and quality of life, together with radiographic evaluation and performance-based tasks, modeling four distinct pain outcomes. Multivariate regression models and network analysis were applied to pain related biopsychosocial measures and their changes with surgery. A total of 106 patients completed the study. Pre-surgical pain levels were not related to post-surgical residual pain. Although distinct pain scales were associated with different aspects of post-surgical pain, multi-factorial models did not reliably predict post-surgical pain in knee OA (across four distinct pain scales) and did not generalize to hip OA. However, network analysis showed significant changes in biopsychosocial-defined OA personality post-surgery, in both groups. Our results show that although tested clinical and biopsychosocial variables reorganize after TJR in OA, their presurgical values are not predictive of post-surgery pain. Derivation of prognostic markers for pain persistence after TJR will require more comprehensive understanding of underlying mechanisms.
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MESH Headings
- Aged
- Arthroplasty, Replacement/adverse effects
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Female
- Humans
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain Management
- Pain Measurement/methods
- Pain, Postoperative/epidemiology
- Pain, Postoperative/physiopathology
- Pain, Postoperative/therapy
- Severity of Illness Index
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Affiliation(s)
- Joana Barroso
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde—i3S, Universidade do Porto, Porto, Portugal
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
| | - Kenta Wakaizumi
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- Shirley Ryan AbilityLab, Chicago, IL, United States of America
| | - Diane Reckziegel
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
| | - João Pinto-Ramos
- Departamento de Medicina Física e de Reabilitação, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Thomas Schnitzer
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- Department of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
| | - Vasco Galhardo
- Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde—i3S, Universidade do Porto, Porto, Portugal
| | - A. Vania Apkarian
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
- * E-mail:
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26
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Twiggs JG, Wakelin EA, Fritsch BA, Liu DW, Solomon MI, Parker DA, Klasan A, Miles BP. Clinical and Statistical Validation of a Probabilistic Prediction Tool of Total Knee Arthroplasty Outcome. J Arthroplasty 2019; 34:2624-2631. [PMID: 31262622 DOI: 10.1016/j.arth.2019.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/17/2019] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Predicting patients at risk of a poor outcome would be useful in patient selection for total knee arthroplasty (TKA). Existing models to predict outcome have seen limited functional implementation. This study aims to validate a model and shared decision-making tool for both clinical utility and predictive accuracy. METHODS A Bayesian belief network statistical model was developed using data from the Osteoarthritis Initiative. A consecutive series of consultations for osteoarthritis before and after introduction of the tool was used to evaluate the clinical impact of the tool. A data audit of postoperative outcomes of TKA patients exposed to the tool was used to evaluate the accuracy of predictions. RESULTS The tool changed consultation outcomes and identified patients at risk of limited improvement. After introduction of the tool, patients booked for surgery reported worse Knee Osteoarthritis and Injury Outcome Score pain scores (difference, 15.2; P < .001) than those not booked, with no significant difference prior. There was a 27% chance of not improving if predicted at risk, and a 1.4% chance if predicted to improve. This gives a risk ratio of 19× (P < .001) for patients not improving if predicted at risk. CONCLUSION For a prediction tool to be clinically useful, it needs to provide a better understanding of the likely clinical outcome of an intervention than existed without its use when the clinical decisions are made. The tool presented here has the potential to direct patients to surgical or nonsurgical pathways on a patient-specific basis, ensuring patients who will benefit most from TKA surgery are selected.
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Affiliation(s)
- Joshua G Twiggs
- 360 Knee Systems, Sydney, Australia; Department of Biomedical Engineering, University of Sydney, Sydney, Australia
| | | | | | - David W Liu
- Gold Coast Centre for Bone & Joint Surgery, Gold Coast, Australia
| | | | - David A Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | - Antonio Klasan
- Sydney Orthopaedic Research Institute, Sydney, Australia
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27
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Bartley EJ, Palit S, Fillingim RB, Robinson ME. Multisystem Resiliency as a Predictor of Physical and Psychological Functioning in Older Adults With Chronic Low Back Pain. Front Psychol 2019; 10:1932. [PMID: 31507491 PMCID: PMC6714590 DOI: 10.3389/fpsyg.2019.01932] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
Evidence supports the benefits of resilience among older adults with chronic pain. While numerous factors confer resilience, research has largely examined these measures in isolation, despite evidence of their synergistic effects. Conceptualizing resilience from a multisystem perspective may provide a deeper understanding of adaptive functioning in pain. Sixty adults (ages 60+ years) with chronic low back pain completed measures of physical function, pain intensity, disability, and a performance-based task assessing back-related physical functioning and movement-evoked pain (MEP). Depressive symptoms, quality of life, and general resilience were also evaluated. To examine multisystem resiliency, principal components analysis (PCA) was conducted to create composite domains for psychological (positive affect, hope, positive well-being, optimism), health (waist–hip ratio, body mass index, medical comorbidities), and social (emotional, instrumental, informational support) functioning measures, followed by cluster analysis to identify participant subgroups based upon composites. Results yielded four clusters: Cluster 1 (high levels of functioning across psychological, health, and social support domains); Cluster 2 (optimal health and low psychosocial functioning); Cluster 3 (high psychological function, moderate-to-high social support, and poorer health); and Cluster 4 (low levels of functioning across the three domains). Controlling for sociodemographic characteristics, individuals with a more resilient phenotype (Cluster 1) exhibited lower levels of disability, higher quality of life and psychological functioning, and greater functional performance when compared to those with a lower degree of personal resources (Cluster 4). No significant cluster differences emerged in self-reported pain intensity or MEP. These findings signify the presence of resiliency profiles based upon psychological, social, and health-related functioning. Further examination of the additive effects of multiple adaptive behaviors and resources may improve our understanding of resilience in the context of pain, informing novel interventions for older adults.
