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Kim AG, Sanghvi P, Rizk AA, Ahn A, Pumo TJ, Kamath AF. Resilience as a psychiatric factor affecting outcomes after total joint arthroplasty: a systematic review. ARTHROPLASTY 2024; 6:16. [PMID: 38576001 PMCID: PMC10996138 DOI: 10.1186/s42836-024-00240-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/01/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Mental and psychiatric status continue to be underscreened prior to total joint arthroplasty (TJA). Research on the role of resilience as a psychiatric factor affecting TJA outcomes remains limited. Therefore, our systematic review sought to evaluate the impact of patient resilience in TJA. METHODS A systematic review of the literature from the Pubmed, MEDLINE, EBSCOhost, and Google Scholar online databases was performed in abidance with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies reporting on outcomes following primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) segregated by patient resilience were included. Case reports, reviews, meta-analyses, and conference abstracts were excluded. Primary outcomes of interest included patient-reported outcomes (PROs), surgical outcomes, and postoperative opioid consumption. RESULTS Twelve articles were included reporting on a total of 1,577 TJAs. There was a strong agreement that the Patient Reported Outcomes Measurement Information System (PROMIS)-Physical Health and Mental Health components were strongly predicted by patient resilience. However, there was inconclusive evidence regarding the impact of resilience on UCLA Activity Scales (UCLA) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) outcomes as well as postoperative hip and knee function. Similarly, conflicting evidence was presented regarding the effect of resilience on length of stay (LOS). Greater resilience was associated with reduced opioid usage in the immediate inpatient postoperative period. However, resilience had no significant effect on opioid requirements in the postoperative outpatient follow-up time frame. CONCLUSION The present analysis demonstrated mixed, inconclusive evidence regarding the impact of resilience on postoperative outcomes. The paucity of research evaluating this relationship warrants further investigation, examining both short and long-term outcomes. Due to the limited literature evaluating resilience as a predictor of outcomes following TJA, we cannot definitively rule out resilience as a valuable metric and must further examine its utility as a preoperative screening tool. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Andrew G Kim
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Parshva Sanghvi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Adam A Rizk
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Aaron Ahn
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Thomas J Pumo
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
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Why Is There a Range in Time Returning to Preoperative Activity Habits After Femoroacetabular Impingement Treatment in Recreational Athletes? J Sport Rehabil 2023; 32:289-295. [PMID: 36535272 DOI: 10.1123/jsr.2021-0343] [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: 09/20/2021] [Revised: 10/05/2022] [Accepted: 10/16/2022] [Indexed: 12/23/2022]
Abstract
CONTEXT Professional athletes showed excellent results after hip preserving procedures. However, there is still a lack of knowledge regarding the rate of return to activity and the rehabilitation time of recreational athletes. Thus, the aim of this study was to investigate factors that were associated with an extended return-to-activity time in nonprofessional athletes. DESIGN Retrospective, quantitative case-control study. METHODS This study included 47 cases (45 nonprofessional athletes), which were divided according to return-to-activity time (short term: 0.0-7.0 mo vs long term: >7.0 mo). The clinical outcome were evaluated with the modified Harris hip score, the nonarthritic hip score, the Western Ontario and McMaster Universities Osteoarthritis Index, and the University of California, Los Angeles activity score. For statistical analysis between both groups, an unpaired student t test and a paired Wilcoxon test were used. In addition, the sports behavior, intraoperative findings, and surgical procedures were also assessed. RESULTS After a mean follow-up of 4.3 years (±0.6; 3.4-5.6), the overall postoperative modified Harris hip score was 81.8 points, the nonarthritic hip score was 75.8 points, the Western Ontario and McMaster Universities Osteoarthritis Index was 36.7 points, and the University of California, Los Angeles activity score was 7.9. Compared with the preoperative results, all scores improved significantly (P < .001). Patients of the short-term return-to-activity group showed a higher preoperative activity diversity and, postoperatively, a higher rate in high-impact sports (P = .024). CONCLUSIONS After mini-open arthrotomy for femoroacetabular impingement syndrome treatment, 92.5% of the recreational athletes returned to sports activity. The findings did not detect factors influencing the return-to-activity time. However, a higher preoperative diversity of activities and a shift to high-level impact sport activities might support a shorter rehabilitation.
