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Monahan PF, Martinazzi BJ, Pahapill NK, Graefe SB, Jimenez AE, Mason MW. Post-Traumatic Stress Disorder Is Associated With Increased Emergency Department Services and Similar Rates of Opioid Prescriptions Following Primary Total Hip Arthroplasty: A Propensity Matched Analysis. J Arthroplasty 2024:S0883-5403(24)00228-6. [PMID: 38492824 DOI: 10.1016/j.arth.2024.03.012] [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: 12/01/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND There is a paucity of literature regarding patients who have post-traumatic stress disorder (PTSD) following primary total hip arthroplasty (THA). The purpose of this study was to compare the rates of postoperative complications, prescriptions, health care utilization, and revision arthroplasty of patients who had PTSD undergoing primary THA against a propensity matched control group of patients who did not have PTSD (NPTSD). METHODS The TriNetX database was queried to identify PTSD patients undergoing primary THA. Patients were then propensity matched in a 1:1 ratio based on twelve preoperative characteristics to a cohort of NPTSD patients. Postoperative prescriptions and rates of health care utilization were analyzed within 5 days, 14 days, and 1 month postoperatively. Complications were analyzed within one month. Revision arthroplasty rates were analyzed within 1 year and 2 years. RESULTS A total of 198,560 patients undergoing primary THA were identified. Ultimately, 1,310 PTSD patients were successfully propensity matched to a cohort of 1,310 NPTSD patients. Patients who have PTSD presented to the emergency department at significantly higher rates than NPTSD patients within 14 days and 1 month postoperatively. Within 1 month postoperatively, cohorts were prescribed opioid analgesics at similar rates (P = .709). Patients who had PTSD received more prescriptions per patient compared to NPTSD patients. Patients who had PTSD were also found to have a higher number of total complications per person within 1 month (P = .022). Within 2 years postoperatively, rates of revision hip arthroplasty were comparable between cohorts (P = .912). CONCLUSIONS Patients who have PTSD experience similar rates of revision hip arthroplasty and opioid prescribing compared to NPTSD patients following primary THA; however, within 1 month postoperatively, emergency department visits were greater in PTSD patients. These findings can help delineate early postoperative education and expectations for patients who have PTSD in contrast to other psychiatric diagnoses.
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Affiliation(s)
- Peter F Monahan
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Brandon J Martinazzi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Natalie K Pahapill
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Steven B Graefe
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, Connecticut
| | - Mark W Mason
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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2
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Little C, Lavender AP, Starcevich C, Mesagno C, Mitchell T, Whiteley R, Bakhshayesh H, Beales D. Understanding Fear after an Anterior Cruciate Ligament Injury: A Qualitative Thematic Analysis Using the Common-Sense Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2920. [PMID: 36833617 PMCID: PMC9957354 DOI: 10.3390/ijerph20042920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Fear is a significant factor affecting successful return to sport following an anterior cruciate ligament (ACL) injury. However, there is a lack of understanding of the emotional drivers of fear and how fear beliefs are formed. This study qualitatively explored the contextual and emotional underpinnings of fear and how these beliefs were formed, with reference to the Common-Sense Model of Self-Regulation. Face-to-face online interviews were conducted with ACL-injured participants (n = 18, 72% female) with a mean age of 28 years (range 18-50 years). Participants were either 1 year post ACL reconstruction surgery (n = 16) or at least 1 year post injury without surgery (n = 2) and scored above average on a modified Tampa Scale of Kinesiophobia. Four participants were playing state-level sport or higher. Five themes emerged describing factors contributing to fear: 'External messages', 'Difficulty of the ACL rehabilitation journey', 'Threat to identity and independence', 'Socioeconomic factors', and 'Ongoing psychological barriers'. A sixth theme, 'Positive coping strategies', provided insight into influences that could reduce fear and resolve negative behaviors. This study identified a broad range of contextual biopsychosocial factors which contribute to fear, supporting the notion that ACL injuries should not be treated through a purely physical lens. Furthermore, aligning the themes to the common-sense model provided a conceptual framework conveying the inter-related, emergent nature of the identified themes. The framework provides clinicians with a means to understanding fear after an ACL injury. This could guide assessment and patient education.
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Affiliation(s)
- Cameron Little
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Andrew P. Lavender
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Cobie Starcevich
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Christopher Mesagno
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3011, Australia
| | | | | | - Hanieh Bakhshayesh
- Curtin School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, WA 6102, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
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O’Connor JP, Holden P, Gagnier JJ. Systematic review: preoperative psychological factors and total hip arthroplasty outcomes. J Orthop Surg Res 2022; 17:457. [PMID: 36253795 PMCID: PMC9575292 DOI: 10.1186/s13018-022-03355-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Total hip arthroplasties (THA) are cost-effective interventions for patients with osteoarthritis refractory to physical therapy or medical management. Most individuals report positive surgical outcomes with reduction in pain and improved joint function. Multiple recent studies demonstrated the influence of patient mental health on surgical success. We sought to determine the relationship between patient preoperative psychological factors and postoperative THA outcomes, specifically pain and function. Methods PubMed, EMBASE and Cochrane Reviews databases were queried using terms “(mental OR psychological OR psychiatric) AND (function OR trait OR state OR predictor OR health) AND (outcome OR success OR recovery OR response) AND total joint arthroplasty).” A total of 21 of 1,286 studies fulfilled inclusion criteria and were included in the review. All studies were analyzed using GRADE and Risk of Bias criteria. Results Overall, compared to cohorts with a normal psychological status, patients with higher objective measures of preoperative depression and anxiety reported increased postoperative pain, decreased functionality and greater complications following THA. Additionally, participants with lower self-efficacy or somatization were found to have worse functional outcomes. Conclusions Preoperative depression, anxiety and somatization may negatively impact patient reported postoperative pain, functionality and complications following THA. Surgeons should consider preoperative psychological status when counseling patients regarding expected surgical outcomes. Level of evidence 3. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03355-3.
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The impact of illness perception on functionality, pain, stiffness, and activity of daily living after total hip replacement surgery. J Psychosom Res 2022; 155:110749. [PMID: 35150982 DOI: 10.1016/j.jpsychores.2022.110749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE According to the Common Sense Model (CSM), cognitive and emotional representations influence recovery. We used groups of individuals grouping multiple cognitive representations (schemas) to predict the recovery process after total hip arthroplasty (THR). METHODS The aim of this prospective cohort study with three collection time points was to examine the significance of these schemas for functionality three and six months after THR. We assessed illness perception with the Illness Perception Questionnaire-Revised and the functionality with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were collected four weeks before (n = 317), three (n = 268), and six months after (n = 292) primary THR. Groups of individuals with the same schemas were identified using a two-step cluster analysis across cognitive representations. Controlling for WOMAC variables (functionality, stiffness, pain, and activities of daily living) before THR, we calculated the regression of schemas and emotional representations before THR on WOMAC variables after THR. RESULTS Before THR, two cognitive schemes were found: Schema One: medium identity, long duration, many consequences, low personal and treatment control, and low coherence; Schema Two: low identity, short timeline, low consequences, and high personal and treatment control. Patients with Schema Two had better functionality and lower pain and stiffness three months after surgery compared to those with Schema One. After three months, the influence of cognitive schemas was stronger on functionality than that of emotional representation (f2: 0.04 /0.02). CONCLUSION Further study is needed to determine whether a psychological intervention can change Schema One.