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Affiliation(s)
- Emily J Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States.,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
| | - Shreela Palit
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States.,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States.,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
| | - Michael E Robinson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States.,Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, United States
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28
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Wang Y, Liu Z, Chen S, Ye X, Xie W, Hu C, Iezzi T, Jackson T. Identifying At-Risk Subgroups for Acute Postsurgical Pain: A Classification Tree Analysis. PAIN MEDICINE 2019; 19:2283-2295. [PMID: 29370426 DOI: 10.1093/pm/pnx339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective Acute postsurgical pain is common and has potentially negative long-term consequences for patients. In this study, we evaluated effects of presurgery sociodemographics, pain experiences, psychological influences, and surgery-related variables on acute postsurgical pain using logistic regression vs classification tree analysis (CTA). Design The study design was prospective. Setting This study was carried out at Chongqing No. 9 hospital, Chongqing, China. Subjects Patients (175 women, 84 men) completed a self-report battery 24 hours before surgery (T1) and pain intensity ratings 48-72 hours after surgery (T2). Results An initial logistic regression analysis identified pain self-efficacy as the only presurgery predictor of postoperative pain intensity. Subsequently, a classification tree analysis (CTA) indicated that lower vs higher acute postoperative pain intensity levels were predicted not only by pain self-efficacy but also by its interaction with disease onset, pain catastrophizing, and body mass index. CTA results were replicated within a revised logistic regression model. Conclusions Together, these findings underscored the potential utility of CTA as a means of identifying patient subgroups with higher and lower risk for severe acute postoperative pain based on interacting characteristics.
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Affiliation(s)
- Yang Wang
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Zejun Liu
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Shuanghong Chen
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Xiaoxuan Ye
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Wenyi Xie
- Beibei Chinese Medicine Hospital, Chongqing, China
| | - Chunrong Hu
- Department of Rheumatology and Immunology, Chongqing Number 9 Hospital, Chongqing, China
| | - Tony Iezzi
- Department of Psychology, London Health Sciences Centre, London, Canada
| | - Todd Jackson
- Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China.,Department of Psychology, University of Macau, Macau, China
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29
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Hiraga Y, Hisano S, Nomiyama K, Hirakawa Y. Effects of using activity diary for goal setting in occupational therapy on reducing pain and improving psychological and physical performance in patients after total knee arthroplasty: A non-randomised controlled study. Hong Kong J Occup Ther 2019; 32:53-61. [PMID: 31217762 PMCID: PMC6560831 DOI: 10.1177/1569186119849117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 04/15/2019] [Indexed: 11/15/2022] Open
Abstract
Background Psychological factors have been reported to affect chronic pain and may lead to inactivity after total knee arthroplasty. This study aimed to determine whether the use of an activity diary for goal setting during occupational therapy would reduce pain, and improve psychological and physical performance in patients after total knee arthroplasty. Methods A total of 41 total knee arthroplasty participants from two cohorts were recruited in the study and allocated by convenience to either the experimental group using an activity diary (n = 20) or the control group (n = 21). Occupational therapy intervention (1–2 weeks postoperatively) to promote goal achievement was performed in both groups, and self-monitoring was performed in the diary group by using the activity diary. The outcome indices were Canadian Occupational Performance Measure, pain (resting pain, walking pain), pain catastrophizing (rumination, helplessness, and magnification), anxiety, depression, pain self-efficacy, and physical activity level. Data were evaluated by using analysis of variance analyses with post hoc tests. Results A time-by-group interaction emerged for Canadian Occupational Performance Measure, walking pain, pain catastrophizing, anxiety, depression, and physical activity level (p < 0.05), both favouring the diary group. The diary group also showed greater improvement in Canadian Occupational Performance Measure, walking pain, anxiety, and physical activity levels at four weeks postoperatively, compared to the control group (p < 0.05). Conclusion The use of the activity diary in this study increased occupational therapy effectiveness, reduced patients’ pain, and prevented a decline in physical performance. We believe that the use of an activity diary is an effective and feasible addition for total knee arthroplasty patients.
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Affiliation(s)
- Yuki Hiraga
- Fukuoka Rehabilitation Hospital, Japan.,Graduate School of Kyushu University, Japan
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30
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Hiyama Y, Kamitani T, Wada O. Association between disease-specific anxiety at discharge and functional outcome in patients after total knee arthroplasty. Knee 2019; 26:477-483. [PMID: 30772184 DOI: 10.1016/j.knee.2019.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 11/21/2018] [Accepted: 01/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients who undergo total knee arthroplasty (TKA) may experience disease-specific problems, including decline in motor function and intense pain, which may result in disease-specific anxiety. This study aimed to investigate disease-specific anxiety at discharge, and any association between anxiety and functional outcomes following TKA. METHODS The study prospectively included 129 patients who had undergone TKA. Each patient's disease-specific anxiety about wounds, pain, gait, and falling was assessed at discharge using a numerical rating scale, in which 0 represented no anxiety and 10 represented the highest level of anxiety. In addition, patient-reported outcomes (PROs) were evaluated using the Knee Society Score (KSS) at six-months postoperatively. The effects of disease-specific anxiety at discharge were evaluated with the KSS at six-months postoperatively and analyzed separately using multiple regression analysis. RESULTS The median score for anxiety about wounds, pain, and gait was 4.0 (IQR 2.0-5.0) at discharge five days after surgery. The median score for anxiety about falling was also 4.0 (IQR 2.0-6.0). The level of anxiety regarding wounds, pain, gait, and falling was negatively associated with the KSS six-months postoperatively after adjusting for all confounding factors (wounds: β = -2.8, 95% CI -4.3 to -1.3; pain: β = -3.4, 95% CI -4.9 to -1.9; gait: β = -4.3, 95% CI -5.8 to -2.9; falling: β = -2.5, 95% CI -3.9 to -1.1). CONCLUSION Patients reported similar levels of anxiety regarding wounds, pain, gait, and falling at discharge after TKA. The severity of anxiety symptoms at discharge was negatively associated with PROs six-months postoperatively.