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Grünwald L, Schröter S, Dickschas J, Harrer J, Minzlaff P, Hinterwimmer S, Saier T, Pattappa G, Angele P. Patient response to osteotomy around the knee joint at one year post-operation-fulfilment of expectations and current health status. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04660-6. [PMID: 36344785 DOI: 10.1007/s00402-022-04660-6] [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: 04/13/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The aim of this study was to investigate patient satisfaction and fulfilment of expectations after osteotomy around the knee at one year postoperatively, using patient-related outcome measures. MATERIALS AND METHODS From the initial sample of 264 patients, a total of 132 patients (age 48y ± 11) were enrolled in this prospective study (response rate 49.3%). Data were collected using the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES), items for satisfaction and the Knee injury and Osteoarthritis Outcome Score (KOOS) measures. At one year postoperative follow-up, an individualized questionnaire asked whether the specific person-related expectations had been fulfilled. RESULTS Satisfaction was high with 83.2% of all participants at one year after surgery. A total of 78% of patients stated they would decide to do the surgery again. This decision was significantly associated with satisfaction, younger age and better KOOS scores scales before surgery for pain, activity and sports. We found high correlations between satisfaction and fulfilment of expectations for the HFES-KSES. Fulfilment of expectations one year after surgery was significantly associated with significant improvements in KOOS scales at one year post-operation. Expectations (1) "to get the knee back to normal status", (2) "improve ability to squat", (3) "improve ability to run", (4) "improve ability to kneel" had been fulfilled worst. A multiple linear regression model for satisfaction had an R2 = 0.797 of the variance. The most influential was the variable fulfilment of "maintain health" that had 70.7% of variance. CONCLUSIONS The fulfilled expectation concerning an improvement of the ability to maintain health was the most influential parameter for satisfaction at one year post-osteotomy. Patients with better health status of the knee and younger age rated the surgery to be more positive and were also more likely to do the surgery again. This provides an indication for an earlier intervention, before the knee and overall health status becomes more detrimental. LEVEL OF EVIDENCE Level II (Therapeutic study).
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Affiliation(s)
- Leonard Grünwald
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Tübingen, Germany.
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany.
| | - Steffen Schröter
- Department of Orthopedics and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
| | - Jörg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany
- Klinik für Unfallchirugie und Orthopädische Chirurgie, Universitätsklinikum Erlangen, Friedrich Alexander Universität Erlange, Maximilianspl. 2, 91054, Erlangen, Germany
| | - Jörg Harrer
- Department of Orthopedics and Traumatology, Helmut-G.-Walther Klinikum, Prof.-Arneth-Straße 2B, 96215, Lichtenfels, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
| | - Philipp Minzlaff
- Orthoclinic Agatharied, Krankenhaus Agatharied GmbH, Norbert-Kerkel-Platz, 83734, Hausham, Germany
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | | | - Tim Saier
- Berufsgenossenschaftliche Unfallklinik Murnau, Prof-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Girish Pattappa
- Department of Experimental Trauma Surgery, University of Regensburg Medical Centre, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Peter Angele
- Department of Experimental Trauma Surgery, University of Regensburg Medical Centre, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Sporthopaedicum Regensburg, Hildegard-Von Bingen-Str. 1, 93053, Regensburg, Germany
- Klinik für Trauma und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
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Assonov D. Two-Step Resilience-Oriented Intervention for Veterans with Traumatic Brain Injury: A Pilot Randomized Controlled Trial. CLINICAL NEUROPSYCHIATRY 2021; 18:247-259. [PMID: 34984068 PMCID: PMC8696289 DOI: 10.36131/cnfioritieditore20210503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present randomized parallel two-arm pilot study aimed to compare the efficacy of two-step resilience-oriented intervention with treatment as usual in veterans with mild to moderate traumatic brain injury. METHOD Two-step Resilience-Oriented Intervention (TROI) is a brief psychological intervention that targets cognitive (step 1) and emotional (step 2) factors of resilience and consists of six 1-hour sessions. Overall, 70 Ukrainian veterans serviced in Anti-Terrorist Operation / Joint Forces Operation were randomly assigned to an intervention group (TROI group) or a control group that underwent treatment as usual (TAU group). For pre- (T1) and post-treatment (T2) assessment the Connor-Davidson Resilience Scale (CD-RISC), Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment Scale (MoCA), Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist 5 (PCL-5), Chaban Quality of Life Scale (CQLS), Positive and Negative Affect Scale (PANAS) were used. RESULTS Multivariable linear regression with the treatment group, gender, baseline cognitive performance level and TBI severity as the independent variables revealed statistically significant improvements in the TROI group in resilience (CD-RISC), cognitive performance (MoCA), postconcussive symptoms (NSI), posttraumatic symptoms (PCL-5), positive affect (PANAS) and quality of life (CQLS) comparing to such in TAU group. We found no statistically significant differences between groups in depression, anxiety (HADS) and negative affect (PANAS) outcomes. Additionally, Wilcoxon signed-rank test revealed that participants who completed two-step resilience-oriented intervention had significantly improved scores for all outcomes compared to the baseline (p < 0.05). CONCLUSIONS In summary, we can tentatively conclude that adding TROI to the standard treatment measures may improve the resilience and sustainable symptoms in veterans with TBI when compared with standard treatment. Targeting cognitive and emotional factors like problem-solving, decision-making, positive thinking can promote resilience in veterans with TBI and be useful in facilitating recovery from injury. Results of this pilot study are promising, but the intervention needs to be studied in a larger trial.
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Affiliation(s)
- Dmytro Assonov
- Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy, Bogomolets National Medical University, Kyiv, Ukraine,Corresponding author Dmytro Assonov, E-mail:
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