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Onghena L, Berrevoet F, Vanlander A, Van Vlierberghe H, Verhelst X, Hoste E, Poppe C. Illness cognitions and health-related quality of life in liver transplant patients related to length of stay, comorbidities and complications. Qual Life Res 2022; 31:2493-2504. [DOI: 10.1007/s11136-022-03083-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
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Haber T, Hinman RS, Dobson F, Bunzli S, Hall M. How do middle-aged and older adults with chronic hip pain view their health problem and its care? A protocol for a systematic review and qualitative evidence synthesis. BMJ Open 2021; 11:e053084. [PMID: 34764175 PMCID: PMC8587503 DOI: 10.1136/bmjopen-2021-053084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/11/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Chronic hip pain in middle-aged and older adults is common and disabling. Patient-centred care of chronic hip pain requires a comprehensive understanding of how people with chronic hip pain view their health problem and its care. This paper outlines a protocol to synthesise qualitative evidence of middle-aged and older adults' views, beliefs, expectations and preferences about their chronic hip pain and its care. METHODS AND ANALYSIS We will perform a qualitative evidence synthesis using a framework approach. We will conduct this study in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and the Enhancing Transparency in Reporting the synthesis of Qualitative research checklist. We will search MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE and PsycINFO using a comprehensive search strategy. A priori selection criteria include qualitative studies involving samples with a mean age over 45 and where 80% or more have chronic hip pain. Two or more reviewers will independently screen studies for eligibility, assess methodological strengths and limitations using the Critical Appraisal Skills Programme qualitative studies checklist, perform data extraction and synthesis and determine ratings of confidence in each review finding using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. Data extraction and synthesis will be guided by the Common-Sense Model of Self-Regulation. All authors will contribute to interpreting, refining and finalising review findings. This protocol is registered on PROSPERO and reported according to the PRISMA Statement for Protocols (PRISMA-P) checklist. ETHICS AND DISSEMINATION Ethics approval is not required for this systematic review as primary data will not be collected. The findings of the review will be disseminated through publication in an academic journal and scientific conferences. PROSPERO REGISTRATION NUMBER PROSPERO registration number: CRD42021246305.
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Affiliation(s)
- Travis Haber
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Dobson
- Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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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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8
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Abstract
BACKGROUND Depression and pain catastrophizing are aspects of the patient's mindset that have been shown to be important in relation to the outcome of carpal tunnel release. However, other factors of the patient's mindset have been understudied, such as treatment expectations and illness perceptions. The aim of the present study was to investigate the influence of these mindset aspects on outcome of carpal tunnel release, in addition to psychological distress and pain catastrophizing. METHODS A total of 307 patients with carpal tunnel syndrome who visited outpatient hand surgery clinics and who completed online questionnaires regarding demographic and psychosocial characteristics and carpal tunnel syndrome severity were included. The patient mindset was measured with the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Credibility Expectancy Questionnaire, and the Brief Illness Perception Questionnaire. Hierarchical linear regression models were used to examine the relation between self-reported severity 6 months after carpal tunnel release, as measured with the Boston Carpal Tunnel Questionnaire, and psychosocial aspects of mindset, adjusting for preoperative Boston Carpal Tunnel Questionnaire score, patient characteristics, and comorbidities. RESULTS Independent associations with better self-reported outcome were found for higher treatment expectations (β = -0.202; p < 0.001) and illness comprehensibility (β = -0.223; p < 0.001). The additional explained variance in Boston Carpal Tunnel Questionnaire scores by the patient's mindset was 13.2 percent (psychological distress and pain catastrophizing together, 2.1 percent; treatment expectations and illness perceptions together, 11.1 percent). CONCLUSION Treatment outcome expectations and comprehensibility of illness are both independently associated with the outcome of carpal tunnel release, showing the importance of these aspects of the patient's mindset for the outcome of carpal tunnel release. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Illness Perceptions of Patients With First Carpometacarpal Osteoarthritis, Carpal Tunnel Syndrome, Dupuytren Contracture, or Trigger Finger. J Hand Surg Am 2020; 45:455.e1-455.e8. [PMID: 31812335 DOI: 10.1016/j.jhsa.2019.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/30/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Previous studies indicate that patients with a more negative perception of their illness tend to respond less favorably to treatment, but little is known about whether illness perceptions differ based on the type of hand or wrist conditions. Therefore, we compared illness perceptions between patients scheduled to undergo surgery for 4 illnesses in hand surgery: carpometacarpal osteoarthritis (CMC OA), Dupuytren disease, carpal tunnel syndrome (CTS), and trigger finger syndrome (TFS). We hypothesized there would be differences in illness perception between these patient groups. METHODS Before surgery, patients were asked to complete the Brief Illness Perception Questionnaire (Brief-IPQ) as part of routine outcome measurement in a specialized hand and wrist surgery clinic. The Brief-IPQ is a validated questionnaire to rapidly assess the cognitive and emotional representation of illness. Differences in illness perception between the 4 diagnostic groups, corrected for age, sex, hand dominance, and work type, were examined. Cohen D effect sizes were calculated for the between-group differences. RESULTS We included 514 patients in the analyses: 87 with CMC OA, 146 with Dupuytren disease, 129 with CTS, and 152 with TFS. On a scale ranging from 0 (most positive perception) to 80 (most negative perception) the Brief-IPQ sum scores for these subgroups were 42.0, 28.2, 38.8, and 33.3, respectively. Corrected for age, sex, hand dominance, and work type, patients with Dupuytren disease had a more positive perception of their illness than patients with CMC OA and CTS. Compared with CMC OA patients, the effect sizes for Dupuytren, CTS, and TFS patients were, respectively, 1.28, 0.32, and 0.81. CONCLUSIONS In these patients with various hand/wrist disorders, differences were found in their preoperative perceptions of illness. Interventions that directly target negative illness perceptions might improve treatment outcomes for CMC OA and CTS. CLINICAL RELEVANCE These differences should be considered during preoperative medical consultations and/or when investigating surgical outcomes.
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I R de Oliveira B, Smith AJ, O'Sullivan PPB, Haebich S, Fick D, Khan R, Bunzli S. 'My hip is damaged': a qualitative investigation of people seeking care for persistent hip pain. Br J Sports Med 2020; 54:858-865. [PMID: 31980419 DOI: 10.1136/bjsports-2019-101281] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Clinicians who use the biopsychosocial approach to manage musculoskeletal pain disorders aim to understand how patients make sense of their symptoms. Treatment includes targeting the negative beliefs and coping responses that can lead to progressive pain and disability. We aimed to explore how people seeking care for persistent hip pain and disability make sense of their symptoms. METHODS Cross-sectional qualitative study. People were eligible if they were aged ≥18 years, were consulting an orthopaedic surgeon for persistent hip pain and offered a non-surgical intervention. Data were collected through interviews that explored patients' beliefs about the identity (diagnosis), causes, consequences, timeline and controllability of their symptoms, their strategies to cope with pain and their experiences in seeking healthcare. Transcribed interview data were analysed thematically using a framework approach. RESULTS Sixteen people (median age=51, range=33-73 years; median duration hip pain=3 years, range=3 months-20 years) participated. Most participants (10/16) believed their pain was caused by an exercise-related injury. Because of the results of imaging and interactions with healthcare professionals, all participants believed they had damaged hip structures. All described ineffective strategies to manage their pain and multiple failed treatments. For many (7/16), a lack of control over symptoms threatened their physical and mental health. CONCLUSIONS The way participants with persistent hip pain and disability made sense of their symptoms contributed to them avoiding physical activity, and it impaired their sleep, emotional well-being and physical health.