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Affiliation(s)
- Yoshinori Hiyama
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan.
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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31
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Coronado RA, Patel AM, McKernan LC, Wegener ST, Archer KR. Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rogelio A. Coronado
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Akshita M. Patel
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Lindsey C. McKernan
- Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Physical Medicine and Rehabilitation; Vanderbilt University Medical Center; Nashville Tennessee
| | - Stephen T. Wegener
- Department of Physical Medicine and Rehabilitation; Johns Hopkins University; Baltimore Maryland
| | - Kristin R. Archer
- Department of Orthopaedic Surgery; Vanderbilt University Medical Center; Nashville Tennessee
- Department of Physical Medicine and Rehabilitation; Vanderbilt University Medical Center; Nashville Tennessee
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32
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Levett DZH, Grimmett C. Psychological factors, prehabilitation and surgical outcomes: evidence and future directions. Anaesthesia 2019; 74 Suppl 1:36-42. [DOI: 10.1111/anae.14507] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 12/23/2022]
Affiliation(s)
- D. Z. H. Levett
- Anaesthesia and Critical Care Research Area; Southampton NIHR Biomedical Research Centre; University Hospital Southampton NHS Foundation Trust; Southampton UK
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - C. Grimmett
- School of Health Sciences; University of Southampton; Southampton UK
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Pre-operative pressure pain thresholds do not meaningfully explain satisfaction or improvement in pain after knee replacement: a cohort study. Osteoarthritis Cartilage 2019; 27:49-58. [PMID: 30243947 DOI: 10.1016/j.joca.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Pain sensitization could be a risk factor for poor outcomes after knee replacement surgery (KR) for knee osteoarthritis (KOA). We aimed to evaluate the association between pre-operative central and peripheral pain sensitization measured using a digital pressure algometer and KR outcomes. METHODS Consecutive patients with severe KOA listed for KR were recruited. Sociodemographic and symptoms data were collected prior to surgery. Pre-operative pressure pain thresholds (PPTs) were measured using a digital pressure algometer at the index knee and forearm. Patient satisfaction at 6 and 12 months after KR was assessed using a 4-point Likert scale, and dichotomized to satisfied and dissatisfied to KR. Western Ontario and McMaster Universities Index (WOMAC) Pain and function was assessed. The associations between pre-operative PPTs with KR outcomes at 6 and 12 months were evaluated. RESULTS Of the 243 patients recruited, response rate at 6 and 12 months were 95.5% and 96.7%. The dissatisfaction rates were 8.2% and 5.1% at 6 and 12 months. There was no statistically significant association between pre-operative index knee or forearm PPTs and patient satisfaction. PPTs measured at the knee, but not the forearm, were weakly associated with change in the WOMAC pain score at 12 months, after adjustment for confounding factors. CONCLUSION Pre-operative central sensitization, measured by handheld digital algometry, was not statistically significantly associated with satisfaction or change in pain after KR. Pre-operative peripheral sensitization was associated with change in pain symptoms after KR; however, this association was weak and unlikely to be a meaningful predictor of KR outcome in clinical practice.
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34
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Screening preoperative anxiety – when does it relate to the quality of life among patients before total joint replacement? Preliminary reports. HEALTH PSYCHOLOGY REPORT 2019. [DOI: 10.5114/hpr.2019.85660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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35
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Jakobsson M, Brisby H, Gutke A, Hägg O, Lotzke H, Smeets R, Lundberg M. Prediction of Objectively Measured Physical Activity and Self-Reported Disability Following Lumbar Fusion Surgery. World Neurosurg 2019; 121:e77-e88. [DOI: 10.1016/j.wneu.2018.08.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 01/05/2023]
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36
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Does Psychological Health Influence Hospital Length of Stay Following Total Knee Arthroplasty? A Systematic Review. Arch Phys Med Rehabil 2018; 99:2583-2594. [DOI: 10.1016/j.apmr.2018.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/29/2018] [Indexed: 11/19/2022]
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Grazette AJ, Wylde V, Dixon S, Whitehouse SL, Blom AW, Whitehouse MR. A 15 to 17-year follow-up of the Kinemax total knee replacement. Knee 2018; 25:1292-1298. [PMID: 30482640 DOI: 10.1016/j.knee.2018.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/11/2018] [Accepted: 09/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a paucity of long-term data concerning the pre- and postoperative patient reported function of total knee replacement. The aim of this study was to determine the mortality, implant survivorship, patient reported function and satisfaction in a cohort of 114 patients, from a single centre, who received a Kinemax total knee replacement more than 15 years ago. METHODS Patients completed a questionnaire incorporating validated disease- and joint-specific scores, patient satisfaction and overall health preoperatively, at three months, one year, two years and a minimum of 15 years following surgery. NHS National Strategic Tracing Service, hospital and primary care records were used to establish mortality and for implant survivorship in deceased patients. RESULTS Forty five patients were alive at final follow-up. The survivorship of the cohort with revision of the TKR as the endpoint was 84%. Four cases were revised for wear, three for loosening and one for peri-prosthetic fracture. There was a significant improvement in WOMAC Pain, Function and Stiffness Scores, Oxford Knee Score and Self-Administered Patient Satisfaction Scale between pre-operative and all post-operative time points, although patient satisfaction had decreased significantly by the time of final follow-up. CONCLUSION In this cohort, the Kinemax TKR showed survivorship of 84% at 16.3 years with functional scores demonstrating a high level of patient satisfaction at all follow-up time points. LEVEL OF EVIDENCE 2 - Prospective Cohort Study.