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Affiliation(s)
- Beatriz I R de Oliveira
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Anne Julia Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Peter P B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Samantha Haebich
- Hollywood Medical Centre, Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Daniel Fick
- Hollywood Medical Centre, Hollywood Private Hospital, Nedlands, Western Australia, Australia.,Faculty of Science and Engineering, Curtin University, Perth, Western Australia, Australia
| | - Riaz Khan
- Faculty of Science and Engineering, Curtin University, Perth, Western Australia, Australia.,School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Damman W, Liu R, Kaptein AA, Evers AWM, van Middendorp H, Rosendaal FR, Kloppenburg M. Illness perceptions and their association with 2 year functional status and change in patients with hand osteoarthritis. Rheumatology (Oxford) 2019; 57:2190-2199. [PMID: 30107461 DOI: 10.1093/rheumatology/key231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the association between illness perceptions and disability both cross-sectionally and over 2 years in patients with hand OA. Methods Illness perceptions and self-reported disability were assessed at baseline and after 2 years in 384 patients with primary hand OA (mean age 61 years, 84% women, n = 312 with follow-up) with the Illness Perception Questionnaire - Revised (IPQ-R), Functional Index for Hand OA, Australian/Canadian Hand OA Index and HAQ. Risk ratios for high disability (highest quartile) at both time points were estimated for tertiles of IPQ-R dimensions, using Poisson regression. The mean IPQ dimension change difference between patients with and without disability progression (change Functional Index for Hand OA ⩾ 1, Australian/Canadian Hand OA Index > 1.4, HAQ > 0.22) was estimated with linear regression. Analyses were adjusted for age, Doyle index and baseline score. Results At baseline, stronger negative illness perceptions were associated with high disability. Baseline illness perceptions were also associated with high disability after 2 years, although adjustment made apparent that these associations were confounded by baseline disability status. Most illness perceptions changed over 2 years; understanding increased, OA was regarded as more chronic and fewer emotions and consequences and less personal and treatment control were experienced. The 2 year change in disability was different between patients with and without progression for the illness perceptions of more perceived consequences, symptoms, treatment control and emotions. Conclusion Illness perceptions seemed to be implicated in disability and its progression. Our results suggest that interventions could focus on improving baseline disability, potentially using illness perceptions to accomplish this goal.
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Affiliation(s)
- Wendy Damman
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Rani Liu
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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13
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Abstract
Research on the Commonsense Self-Regulation Model has emphasised reflective/conscious perceptual processes regarding illness threat (beliefs about symptoms, consequences, timeline, and curability) in predicting and changing coping behaviours. Understanding of illness self-regulation and avenues for intervention might be enriched by consideration of automatic processes that influence the recognition and identification of illness, response to illness, and ongoing management. This article adopts an integrative approach to (1) outline the theoretical importance of implicit processes in patients' self-regulation of illness and methods to study them; (2) review research evidence for these processes, including interventions tested to modify them; and (3) outline avenues for future research. A substantial body of research on implicit processes (cognitive bias and interpretational bias) in illness maintenance in chronic illness has recently been extended to detection and interpretation of acute illness and new perspectives relating to the self-system. There is encouraging evidence that cognitive accessibility of coping and implicit attitudes may impact upon coping behaviours. Procedures that strategically automatise coping responses and create habits have considerable promise. We outline an agenda for future research in which health psychology accepts the challenge posed by the interplay of the reflective and associative systems in promoting effective self-regulation of illness.
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Affiliation(s)
- Sheina Orbell
- Department of Psychology, University of Essex, Colchester, UK
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14
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Sweeny K, Andrews SE. Should patients be optimistic about surgery? Resolving a conflicted literature. Health Psychol Rev 2017; 11:374-386. [DOI: 10.1080/17437199.2017.1320771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kate Sweeny
- Department of Psychology, University of California, Riverside, CA, USA
| | - Sara E. Andrews
- Department of Psychology, University of California, Riverside, CA, USA
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15
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Scott JE, Mathias JL, Kneebone AC. Depression and anxiety after total joint replacement among older adults: a meta-analysis. Aging Ment Health 2016; 20:1243-1254. [PMID: 26252414 DOI: 10.1080/13607863.2015.1072801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Patients usually experience good physical recovery after total joint replacement (TJR); however, it is unclear whether mood also improves. The current meta-analysis examined changes in depression and anxiety following TJR in older (≥50 years) patients in order to address this gap in the literature. METHODS Data from 26 studies (4045 TJR, 55 controls) that assessed depression and/or anxiety pre- and post-surgery in TJR patients, with or without a control group, were analyzed. Prevalence rates and Cohen's d effect sizes were used to evaluate changes in the prevalence and severity of depression/anxiety, respectively. RESULTS Approximately 23% of TJR patients had clinically significant levels of depression prior to surgery, which decreased to 13% one year later. The prevalence of anxiety could not be evaluated due to the limited available data. TJR patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery. Compared to controls, there was no difference in symptom progression over time; although only one study examined this. CONCLUSIONS TJR patients appear to have higher rates of clinically significant symptoms of depression before and after surgery, compared to the general population, however more research with adequate control groups is needed to confirm this. Only a modest improvement in the severity of depression and anxiety symptoms was noted post-surgery. However, existing research is limited; preventing definite conclusions regarding the impact of TJR on mood.
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Affiliation(s)
- J E Scott
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J L Mathias
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - A C Kneebone
- a School of Psychology , University of Adelaide , Adelaide , Australia.,b Department of Clinical Psychology , Flinders Medical Centre , Bedford Park , Australia
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Lindberg MF, Miaskowski C, RustøEn T, Rosseland LA, Cooper BA, Lerdal A. Factors that can predict pain with walking, 12 months after total knee arthroplasty. Acta Orthop 2016; 87:600-606. [PMID: 27658970 PMCID: PMC5119443 DOI: 10.1080/17453674.2016.1237440] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Functional limitations after total knee arthroplasty (TKA) are common. In this longitudinal study, we wanted to identify subgroups of patients with distinct trajectories of pain-related interference with walking during the first year after TKA and to determine which demographic, clinical, symptom-related, and psychological characteristics were associated with being part of this subgroup. Patients and methods - Patients scheduled for primary TKA for osteoarthritis (n = 202) completed questionnaires that evaluated perception of pain, fatigue, anxiety, depression, and illness on the day before surgery. Clinical characteristics were obtained from the medical records. Interference of pain with walking was assessed preoperatively, on postoperative day 4, and at 6 weeks, 3 months, and 12 months after TKA. Results - Using growth mixture modeling, 2 subgroups of patients were identified with distinct trajectories of pain-related interference with walking over time. Patients in the Continuous Improvement class (n = 157, 78%) had lower preoperative interference scores and reported a gradual decline in pain-related interference with walking over the first 12 months after TKA. Patients in the Recurrent Interference class (n = 45, 22%) reported a high degree of preoperative pain-related interference with walking, initial improvement during the first 3 months after TKA, and then a gradual increase-returning to preoperative levels at 12 months. Patients in the Recurrent Interference class had higher preoperative pain, fatigue, and depression scores, and poorer perception of illness than the Continuous Improvement class. Interpretation - 1 in 5 patients did not improve in pain-related interference with walking at 12 months after TKA. Future studies should test the efficacy of interventions designed to modify preoperative characteristics.
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Affiliation(s)
- Maren Falch Lindberg
- Department of Surgery, Lovisenberg Diakonale Hospital, Oslo;,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway;,Correspondence:
| | | | - Tone RustøEn
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway;,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway;,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Anners Lerdal
- Department of Surgery, Lovisenberg Diakonale Hospital, Oslo;,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Abstract
In this article I aim to outline the ways in which psychological research, and in particular, a social–cognitive approach, can make a meaningful contribution to the development of public policy and health and community care practice.
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Affiliation(s)
- Sheina Orbell
- Department of Psychology, University of Sheffield, UK
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Knowles SR, Nelson EA, Castle DJ, Salzberg MR, Choong PFM, Dowsey MM. Using the common sense model of illness to examine interrelationships between symptom severity and health outcomes in end-stage osteoarthritis patients. Rheumatology (Oxford) 2016; 55:1066-1073. [DOI: 10.1093/rheumatology/kew022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Aree-Ue S, Roopsawang I, Belza B. Self-regulation in older Thai women with self-reported knee osteoarthritis: A path analysis. J Women Aging 2016; 28:247-58. [PMID: 26931204 DOI: 10.1080/08952841.2014.951240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed at testing factors influencing coping behavior and health status among older women with knee osteoarthritis. A total of 274 participants completed questionnaires. Model testing revealed that self-efficacy was the most powerful predictor of coping behavior. Illness representation had a significant direct and indirect effect on health status and was a better predictor of health status than were the other variables. Understanding the complex relationships among study variables should help to tailor future interventions to better address the symptoms of osteoarthritis and to promote optimal health in older Thai women who report knee osteoarthritis.