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Affiliation(s)
- Andrew J Grazette
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; The Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom of Great Britain and Northern Ireland.
| | - Vikki Wylde
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Samantha Dixon
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland
| | - Sarah L Whitehouse
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; Institute of Health and Biomedical Innovation, Queensland University of Technology, The Prince Charles Hospital, Brisbane, Queensland, Australia, 4032
| | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, University of Bristol, School of Clinical Sciences, 1st Floor Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, United Kingdom of Great Britain and Northern Ireland; National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, United Kingdom of Great Britain and Northern Ireland
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Lane E, Fritz JM, Greene T, Maddox D. The effectiveness of training physical therapists in pain neuroscience education on patient reported outcomes for patients with chronic spinal pain: a study protocol for a cluster randomized controlled trial. BMC Musculoskelet Disord 2018; 19:386. [PMID: 30360762 PMCID: PMC6203285 DOI: 10.1186/s12891-018-2269-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic spinal pain affects many in the United States and is associated with rising healthcare costs - but not improved outcomes. Education and self-care promotion are hallmarks of the recommended approach for this condition. Pain Neuroscience Education (PNE) is a method of educating patients about the neurophysiology of pain that aims to reconceptualize pain from an indicator of damage to an interpretation of input signals by the brain and nervous system. PNE has shown efficacy in controlled situations when delivered by experts, but its effectiveness has not been investigated among trained clinicians in a pragmatic setting. METHODS A cluster randomized trial will randomly assign 16 clinic regions to either receive PNE training or continue with usual care. Patients with chronic neck or back pain will be enrolled to provide outcome data. Measures will be collected at baseline, 2 weeks, and 12 weeks. The primary outcome will be the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function computer-adapted test (PF-CAT). Pre-specified statistical analyses will compare outcomes between clinic regions assigned to PNE treatment or usual care while using random effects to account for region-level clustering. DISCUSSION Pain Neuroscience Education has been shown efficacious for a variety of patient-centered outcomes for those with chronic pain, but it has not yet been investigated outside of controlled settings. This trial has the potential to promote PNE as a low-cost intervention for chronic spinal pain and affect physical therapy education. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03168165 , registered May 30, 2017.
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Affiliation(s)
- Elizabeth Lane
- Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Julie M Fritz
- College of Health, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Tom Greene
- Department of Internal Medicine and Director, Population Health Research Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Daniel Maddox
- Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, 500 Washington St. SE, Gainesville, GA, 30501, USA
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Ponce BA, Archie AT, Watson SL, Hudson PW, Menendez ME, McGwin G, Brabston EW. Sternoclavicular joint palpation pain: the shoulder's Waddell sign? J Shoulder Elbow Surg 2018; 27:e203-e209. [PMID: 29778590 DOI: 10.1016/j.jse.2018.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/02/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pain is a complex and subjective reality and can be magnified by nonorganic or nonanatomic sources. Multiple studies have demonstrated a correlation between psychological factors and patients' perceptions of musculoskeletal pain and disability. In addition, nonorganic findings as part of the physical examination are well and long recognized. The purpose of this study was to analyze the relationship between a shoulder examination test, palpation of the sternoclavicular joint (SCJ), and psychosocial conditions including chronic pain, depression, and anxiety. METHODS From June until October 2016, all new patients of 2 sports/shoulder fellowship-trained surgeons at an academic practice were screened for study enrollment. After their consent was obtained, patients were given a set of 5 surveys (Pain Catastrophizing Scale; Patient-Health Questionnaire 2; Pain Self-Efficacy Questionnaire; shortened Disabilities of the Arm, Shoulder and Hand questionnaire; and Shoulder Pain and Disability Index) to complete. The physician then completed a comprehensive standardized physical examination, with the examining physician being blinded to the patient's survey responses. Palpation of the SCJ was done with the examiner's thumbs and was accompanied by the question "Does this hurt?" If a positive pain response was given, clarification as to the correct side of the pain was made. RESULTS A total of 132 patients were enrolled and completed the surveys and physical examination. Of the patients, 26 (19.7%) reported SCJ pain with SCJ palpation. Patients with and without confirmed pain on SCJ palpation had significantly different (P < .001) mean scores for all 5 surveys. A review of the medical histories between the 2 groups identified a significantly increased prevalence of chronic pain and mental health disorders, such as anxiety and depression, in SCJ palpation-positive patients. CONCLUSIONS Patients who confirmed pain on SCJ palpation had significantly higher scores on various psychological surveys than those who denied pain on palpation, indicating that a portion of their pain was stemming from a nonorganic source. Inclusion of SCJ palpation during a routine shoulder or upper extremity physical examination may improve selection of treatment options for patients.
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Affiliation(s)
- Brent A Ponce
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Adam T Archie
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shawna L Watson
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Parke W Hudson
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mariano E Menendez
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene W Brabston
- Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
PURPOSE OF REVIEW Osteoarthritis (OA) is one of the most common and disabling forms of arthritis worldwide, with joint pain being a primary symptom. Given that clinical symptoms often show poor concordance with tissue damage in OA, processes other than joint remodeling likely play a role in the condition. Using the biopsychosocial model of pain as a guiding framework, the purpose of this review is to highlight the extra-articular mechanisms that contribute to pain and dysfunction in OA, with a specific focus on resilience. RECENT FINDINGS Whereas previous research has mostly focused on risk factors for worsening of OA pain, recently emerging evidence places greater emphasis on the identification of protective mechanisms that enhance pain adaptation and palliate the negative effects of joint pain. In view of this new and important research, more emphasis should be placed on endogenous pain modulation and, in particular, pain attenuation. The result of such work could serve as a basis for optimizing treatment in the OA population.