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Affiliation(s)
- Suparb Aree-Ue
- a Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital , Mahidol University , Bangkok , Thailand
| | - Inthira Roopsawang
- a Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital , Mahidol University , Bangkok , Thailand
| | - Basia Belza
- b School of Nursing , University of Washington , Seattle , Washington, USA
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Pinto A, Faiz O, Davis R, Almoudaris A, Vincent C. Surgical complications and their impact on patients' psychosocial well-being: a systematic review and meta-analysis. BMJ Open 2016; 6:e007224. [PMID: 26883234 PMCID: PMC4762142 DOI: 10.1136/bmjopen-2014-007224] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Surgical complications may affect patients psychologically due to challenges such as prolonged recovery or long-lasting disability. Psychological distress could further delay patients' recovery as stress delays wound healing and compromises immunity. This review investigates whether surgical complications adversely affect patients' postoperative well-being and the duration of this impact. METHODS The primary data sources were 'PsychINFO', 'EMBASE' and 'MEDLINE' through OvidSP (year 2000 to May 2012). The reference lists of eligible articles were also reviewed. Studies were eligible if they measured the association of complications after major surgery from 4 surgical specialties (ie, cardiac, thoracic, gastrointestinal and vascular) with adult patients' postoperative psychosocial outcomes using validated tools or psychological assessment. 13,605 articles were identified. 2 researchers independently extracted information from the included articles on study aims, participants' characteristics, study design, surgical procedures, surgical complications, psychosocial outcomes and findings. The studies were synthesised narratively (ie, using text). Supplementary meta-analyses of the impact of surgical complications on psychosocial outcomes were also conducted. RESULTS 50 studies were included in the narrative synthesis. Two-thirds of the studies found that patients who suffered surgical complications had significantly worse postoperative psychosocial outcomes even after controlling for preoperative psychosocial outcomes, clinical and demographic factors. Half of the studies with significant findings reported significant adverse effects of complications on patient psychosocial outcomes at 12 months (or more) postsurgery. 3 supplementary meta-analyses were completed, 1 on anxiety (including 2 studies) and 2 on physical and mental quality of life (including 3 studies). The latter indicated statistically significantly lower physical and mental quality of life (p<0.001) for patients who suffered surgical complications. CONCLUSIONS Surgical complications appear to be a significant and often long-term predictor of patient postoperative psychosocial outcomes. The results highlight the importance of attending to patients' psychological needs in the aftermath of surgical complications.
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Affiliation(s)
- Anna Pinto
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Omar Faiz
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Rachel Davis
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Alex Almoudaris
- Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Charles Vincent
- Department of Experimental Psychology, Oxford University, Oxford, UK
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Magklara E, Morrison V. The associations of illness perceptions and self-efficacy with psychological well-being of patients in preparation for joint replacement surgery. PSYCHOL HEALTH MED 2015; 21:735-42. [PMID: 26610604 DOI: 10.1080/13548506.2015.1115109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patient well-being on referral to surgery likely affects their surgical experience yet few studies examine pre-surgical correlates of well-being. Guided by the Common Sense Model of Self-Regulation and Social Cognitive theory, this study examined whether illness and emotional representations, general and domain self-efficacy were associated with pre-surgical well-being. The pre-surgical assessment of a three-wave prospective study is reported. Fifty-four hip and knee replacements patients (mean age = 69.33; SD = 8.57) were recruited in the pre-surgery educational clinic at a UK general hospital. Patients completed a questionnaire-pack including the Revised Illness Perceptions Questionnaire, the General Self-Efficacy Scale, the Self-Efficacy for Rehabilitation Outcome Scale, the Falls-Efficacy Scale, and the Short Form of Psychological Well-Being Index. Multiple hierarchical regression analyses showed that above and beyond demographic and clinical characteristics, negative emotional representations were associated with lower psychological well-being while strong general self-efficacy beliefs were positively related to psychological well-being. Independent of demographic and clinical characteristics, joint replacement patients' psychological well-being was associated with their cognitions and emotional reactions to their condition before surgery. Early interventions could potentially target these modifiable factors to improve pre-surgical well-being in this group of patients, with potential for additional post-surgical benefit.
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Affiliation(s)
- Eleni Magklara
- a School of Psychology , Bangor University , Brigantia Building, Penrallt Road, LL57 2AS , Bangor , UK
| | - Val Morrison
- a School of Psychology , Bangor University , Brigantia Building, Penrallt Road, LL57 2AS , Bangor , UK
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Auer CJ, Glombiewski JA, Doering BK, Winkler A, Laferton JAC, Broadbent E, Rief W. Patients’ Expectations Predict Surgery Outcomes: A Meta-Analysis. Int J Behav Med 2015. [DOI: 10.1007/s12529-015-9500-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Makovey J, Metcalf B, Zhang Y, Chen JS, Bennell K, March L, Hunter DJ. Web-Based Study of Risk Factors for Pain Exacerbation in Osteoarthritis of the Knee (SPARK-Web): Design and Rationale. JMIR Res Protoc 2015; 4:e80. [PMID: 26156210 PMCID: PMC4526980 DOI: 10.2196/resprot.4406] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 11/13/2022] Open
Abstract
Background Knee osteoarthritis (OA) is the most frequent cause of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Many persons with symptomatic knee OA experience recurrent pain exacerbations. Knowledge and clarification of risk factors for pain exacerbation may allow those affected to minimize reoccurrence of these episodes. Objective The aim of this study is to use a Web-based case-crossover design to identify risk factors for knee pain exacerbations in persons with symptomatic knee OA. Methods Web-based case-crossover design is used to study persons with symptomatic knee OA. Participants with knee pain and radiographic knee OA will be recruited and followed for 90 days. Participants will complete an online questionnaire at the baseline and every 10 days thereafter (totaling up to 10 control-period questionnaires); participants will also be asked to report online when they experience an episode of increased knee pain. Pain exacerbation will be defined as an increase in knee pain severity of two points from baseline on a numeric rating scale (NRS 0-10). Physical activity, footwear, knee injury, medication use, climate, psychological factors, and their possible interactions will be assessed as potential triggers for pain exacerbation using conditional logistic regression models. Results This project has been funded by the National Health and Medical Research Council (NHMRC). The enrollment for the study has started. So far, 343 participants have been enrolled. The study is expected to be finished in October 2015. Conclusions This study will identify risk factors for pain exacerbations in knee OA. The identification and possible modification/elimination of such risk factors will help to prevent the reoccurrence of pain exacerbation episodes and therefore improve knee OA management.
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Affiliation(s)
- Joanna Makovey
- Northern Clinical School, Kolling Institute, Institute of Bone and Joint Research,, Department of Rheumatology, RNSH, University of Sydney, St Leonards, NSW, Australia.
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Günther KP, Haase E, Lange T, Kopkow C, Schmitt J, Jeszenszky C, Balck F, Lützner J, Hartmann A, Lippmann M. [Personality and comorbidity: are there "difficult patients" in hip arthroplasty?]. DER ORTHOPADE 2015; 44:555-65. [PMID: 25925089 DOI: 10.1007/s00132-015-3097-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Concomitant disorders at the time of surgery in addition to psychological and socioeconomic patient characteristics may influence treatment outcomes in hip arthroplasty. OBJECTIVES To describe the impact of these factors on perioperative complications and postoperative results in terms of function, quality of life, and patient satisfaction. MATERIALS AND METHODS Review of relevant clinical studies, meta-analyses, and presentation of our own results. RESULTS Comorbidities in general, especially in combination, increase the perioperative risk profile. Socioeconomic factors (education, professional qualifications, social deprivation) in addition to psychological variables (depression, distressed personality) can have a major impact on postoperative functional outcomes and patient satisfaction. CONCLUSIONS It is of crucial importance to avoid inequalities in the provision of joint replacement for patients with hip osteoarthritis and co-existing risk factors. Preventive strategies should be implemented to reduce the negative impact of comorbidities on treatment outcome. Personalized communication and education may be helpful in avoiding unrealistic patient expectations before hip replacement.
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Affiliation(s)
- K-P Günther
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Medizinische Fakultät der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland,
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Hanusch BC, O'Connor DB, Ions P, Scott A, Gregg PJ. Effects of psychological distress and perceptions of illness on recovery from total knee replacement. Bone Joint J 2014; 96-B:210-6. [PMID: 24493186 DOI: 10.1302/0301-620x.96b2.31136] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This cohort study investigated the influence of psychological factors, including perception of illness, anxiety and depression on recovery and functional outcome after total knee replacement surgery. A total of 100 patients (55 male; 45 female) with a mean age of 71 (42 to 92) who underwent a primary total knee replacement for osteoarthritis were recruited into this study. In all 97 participants completed the six week and 87 the one year follow-up questionnaires. Pre-operatively patients completed the revised Illness Perception Questionnaire, Hospital Anxiety and Depression Scale and Recovery Locus of Control Scale. Function was assessed pre-operatively, at six weeks and one year using Oxford Knee Score (OKS) and the goniometer-measured range of movement (ROM). The results showed that pre-operative function had the biggest impact on post-operative outcome for ROM and OKS. In addition questionnaire variables and depression had an impact on the OKS at six weeks. Depression and anxiety were also associated with a higher (worse) knee score at one year but did not influence the ROM at either six weeks or one year. Recovery from total knee replacement can be difficult to predict. This study has identified psychological factors that play an important role in recovery from surgery and functional outcome. These should be taken into account when considering patients for total knee replacement.
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Affiliation(s)
- B C Hanusch
- The James Cook University Hospital, Academic Centre, Marton Road, Middlesbrough, TS4 3BW, UK
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Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study. PLoS One 2013; 8:e73917. [PMID: 24058502 PMCID: PMC3772812 DOI: 10.1371/journal.pone.0073917] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/24/2013] [Indexed: 12/27/2022] Open
Abstract
Persistent post-surgical pain (PPSP) is a major clinical problem with significant individual, social and health care costs. The aim of this study was to examine the joint role of demographic, clinical and psychological risk factors in the development of moderate and severe PPSP after Total Knee and Hip Arthroplasty (TKA and THA, respectively). This was a prospective study wherein a consecutive sample of 92 patients were assessed 24 hours before (T1), 48 hours after (T2) and 4–6 months (T3) after surgery. Hierarchical logistic regression analyses were performed to identify predictors of moderate and severe levels of PPSP. Four to six months after TKA and THA, 54 patients (58.7%) reported none or mild pain (Numerical Rating Scale: NRS ≤3), whereas 38 (41.3%) reported moderate to severe pain (NRS >3). In the final multivariate hierarchical logistic regression analyses, illness representations concerning the condition leading to surgery (osteoarthritis), such as a chronic timeline perception of the disease, emerged as a significant predictor of PPSP. Additionally, post-surgical anxiety also showed a predictive role in the development of PPSP. Pre-surgical pain was the most significant clinical predictive factor and, as expected, undergoing TKA was associated with greater odds of PPSP development than THA. The findings on PPSP predictors after major joint arthroplasties can guide clinical practice in terms of considering cognitive and emotional factors, together with clinical factors, in planning acute pain management before and after surgery.
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Affiliation(s)
- Patrícia R. Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Health Psychology Group, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Teresa McIntyre
- Texas Institute for Measurement, Evaluation and Statistics (TIMES) and Department of Psychology, University of Houston, Houston, United States of America
| | - Ramón Ferrero
- Alto Ave Hospital Center, Orthopedics Unit, Guimarães, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Vera Araújo-Soares
- Health Psychology Group, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Pouli N, Das Nair R, Lincoln NB, Walsh D. The experience of living with knee osteoarthritis: exploring illness and treatment beliefs through thematic analysis. Disabil Rehabil 2013; 36:600-7. [PMID: 23789746 PMCID: PMC4002631 DOI: 10.3109/09638288.2013.805257] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 05/08/2013] [Accepted: 05/10/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Knee osteoarthritis (OA) is a major cause of disability in older adults. However, there is limited research on the daily experience of living with knee OA. We aimed to offer insight into the beliefs of patients with knee OA about their illness and treatment. METHOD Twenty-four semi-structured interviews were conducted with 17 women and 7 men with physician-diagnosed knee OA, aged between 48 and 84 years (mean = 62, SD = 7). The audio-taped interviews lasted from 30 min to 1 h, and were transcribed verbatim. The data were subjected to thematic analysis. The transcripts were independently coded by two researchers to increase reliability of coding. RESULTS Six themes were developed and two of these are examined in further detail: (i) Illness representation and (ii) Beliefs about the medical and surgical control of pain. Illness representation comprised beliefs about people's understanding of OA and their pain experience, as well as expectations about the course of illness. The second theme presented experiences of limited pain relief and concerns about the use of drugs and surgery. CONCLUSION Exploring illness representations and beliefs about medical and surgical control of pain may provide the basis for initiating psychological interventions for people with knee OA. IMPLICATIONS FOR REHABILITATION People with knee OA place pain at the core of their living, and hold beliefs about knee OA being an incurable disease of a progressive nature, linked to specific causal factors. People with OA have concerns and worries about use of medication to control pain, and are ambivalent towards relying on medical or surgical interventions. Exploring and addressing patient illness beliefs and treatment expectations may help improve concordance with and outcomes from intervention.
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Affiliation(s)
- Nektaria Pouli
- Arthritis Research UK Pain Centre, University of NottinghamNottinghamUK
| | - Roshan Das Nair
- Arthritis Research UK Pain Centre, University of NottinghamNottinghamUK
| | | | - David Walsh
- Arthritis Research UK Pain Centre, University of NottinghamNottinghamUK
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Predictors of Acute Postsurgical Pain and Anxiety Following Primary Total Hip and Knee Arthroplasty. THE JOURNAL OF PAIN 2013; 14:502-15. [DOI: 10.1016/j.jpain.2012.12.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/15/2012] [Accepted: 12/31/2012] [Indexed: 11/20/2022]
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Risk factors for persistent postsurgical pain in women undergoing hysterectomy due to benign causes: a prospective predictive study. THE JOURNAL OF PAIN 2012; 13:1045-57. [PMID: 23063345 DOI: 10.1016/j.jpain.2012.07.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 07/15/2012] [Accepted: 07/25/2012] [Indexed: 11/23/2022]
Abstract
UNLABELLED Persistent postsurgical pain (PPSP) is a major clinical problem with significant individual, social, and healthcare costs. The aim of this study was to examine the role of demographic, clinical, and psychological risk factors in the development of PPSP after hysterectomy due to benign disorders. In a prospective study, a consecutive sample of 186 women was assessed 24 hours before surgery (T1), 48 hours after surgery (T2), and 4 months after surgery (T3). Regression analyses were performed to identify predictors of PPSP. Four months after hysterectomy, 93 (50%) participants reported experiencing pain (numerical rating scale >0). Age, pain due to other causes, and type of hysterectomy emerged as significant predictive factors. Baseline presurgical psychological predictors identified were anxiety, emotional illness representation of the condition leading to surgery, and pain catastrophizing. Among the identified psychological predictors, emotional illness representation emerged as the strongest. Acute postsurgical pain frequency and postsurgical anxiety also revealed a predictive role in PPSP development. These results increase the knowledge on PPSP predictors and point healthcare professionals toward specific intervention targets such as anxiety (presurgical and postsurgical), pain catastrophizing, emotional illness representations, and acute pain control after surgery. PERSPECTIVE This study found that presurgical anxiety, emotional illness representations, and pain catastrophizing are risk factors for PPSP 4 months after hysterectomy, over and above age and clinical variables. These findings improve knowledge on PPSP and highlight potential intervention targets for healthcare professionals.