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Affiliation(s)
- Emily J Bartley
- Department of Community Dentistry and Behavioral Science, Pain Research & Intervention Center of Excellence, University of Florida, 1395 Center Drive, Room D2-13, PO Box 100404, Gainesville, FL, 32610, USA.
| | - Shreela Palit
- The University of Tulsa, Department of Psychology, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Roland Staud
- College of Medicine, Pain Research & Intervention Center of Excellence, University of Florida, PO Box 100221, Gainesville, FL, 32610, USA
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Wu KT, Lee PS, Chou WY, Chen SH, Huang YT. Relationship between the social support and self-efficacy for function ability in patients undergoing primary hip replacement. J Orthop Surg Res 2018; 13:150. [PMID: 29914520 PMCID: PMC6006925 DOI: 10.1186/s13018-018-0857-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization (WHO) reported that nearly 25% of people will suffer from physical disability owing to the bone and joint problems until 2050. The condition of patients with this type of difficulty could be improved by increasing positive self-efficacy and instigating suitable medical treatment to implement self-efficacy for functional ability (SEFA) and physical functional ability self-care. In this study, we aim to evaluate the influence of social support on SEFA in patients after total hip arthroplasty. Methods This cross-sectional study used structural questionnaires, telephone appointments, and data collection to obtain patient characteristics, such as gender, age, educational level, and marital status. Questionnaires about social support and self-efficacy for functional ability (SEFA) were sent to 200 patients at 3 months following a primary total hip replacement from September 2011 to December 2014. Factor analysis was used to categorize the dimensions of social support; the t test, analysis of variance (ANOVA), and correlation analysis were applied to screen factors influencing SEFA. Multiple regression analysis was employed to ascertain the relationships between patient characteristics, social support, and SEFA. Results In total, 134 patients responded to the questionnaires. Lower SEFA scores were observed in patients of an older age, unmarried patients, and those with a low level of education. Correlation analysis showed that emotional information and appraisal support, instrumental support, and SEFA were positively correlated. Multiple regression analysis was applied to ascertain the relationships between patient characteristics, social support, and SEFA. We identified significant coefficient values of − 0.187 for age, 5.344 for emotional information and appraisal support, and 1.653 for instrumental support. Conclusion The results of this study demonstrated that in patients undergoing primary hip replacement, positive impacts on SEFA were observed in relation to emotional information, appraisal support and instrumental support. The results indicated that enhancing emotional information and appraisal support could improve a patient’s self-efficacy for functional ability.
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Affiliation(s)
- Kuan-Ting Wu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd., Niaosong Dist., Kaohsiung city, 833, Taiwan, Republic of China
| | - Pei-Shan Lee
- Department of Orthopedics Operation Room, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd., Niaosong Dist., Kaohsiung city, 833, Taiwan, Republic of China
| | - Wen-Yi Chou
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd., Niaosong Dist., Kaohsiung city, 833, Taiwan, Republic of China.
| | - Shu-Hua Chen
- Department of Orthopedics Operation Room, Kaohsiung Chang Gung Memorial Hospital, No.123, Dapi Rd., Niaosong Dist., Kaohsiung city, 833, Taiwan, Republic of China
| | - Yee-Tzu Huang
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, No.60, Sec. 1, Erren Rd., Rende Dist, Tainan city 717, Taiwan, Republic of China
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[A review on psychosomatic factors affecting the outcome after total knee-arthroplasty (TKA)]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2017; 63:370-387. [PMID: 29214949 DOI: 10.13109/zptm.2017.63.4.370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A review on psychosomatic factors affecting the outcome after total knee-arthroplasty (TKA) Objectives: In today's ageing Western societies, arthroplasty is a common treatment for endstage osteoarthritis. Despite highly developed implants and surgery, however, this treatment does not always succeed in relieving pain and restoring joint function, i.e., in restoring satisfactory algofunction. Clinicians partly blame psychological factors for this discrepancy, especially in the absence of objective medical complications. METHODS The present review summarizes previous studies on the role of psychosomatic interactions affecting the course after total knee arthroplasty (TKA). RESULTS During the perioperative period, patients with TKA suffer from marked psychic distress that is also linked to the postoperative algofunction. CONCLUSIONS We discuss the theoretical and clinical implications of the findings reviewed.
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Harmelink KEM, Zeegers AVCM, Hullegie W, Hoogeboom TJ, Nijhuis-van der Sanden MWG, Staal JB. Are There Prognostic Factors for One-Year Outcome After Total Knee Arthroplasty? A Systematic Review. J Arthroplasty 2017; 32:3840-3853.e1. [PMID: 28927646 DOI: 10.1016/j.arth.2017.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 07/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Preoperative factors predicting outcome for pain, physical function and quality of life after total knee arthroplasty (TKA) have not been clearly identified. METHODS Embase and MEDLINE were searched for relevant studies. A study was considered for inclusion if the study aimed to identify preoperative prognostic factors for pain, physical function, and/or quality of life after a follow-up period of at least 1 year; included at least 200 adults suffering from osteoarthritis and undergoing TKA; and analyzed data using multivariable modeling. The quality of the evidence per prognostic factor was determined using the Grading of Recommendations, Assessment, Development and Evaluation framework for prognosis studies. RESULTS A total of 18 studies were included. There is very low-quality evidence that preoperative more pain, presence of social support, absence of anxiety, and presence of more radiographic damage are prognostic factors for lower pain levels after TKA. There is very low-quality evidence that low preoperative physical function, less comorbidity, absence of anxiety, presence of social support, higher income, normal body mass index, and more radiographic damage are prognostic factors for better physical function. There is very low-quality evidence that female sex and less comorbidity are prognostic factors for better quality of life. CONCLUSION Only very low-quality evidence was found for a number of prognostic factors of long-term outcome after TKA. More studies that seek to generate understanding of the underlying process for the prognosis of outcome in TKA are needed to understand and test prognostic pathways, and it might be more valuable to look at recovery curves rather than at recovery points. Systematic review registration number: CRD42015026814.