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Nicholls EE, Hill S, Foster NE. Musculoskeletal pain illness perceptions: factor structure of the Illness Perceptions Questionnaire-Revised. Psychol Health 2012; 28:84-102. [PMID: 22891727 PMCID: PMC3516816 DOI: 10.1080/08870446.2012.714782] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Revised Illness Perceptions Questionnaire (IPQ-R) is commonly used to measure illness perceptions. We tested whether the structure of the IPQ-R was appropriate for use with primary care musculoskeletal pain patients. METHODS Confirmatory (C) and exploratory (E) factor analyses (FA) were used to test whether the structure of the IPQ-R was supported for patients with knee pain (n = 393), hand pain (n = 2113) and back pain (n = 1591). CFA was used to test whether the timeline acute/chronic, timeline cyclical, consequences, personal control, treatment control, illness coherence and emotional representation dimensions of the IPQ-R were distinct; EFA was used to explore potential structure for patients' views on the cause of their condition. RESULTS Goodness-of-fit indices for the CFA were below our criteria for good model fit. Removal of six items from the model improved model fit, but our criteria for good model fit was still not achieved. An interpretable factor solution could not be determined for the causal items on the questionnaire. CONCLUSIONS Our data show limited evidence that the seven dimensions of the IPQ-R are distinct. A clear structure for the causal items was not determined. Further work is needed to develop the IPQ-R for use with primary care musculoskeletal pain patients.
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Affiliation(s)
- Elaine E Nicholls
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
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Hobbs N, Dixon D, Rasmussen S, Judge A, Dreinhöfer KE, Günther KP, Dieppe P. Patient preoperative expectations of total hip replacement in European orthopedic centers. Arthritis Care Res (Hoboken) 2011; 63:1521-7. [PMID: 22034114 DOI: 10.1002/acr.20596] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Patient expectations have been identified as a factor that may account for individual differences in recovery after total hip replacement (THR) surgery. However, patient expectations have not been studied within a valid theoretical framework. This study employed the World Health Organization's model of health, the International Classification of Functioning, Disability and Health (ICF), to classify the content of preoperative patient expectations of THR. METHODS A European cohort of 1,108 patients preoperatively reported 2 types of expectations. Patients reported what they anticipated surgery would enable them to do that they needed to be able to do ("need" expectation), and what they would like to be able to do ("desire" expectation) in a year's time. Free-text responses were independently classified by 2 researchers to 1 or more of the ICF constructs of impairment, activity limitation, and participation restriction. RESULTS Interrater reliability was high (κ = ≥0.87). All patient expectations were classified to the ICF constructs. Less than 5% of patient expectations were identified as impairment, 58% of "need" expectations were identified as activity limitations, and 45% of "desire" expectations were identified as activity limitations and participation restrictions combined. CONCLUSION The ICF is a suitable theoretical framework to study patient expectations of THR. THR targets impairment; however, few patient expectations were classified to the ICF definition of impairment. The majority of patient expectations were classified as activity limitation or a combination of activity limitation and participation restriction. Therefore, patient expectations of surgery focus on recovering valued activities rather than reversal of bodily impairments.
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Wilkinson AN, Maher AJ. Patient expectations of podiatric surgery in the United Kingdom. J Foot Ankle Res 2011; 4:27. [PMID: 22145971 PMCID: PMC3251527 DOI: 10.1186/1757-1146-4-27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 12/06/2011] [Indexed: 11/29/2022] Open
Abstract
Background Patient expectations can be difficult to conceptualise and are liable to change with time, health and environmental factors. Patient expectation is known to influence satisfaction, however little is known about the expectations of patients attending for podiatric surgery. This paper will explore the expectations of a large cohort of patients undergoing elective foot surgery. Methods The UK based podiatric audit of surgery and clinical outcome measurement (PASCOM) audit system was applied to a consecutive cohort of patients undergoing elective podiatric surgery in Doncaster, South Yorkshire between 2004 and 2010. Data was collected relating to the surgical episode and patient expectations. A patient questionnaire was administered at 6 months post intervention. Results A total of 2910 unique surgical admissions were completed and satisfaction questionnaires were returned by 1869 patients. A total of 1430 patients answered question 1 which relates to patient expectations. Pain relief was the most frequent expectation with 1191 counts (52.3%), while footwear and mobility accounted for 16.6% and 16.4% respectively. Cosmesis counts occurred less commonly; 12.2%. 709 patients (49.6%) stated only a single expectation, 599 patients (41.9%) stated two expectations, 114 patients (8%) stated three expectations and 7 patients (0.5%) stated 4 expectations. Pain relief was the dominant expectation accounting for 515 counts (72.6%) of patients who provided only one response. Conclusions This paper demonstrates the expectations of a large cohort of podiatric surgery patients. For the most part patients expect pain relief, improved mobility and improved shoe fitting, while a small number of patients also expect a cosmetic improvement. Further research is required to determine the relationship between patient expectation and health related quality of life, and to determine whether podiatric surgery is successful in addressing the expectations of patients.
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Affiliation(s)
- Antony N Wilkinson
- Department of Podiatric Surgery, Park House Health and Social Care Centre, 61 Burton Road, Carlton, Nottingham, NG4 3DQ, UK.
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McCABE PAMELAJ, BARNASON SUSANA, HOUFEK JULIA. Illness Beliefs in Patients with Recurrent Symptomatic Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:810-20. [DOI: 10.1111/j.1540-8159.2011.03105.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chilcot J, Wellsted D, Davenport A, Farrington K. Illness representations and concurrent depression symptoms in haemodialysis patients. J Health Psychol 2011; 16:1127-37. [DOI: 10.1177/1359105311401672] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We examined the association between illness perceptions and depression symptoms in established haemodialysis patients (HD). Two hundred and fifteen patients completed the Revised Illness Perception Questionnaire and the Beck Depression Inventory-II (BDI). Patients with a BDI ≥ 16 were termed as ‘depressed’. Lower personal control and illness coherence, and greater perceived consequences were all related to depression significantly increasing the explained variance over clinical factors. Our findings suggest it is not disease characteristics or co-morbidity per se that is related to mood symptoms in HD patients, rather the apparent interpretation and regulation of the illness.
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Jeffery AE, Wylde V, Blom AW, Horwood JP. "It's there and I'm stuck with it": patients' experiences of chronic pain following total knee replacement surgery. Arthritis Care Res (Hoboken) 2011; 63:286-92. [PMID: 20890979 DOI: 10.1002/acr.20360] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To gain insight into patients' experiences of adjustment to chronic pain following recovery from total knee replacement (TKR) surgery. METHODS Participants were purposively sampled and comprised 28 individuals, 18 women and 10 men, ages 57-87 years, who had undergone a TKR between 2 and 5 years previously. Semistructured interviews explored participants' perceptions of their condition and its impact, including its causes and consequences. Thematic analysis, using the constant comparison technique, was used to identify and analyze patterns and themes from the transcripts. RESULTS Although some individuals expressed acceptance of their continuing pain, others reported that it caused them considerable distress. Variation in expressed acceptance and distress was not related to self-reported pain severity. Various factors relating to adjustment emerged, including perceived improvement or deterioration in circumstances since TKR, surgeon input pre- and postsurgery, and beliefs about pain in the context of an individual's life. Participants described a sense of abandonment following TKR and discussed the support they felt they should have received. CONCLUSION The data suggest that adjustment to chronic pain following recovery from TKR surgery is influenced by biomedical and psychosocial factors, including an individual's pain-related illness cognitions, beliefs, and their perceptions of their condition in a social context. Patient care could be improved by clinicians utilizing a biopsychosocial framework to acknowledge the impact of osteoarthritis of the knee as a multidimensional health condition.