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Affiliation(s)
- Karen E M Harmelink
- FysioHolland Twente, Enschede, The Netherlands; Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Adelgunde V C M Zeegers
- Department of Orthopaedic Surgery, Medisch Spectrum Twente (MST), Haaksbergen, The Netherlands
| | - Wim Hullegie
- Fysiotherapie Hullegie & Richter, Enschede, The Netherlands
| | - Thomas J Hoogeboom
- Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | | | - J Bart Staal
- Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Weinrib AZ, Azam MA, Birnie KA, Burns LC, Clarke H, Katz J. The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Br J Pain 2017; 11:169-177. [PMID: 29123661 PMCID: PMC5661689 DOI: 10.1177/2049463717720636] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In an era of considerable advances in anaesthesiology and pain medicine, chronic pain after major surgery continues to be problematic. This article briefly reviews the known psychological risk and protective factors associated with the development of chronic postsurgical pain (CPSP). We begin with a definition of CPSP and then explain what we mean by a risk/protective factor. Next, we summarize known psychological risk and protective factors for CPSP. Psychological interventions that target risk factors and may impact postsurgical pain are reviewed, including the acceptance and commitment therapy (ACT)-based approach to CPSP prevention and management we use in the Transitional Pain Service (TPS) at the Toronto General Hospital. Finally, we conclude with recommendations for research in risk factor identification and psychological interventions to prevent CPSP. Several pre-surgical psychological risk factors for CPSP have been consistently identified in recent years. These include negative affective constructs, such as anxiety symptoms, depressive symptoms, pain catastrophizing and general psychological distress. In contrast, relatively few studies have examined psychological protective factors for CPSP. Psychological interventions that target known psychological risk factors while enhancing protective psychological factors may reduce new incidence of CPSP. The primary goal of our ACT intervention is to teach patients a mindful way of responding to their postsurgical pain that empowers them to interrupt the negative cycle of pain, distress, behavioural avoidance and escalating opioid use that can limit functioning and quality of life while paradoxically amplifying pain over time. Early clinical outcome data suggest that patients who receive care from TPS physicians reduce their pain and opioid use, yet patients who also receive our ACT intervention have a larger decrease in daily opioid dose while reporting less pain interference and lower depression scores.
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Affiliation(s)
- Aliza Z Weinrib
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Muhammad A Azam
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Kathryn A Birnie
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, ON, Canada
| | - Lindsay C Burns
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Hance Clarke
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, ON, Canada
| | - Joel Katz
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
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Bletterman AN, de Geest-Vrolijk ME, Vriezekolk JE, Nijhuis-van der Sanden MW, van Meeteren NL, Hoogeboom TJ. Preoperative psychosocial factors predicting patient's functional recovery after total knee or total hip arthroplasty: a systematic review. Clin Rehabil 2017; 32:512-525. [PMID: 28922942 DOI: 10.1177/0269215517730669] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the predictive value of preoperative psychosocial factors on the perceived and observed postoperative patient's functional recovery during the post-hospital phase and up to 12 months after hospital discharge of patients who underwent total knee or total hip arthroplasty. METHODS A systematic review was performed. MEDLINE, CINAHL, EMBASE and PsychINFO were systematically screened in order to find prospective longitudinal studies. Risk of bias was assessed using a modified version of a 27-item checklist for prognostic studies, as previously used by Veerbeek. A qualitative analysis was performed using the method of Zwikker. RESULTS A total of 26 studies, with a total of 11,020 patients, were included. In total, 22 studies were judged as having a high risk of bias. Overall, no longitudinal association with perceived or observed functional recovery was found in all of the seven preoperative psychosocial categories: A: mental well-being, B: cognitions, C: beliefs, D: expectations, E: coping, F: social support or G: personality traits in total joint arthroplasty. Mental well-being seems to be the exception in one time period (>6 weeks through ≤3 months) and change score in observed functional recovery, but only in patients awaiting total knee arthroplasty (100% and 75% of the variables were significantly and consistently associated, respectively). CONCLUSION Overall, the results of this systematic review suggest that there is no longitudinal association between preoperative psychosocial factors and perceived or observed patient's postoperative functional recovery after total joint arthroplasty. The psychological category mental well-being is related to observed postoperative recovery >6 weeks through ≤3 months and to change score after total knee arthroplasty.