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Affiliation(s)
- Alison E Jeffery
- University of Bristol, and Musculoskeletal Research Unit, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
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Stockford K, Turner H, Cooper M. Illness perception and its relationship to readiness to change in the eating disorders: A preliminary investigation. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 46:139-54. [PMID: 17524209 DOI: 10.1348/014466506x115786] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study investigated the psychometric properties of a modified version of the Illness Perception Questionnaire - Revised (IPQ-R) in individuals with eating disorders. The relationship between illness representations and stage of change was then explored. Design and method. A cross-sectional design was employed and participants were asked to complete a set of questionnaires. A subset of participants completed the IPQ-R again after 2 weeks in order to assess test-retest reliability. The relationship between illness representations and stage of change was explored using hierarchical multiple regression analyses. RESULTS Sixty-nine participants with a clinical eating disorder took part in the study. With the exception of the causal subscales, the modified version of the IPQ-R had good internal validity and good test-retest reliability. Consequences, treatment control and personal control as well as cyclical timeline perceptions accounted for a significant and unique amount of variance in readiness to change stage scores. CONCLUSIONS Findings suggest that this modified version of the IPQ-R provides a reliable means of exploring illness representations in individuals with eating disorders. Given the significant relationships between illness representations and stage of change, it may be helpful to consider these aspects of illness representations when carrying out therapeutic work with this clinical population. Further research might usefully investigate the relationship between illness perceptions and clinical outcome, as well as examine what factors are important in the shift between stages of change in a longitudinal design.
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Gould RV, Brown SL, Bramwell R. Psychological adjustment to gynaecological cancer: Patients’ illness representations, coping strategies and mood disturbance. Psychol Health 2010; 25:633-46. [DOI: 10.1080/08870440902811163] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hoving JL, van der Meer M, Volkova AY, Frings-Dresen MHW. Illness perceptions and work participation: a systematic review. Int Arch Occup Environ Health 2010; 83:595-605. [PMID: 20130906 PMCID: PMC2902734 DOI: 10.1007/s00420-010-0506-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 01/14/2010] [Indexed: 11/17/2022]
Abstract
Purpose Self-regulatory processes play an important role in mediating between the disease and the health outcomes, and potentially also work outcomes. This systematic review aims to explore the relationship between illness perceptions and work participation in patients with somatic diseases and complaints. Methods The bibliographic databases Medline, PsycINFO and Embase were searched from inception to March 2008. Included were cross-sectional or longitudinal studies, patients with somatic diseases or complaints, illness perceptions based on at least four dimensions of the common sense model of self-regulation, and work participation. Results Two longitudinal and two cross-sectional studies selected for this review report statistically significant findings for one or more illness perception dimensions in patients with various complaints and illnesses, although some dimensions are significant in one study but not in another. Overall, non-working patients perceived more serious consequences, expected their illness to last a longer time, and reported more symptoms and more emotional responses as a result of their illness. Alternatively, working patients had a stronger belief in the controllability of their condition and a better understanding of their disease. Conclusions The limited number of studies in this review suggests that illness perceptions play a role in the work participation of patients with somatic diseases or complaints, although it is not clear how strong this relationship is and which illness perception dimensions are most useful. Identifying individuals with maladaptive illness perceptions and targeting interventions toward changing these perceptions are promising developments in improving work participation.
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Affiliation(s)
- J L Hoving
- Coronel Institute of Occupational Health, Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 Amsterdam, The Netherlands.
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Rozema H, Völlink T, Lechner L. The role of illness representations in coping and health of patients treated for breast cancer. Psychooncology 2009; 18:849-57. [DOI: 10.1002/pon.1488] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hall M, Migay AM, Persad T, Smith J, Yoshida K, Kennedy D, Pagura S. Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty. Physiother Theory Pract 2009; 24:167-81. [DOI: 10.1080/09593980701588326] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Callaghan BG, Johnston M, Condie ME. Using the theory of planned behaviour to develop an assessment of attitudes and beliefs towards prosthetic use in amputees. Disabil Rehabil 2009; 26:924-30. [PMID: 15497923 DOI: 10.1080/09638280410001708959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To develop a questionnaire based on the theory of planned behaviour (TPB) to predict prosthetic use. METHOD In part one, 31 amputees over 50 years of age with peripheral arterial disease completed attitude items containing 27 bipolar adjectives and open-ended questions on behavioural, normative and control beliefs relating to using the prosthesis. Academic, clinical and patient experts (n = 12) identified bipolar adjectives with best face validity. In part two, 15 amputees completed three behavioural format questions relating to prosthetic use and were asked to indicate the easiest to answer. RESULTS Following the completion of the attitude items by the amputees and the expert panel review, 5 items remained (Cronbach's alpha = 0.87) with corrected item-total correlations ranging from 0.43 to 0.83. Modal behavioural beliefs concerned mobility (46.5%), independence (25.6%) and participation restrictions (16.3%), normative beliefs concerned family (33.3%), NHS staff (31.7%), friends (19.1%) and other patients (15.9%) and control beliefs concerned stairs (21.1%), slippery/rough surfaces (28.9%), disabled facilities (54.8%) and people helping (22.6%). In relation to part 2, an exact numerical report of hours and days of prosthetic use was found easiest to answer (73%). CONCLUSIONS Based on this qualitative and quantitative development work, the questionnaire contains five attitude items, six behavioural, eight normative, eight control belief items and two self-report questions of the behaviour.
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Affiliation(s)
- B G Callaghan
- The National Centre for Training and Education in Prosthetics and Orthotics, University of Strathclyde, Glasgow, UK.
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Abstract
This article delineates the characteristic symptoms and signs associated with OA and how they can be used to make the clinical diagnosis. The predominant symptom in most patients is pain. The remainder of the article focuses on what we know causes pain in OA and contributes to its severity. Much has been learned over recent years; however, for the budding researcher much of this puzzle remains unexplored or inadequately understood.
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Affiliation(s)
- David J Hunter
- Division of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston MA 02120, USA.
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Kadzielski J, Malhotra LR, Zurakowski D, Lee SGP, Jupiter JB, Ring D. Evaluation of preoperative expectations and patient satisfaction after carpal tunnel release. J Hand Surg Am 2008; 33:1783-8. [PMID: 19084178 DOI: 10.1016/j.jhsa.2008.06.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 06/17/2008] [Accepted: 06/19/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE We tested the hypothesis that preoperative expectations affect postoperative satisfaction and arm-specific, self-reported health status after elective carpal tunnel release. METHODS Forty-nine patients having elective carpal tunnel release completed questionnaires evaluating self-rated upper extremity-specific disability using the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire, expectations regarding surgery (Preop Expectations Score), personal importance of upper-extremity function, measures of general optimism, the Life Orientation Test (LOT), as well as health-specific optimism, and the Multidimensional Health Locus of Control scale. Six months after surgery, patients completed a 10-point Likert scale to assess satisfaction, the DASH, and measures determining (1) fulfillment of expectations (Postop Met Expectations Score) and (2) relief of specific systems (Postop Help Score). RESULTS The DASH scores decreased significantly from an average of 37 points before surgery to an average of 15 points 6 months after carpal tunnel release (p<.001), and patients rated their satisfaction (mean +/- standard deviation) as 8 +/- 3. Preoperative expectations did not correlate with patient satisfaction or postoperative DASH scores. Multivariable analyses determined that patient satisfaction was best predicted by fulfillment of expectations (Postop Help Score alone, accounting for 41% of the variance in scores) and postoperative DASH scores were predicted by a combination of Postop Met Expectations Score and the LOT score (accounting for 31% of the variance in scores). CONCLUSIONS As measured in this study, the strongest predictor of satisfaction after carpal tunnel release was relief of symptoms, and the strongest predictors of postoperative disability were met expectations and optimism; however, the majority of the variance in postoperative satisfaction remains unexplained. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
- John Kadzielski
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114-2696, USA
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Illness representations and coping following an abnormal colorectal cancer screening result. Soc Sci Med 2008; 67:1465-74. [DOI: 10.1016/j.socscimed.2008.06.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Indexed: 12/20/2022]
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Hunter DJ, McDougall JJ, Keefe FJ. The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am 2008; 34:623-43. [PMID: 18687276 DOI: 10.1016/j.rdc.2008.05.004] [Citation(s) in RCA: 253] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Symptomatic osteoarthritis (OA) causes substantial physical and psychosocial disability. This article delineates the characteristic symptoms and signs associated with OA and how they can be used to make the clinical diagnosis. The predominant symptom in most patients is pain. The remainder of the article focuses on what is known about the causes of pain in OA and factors that contribute to its severity. Much has been learned during recent years, but much of this puzzle remains unexplored or inadequately understood.