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Affiliation(s)
- Anouck N Bletterman
- 1 Outpatient Physical Therapy Practice, FysioStiens, Stiens, the Netherlands
| | | | | | | | - Nico Lu van Meeteren
- 5 Caphri, Maastricht University Medical Centre, Maastricht, The Netherlands.,6 Topsector Life Sciences and Health (Health~Holland), The Hague, The Netherlands
| | - Thomas J Hoogeboom
- 4 Radboud Institute for Health Sciences, Radboud university medical center, IQ Healthcare, Nijmegen, The Netherlands
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Harmelink KEM, Zeegers AVCM, Tönis TM, Hullegie W, Nijhuis-van der Sanden MWG, Staal JB. The effectiveness of the use of a digital activity coaching system in addition to a two-week home-based exercise program in patients after total knee arthroplasty: study protocol for a randomized controlled trial. BMC Musculoskelet Disord 2017; 18:290. [PMID: 28679400 PMCID: PMC5498982 DOI: 10.1186/s12891-017-1647-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is consistent evidence that supervised programs are not superior to home-based programs after total knee arthroplasty (TKA), especially in patients without complications. Home-based exercise programs are effective, but we hypothesize that their effectiveness can be improved by increasing the adherence to physical therapy advice to reach an adequate exercise level during the program and thereafter. Our hypothesis is that an activity coaching system (accelerometer-based activity sensor), alongside a home-based exercise program, will increase adherence to exercises and the activity level, thereby improving physical functioning and recovery. The objective of this study is to determine the effectiveness of an activity coaching system in addition to a home-based exercise program after a TKA compared to only the home-based exercise program with physical functioning as outcome. METHODS This study is a single-blind randomized controlled trial. Both the intervention (n = 55) and the control group (n = 55) receive a two-week home-based exercise program, and the intervention group receives an additional activity coaching system. This is a hand-held electronic device together with an app on a smartphone providing information and advice on exercise behavior during the day. The primary outcome is physical functioning, measured with the Timed Up and Go test (TUG) after two weeks, six weeks and three months. Secondary outcomes are 1) adherence to the activity level (activity diary); 2) physical functioning, measured with the 2-Minute Walk Test (2MWT) and the Knee Osteoarthritis Outcome Score; 3) quality of life (SF-36); 4) healthcare use up to one year postoperatively and 5) cost-effectiveness. Data are collected preoperatively, three days, two and six weeks, three months and one year postoperatively. DISCUSSION The strengths of the study are the use of both performance-based tests and self-reported questionnaires and the personalized tailored program after TKA given by specialized physical therapists. Its weakness is the lack of blinding of the participants to treatment allocation. Outcomes are generalizable to uncomplicated patients as defined in the inclusion criteria. TRIAL REGISTRATION The trial is registered in the Dutch Trial Register ( www.trialregister.nl , NTR 5109) (March 22, 2015).
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Affiliation(s)
- Karen E M Harmelink
- FysioHolland Twente, Geessinkbrink 7, 7544 CW, Enschede, the Netherlands. .,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - A V C M Zeegers
- Medisch Spectrum Twente (MST), Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - Thijs M Tönis
- Roessingh Research & Development (RRD), Telemedicine group, Roessinghsbleekweg 33b, 7522 AH, Enschede, the Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, University of Twente, P.O. Box 217, 7500 AE, Enschede, the Netherlands
| | - Wim Hullegie
- Fysiotherapie Hullegie & Richter, Geessinkbrink 7, 7544 CW, Enschede, the Netherlands
| | | | - J Bart Staal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Brembo EA, Kapstad H, Van Dulmen S, Eide H. Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study. Health Qual Life Outcomes 2017; 15:68. [PMID: 28399883 PMCID: PMC5387328 DOI: 10.1186/s12955-017-0649-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/05/2017] [Indexed: 12/27/2022] Open
Abstract
Background Despite the overall success of total hip replacement (THR) in patients with symptomatic osteoarthritis (OA), up to one-quarter of patients report suboptimal recovery. The aim of this study was to determine whether social support and general self-efficacy predict variability in short-term recovery in a Norwegian cohort. Methods We performed secondary analysis of a prospective multicenter study of 223 patients who underwent THR for OA in 2003–2004. The total score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3 months after surgery was used as the recovery variable. We measured self-efficacy using the General Self-Efficacy Scale (GSES) and social support with the Social Provisions Scale (SPS). Preoperative and postoperative scores were compared using Wilcoxon tests. The Mann–Whitney U test compared scores between groups that differed in gender and age. Spearman’s rho correlation coefficients were used to evaluate associations between selected predictor variables and the recovery variable. We performed univariate and multiple linear regression analyses to identify independent variables and their ability to predict short-term recovery after THR. Results The median preoperative WOMAC score was 58.3 before and 23.9 after surgery. The mean absolute change was 31.9 (standard deviation [SD] 17.0) and the mean relative change was 54.8% (SD 26.6). Older age, female gender, higher educational level, number of comorbidities, baseline WOMAC score, self-efficacy, and three of six individual provisions correlated significantly with short-term recovery after THR and predicted the variability in recovery in the univariate regression model. In multiple regression models, baseline WOMAC was the most consistent predictor of short-term recovery: a higher preoperative WOMAC score predicted worse short-term recovery (β = 0.44 [0.29, 0.59]). Higher self-efficacy predicted better recovery (β = −0.44 [−0.87, −0.02]). Reliable alliance was a significant predictor of improved recovery (β = −1.40 [−2.81, 0.01]). Conclusions OA patients’ general self-efficacy and the expectation of others’ tangible assistance predict recovery after THR. Researchers and clinicians should target these psychosocial factors together with the patients and their families to improve the quality of care and surgical outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0649-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Espen Andreas Brembo
- Faculty of Health and Social Sciences, University College of Southeast Norway, P.O Box 7053, 3007, Papirbredden - Drammen kunnskapspark Grønland 58, Drammen, 3045, Norway. .,Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, Oslo, 0372, Norway.
| | - Heidi Kapstad
- Faculty of Health and Social Sciences, University College of Southeast Norway, P.O Box 7053, 3007, Papirbredden - Drammen kunnskapspark Grønland 58, Drammen, 3045, Norway
| | - Sandra Van Dulmen
- Faculty of Health and Social Sciences, University College of Southeast Norway, P.O Box 7053, 3007, Papirbredden - Drammen kunnskapspark Grønland 58, Drammen, 3045, Norway.,NIVEL (Netherlands institute for health services research), Otterstraat 118-124, Utrecht, 3513 CR, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein noord 21, Nijmegen, 6525 EZ, The Netherlands
| | - Hilde Eide
- Faculty of Health and Social Sciences, University College of Southeast Norway, P.O Box 7053, 3007, Papirbredden - Drammen kunnskapspark Grønland 58, Drammen, 3045, Norway
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Hayashi K, Kobayashi K, Shimizu M, Tsuchikawa Y, Kodama A, Komori K, Nishida Y. Self-efficacy is an independent predictor for postoperative six-minute walk distance after elective open repair of abdominal aortic aneurysm. Disabil Rehabil 2017; 40:1114-1118. [DOI: 10.1080/09638288.2017.1287962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kazuhiro Hayashi
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | | | - Miho Shimizu
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Yohei Tsuchikawa
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Akio Kodama
- Department of Vascular Surgery and Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Kimihiro Komori
- Department of Vascular Surgery and Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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49
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Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3403-3410. [PMID: 27734110 PMCID: PMC5644683 DOI: 10.1007/s00167-016-4314-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/31/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE Around 10-30 % of patients are dissatisfied with the results of their total knee arthroplasty (TKA). This review aimed to identify and evaluate the predictors of outcome measured by the three domains of health-related quality of life (pain, stiffness and function). The focus was on pre-operative psychological factors as related to other patient-related variables. METHODS A systematic search was performed using the following databases: MEDLINE, PubMed, AMED, CINAHL, PsychINFO, SciFinder, Scopus, EMBASE, Cochrane, Lilacs, Web of Science and ScienceDirect. The quality of identified studies was assessed using the Critical Appraisal Skills Programme Cohort checklist. RESULTS Ten studies met the eligibility criteria. From these, nine patient-related predictors of outcome were identified (depression, anxiety, age at surgery, gender (being female), medical co-morbidities, BMI, level of education, pre-operative pain severity and pre-operative knee function). Greater anxiety, pre-operative pain and function were the most significant factors to predict a poorer outcome of a TKA. The results of depression, gender (female), medical co-morbidities, BMI and level of education were variable among the included studies. There was very little evidence to support older age at operation as a predictor of poorer outcome. CONCLUSION Patients experiencing high levels of pain before surgery should be informed of the chances of improvement by having a TKA. A validated psychological screening tool that separates depression and anxiety is recommended as part of the pre-operative assessment stage. Patients presenting with symptoms of depression and anxiety should be identified and consulted before a TKA. LEVEL OF EVIDENCE II.
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50
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Qi A, Lin C, Zhou A, Du J, Jia X, Sun L, Zhang G, Zhang L, Liu M. Negative emotions affect postoperative scores for evaluating functional knee recovery and quality of life after total knee replacement. ACTA ACUST UNITED AC 2016; 49:e4616. [PMID: 26577843 PMCID: PMC4678652 DOI: 10.1590/1414-431x20154616] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/24/2015] [Indexed: 12/17/2022]
Abstract
This study aimed to determine whether psychological factors affect health-related
quality of life (HRQL) and recovery of knee function in total knee replacement (TKR)
patients. A total of 119 TKR patients (male: 38; female: 81) completed the Beck
Anxiety Inventory (BAI), Beck Depression Inventory (BDI), State Trait Anxiety
Inventory (STAI), Eysenck Personality Questionnaire-revised (EPQR-S), Knee Society
Score (KSS), and HRQL (SF-36). At 1 and 6 months after surgery, anxiety, depression,
and KSS scores in TKR patients were significantly better compared with those
preoperatively (P<0.05). SF-36 scores at the sixth month after surgery were
significantly improved compared with preoperative scores (P<0.001). Preoperative
Physical Component Summary Scale (PCS) and Mental Component Summary Scale (MCS)
scores were negatively associated with extraversion (E score) (B=-0.986 and -0.967,
respectively, both P<0.05). Postoperative PCS and State Anxiety Inventory (SAI)
scores were negatively associated with neuroticism (N score; B=-0.137 and -0.991,
respectively, both P<0.05). Postoperative MCS, SAI, Trait Anxiety Inventory (TAI),
and BAI scores were also negatively associated with the N score (B=-0.367, -0.107,
-0.281, and -0.851, respectively, all P<0.05). The KSS function score at the sixth
month after surgery was negatively associated with TAI and N scores (B=-0.315 and
-0.532, respectively, both P<0.05), but positively associated with the E score
(B=0.215, P<0.05). The postoperative KSS joint score was positively associated
with postoperative PCS (B=0.356, P<0.05). In conclusion, for TKR patients, the
scores used for evaluating recovery of knee function and HRQL after 6 months are
inversely associated with the presence of negative emotions.
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Affiliation(s)
- A Qi
- Department of Nursing, Laiwu People's Hospital, Laiwu, China
| | - C Lin
- Department of Cardiology, Laiwu People's Hospital, Laiwu, China
| | - A Zhou
- The First Ward of the Surgical Department, Laiwu People's Hospital, Laiwu, China
| | - J Du
- Laiwu People's Hospital, Department of Internal Medicine, Branch of Laiwu People's Hospital, Laiwu, China
| | - X Jia
- Department of Nursing, Laiwu People's Hospital, Laiwu, China
| | - L Sun
- Department of Nursing, Laiwu People's Hospital, Laiwu, China
| | - G Zhang
- Department of Nursing, Laiwu People's Hospital, Laiwu, China
| | - L Zhang
- China Medical University, Department of Traumatic Orthopedics, Shengjing Hospital, Shenyang, China
| | - M Liu
- China Medical University, Department of Traumatic Orthopedics, Shengjing Hospital, Shenyang, China
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