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Affiliation(s)
- David J Hunter
- Division of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA.
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Callaghan B, Condie E, Johnston M. Using the common sense self-regulation model to determine psychological predictors of prosthetic use and activity limitations in lower limb amputees. Prosthet Orthot Int 2008; 32:324-36. [PMID: 18825576 DOI: 10.1080/03093640802242326] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE There are around 800 lower limb amputations performed each year in Scotland, however one unpublished study showed that 20% of fitted transtibial amputees do not use, and 20% only occasionally use, their prosthesis at one-year follow-up. This finding has implications for patients' well-being and healthcare cost efficiency. Leventhal's common sense self-regulation model (CS-SRM), a social cognition model in health psychology, was used to determine if psychological variables would predict prosthetic use and activity limitations in lower limb amputees. METHOD A longitudinal study recruited 166 peripheral arterial disease amputees (aged: 50+ yrs). The illness perception questionnaire-revised (IPQ-R) assessed psychological variables at 3-4 weeks post-operatively. Items from the functional measure for amputees (FMA) assessed prosthetic use and the locomotor capabilities index (LCI) evaluated activity limitations at 1-month and 6-months post-discharge. Outcome variables were entered into multiple regression equations with predictor variables. RESULTS Significant CS-SRM regression models emerged for predicting prosthetic use, with timeline cyclical (perceptions of symptoms fluctuating) and treatment control (beliefs about treatment efficacy) being the most influential variables. Their effects were stronger at 6-months than at 1-month. The same variables were influential for predicting activity limitations at both 1-month and 6-months. Emotional representations (distressing thoughts) were also influential at 1-month. CONCLUSIONS Knowledge of how psychological variables determined prosthetic use and activity limitations is valuable because it raises the prospect of being able to identify patients whose psychological profiles render them more at risk of not rehabilitating successfully with a prosthesis, in this case those who perceived symptoms as fluctuating and treatment to be ineffective. Such information could also inform the formulation of elements of psychological care aimed at increasing the number of patients making effective use of their prosthesis and achieving improved activity post-discharge from hospital.
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Affiliation(s)
- Brian Callaghan
- National Centre for Prosthetics and Orthotics, University of Strathclyde, Glasgow, UK
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McCabe PJ. Self-management of atrial fibrillation: a new frontier for nursing research. ACTA ACUST UNITED AC 2008; 23:37-40. [PMID: 18326995 DOI: 10.1111/j.1751-7117.2008.07351.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Godoy-Izquierdo D, López-Chicheri I, López-Torrecillas F, Vélez M, Godoy JF. Contents of lay illness models dimensions for physical and mental diseases and implications for health professionals. PATIENT EDUCATION AND COUNSELING 2007; 67:196-213. [PMID: 17462850 DOI: 10.1016/j.pec.2007.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 03/18/2007] [Accepted: 03/19/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The main aim of this study was to establish the contents of the lay illness models on depression, cancer, hypertension, schizophrenia and influenza in healthy and ill people suffering from these diseases who have/have not coexisted with people with these health alterations. METHODS Dimensions of lay illness models for depression, schizophrenia, cancer, hypertension and influenza were assessed in 348 people (62.6% women) aged 13-50 (M=20.72; S.D.=5.96) with different personal experience with the studied diseases. RESULTS Lay illness beliefs are usually close to medical knowledge, but in some relevant cases they are very divergent from this. Experience with the disease (to have suffered from it or to have coexisted with an ill relative) seems to have a great influence in the contents of lay illness models. CONCLUSION People's representations on illnesses are not complete or correct at all, and this will have, as the Common Sense Model establishes, relevant repercussions on individuals' behaviors in relation to health and illness and on the outcomes of diseases. PRACTICE IMPLICATIONS To know the personal illness models for physical and mental health threats of healthy and ill people with different personal experience with the disease has important implications for health professionals' promotion and prevention strategies and clinical (treatment/rehabilitation) actuations.
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Affiliation(s)
- Débora Godoy-Izquierdo
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Granada, Campus de Cartuja, 18071 Granada, Spain.
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Llewellyn CD, McGurk M, Weinman J. Illness and treatment beliefs in head and neck cancer: is Leventhal's common sense model a useful framework for determining changes in outcomes over time? J Psychosom Res 2007; 63:17-26. [PMID: 17586334 DOI: 10.1016/j.jpsychores.2007.01.013] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 01/16/2007] [Accepted: 01/18/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The main aim of this prospective study was to examine the utility of Leventhal's common sense model in predicting longitudinal judgement-based outcomes in patients with head and neck cancer (HNC). The study is of potential importance as it focuses on the relations between personality factors, coping styles, informational needs, illness representations, and outcomes using a longitudinal study design. This has particular value as the trend in similar research is to focus on concurrent relations between variables. In addition, the prediction of numerous outcomes from illness perceptions has received relatively scant attention in the field of HNC. METHODS Fifty patients completed the following measures prior to treatment, 1 month and 6-8 months after treatment: IPQ-R, BMQ, Brief COPE, LOT-R, SCIP, EORTC QLQ-C30, SF-12, Patient Generated Index (PGI), and HADS. RESULTS Baseline illness and treatment beliefs were not predictive of HR-QoL, individualized QoL, or anxiety 6-8 months after treatment; however, beliefs about the chronicity of the disease (timeline beliefs) were predictive of depression after treatment. Coping strategies employed and levels of satisfaction with information before treatment were significant predictors of several outcomes. CONCLUSIONS Our findings suggest that a common sense model may be a useful framework for eliciting and understanding patients' beliefs regarding HNC; however, there are concerns regarding the use of a 'dynamic' model to predict longitudinal outcomes from baseline factors that may change over the course of an illness.
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Affiliation(s)
- Carrie Diane Llewellyn
- Health Psychology Section, Department of Psychology, Institute of Psychiatry (Guy's Campus) King's College London, Guy's Hospital, London, United Kingdom.
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Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J, Marcus MAE, Vlaeyen JWS, van Kleef M. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 2007; 245:487-94. [PMID: 17435557 PMCID: PMC1877005 DOI: 10.1097/01.sla.0000245495.79781.65] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify somatic and psychologic predictors of pain, functional limitations, global perceived recovery, and quality of life 6 months after surgical intervention. SUMMARY BACKGROUND DATA Recent studies have indicated that chronic pain after surgical intervention is more common than previously assumed. Several demographic and somatic predictors of long-term unfavorable outcome have been identified, but little is known about the contribution of psychologic risk factors. METHODS A prospective cohort study, including 625 patients undergoing elective surgery at the University Hospital Maastricht, The Netherlands, was conducted between February and August 2003. Psychologic questionnaires were completed preoperatively and acute postoperative pain was recorded until 4 days after the operation. Six months later, all patients received follow-up questionnaires to assess pain, functional limitations, global perceived recovery, and quality of life. Multivariable logistic regression analyses were used to estimate relative risk of poor outcome in terms of pain, functional limitations, and global recovery. Multivariable linear regression analysis was used to assess associations with quality of life at 6 months. RESULTS The most important somatic predictors of unfavorable outcome were duration of the operation and high levels of acute postoperative pain. Patients reporting high levels of pain 4 days after the operation and patients undergoing an operation of longer than 3 hours were at risk for increased pain, increased functional limitations, poor global recovery, and reported lower levels of quality of life 6 months after the operation. Psychologic variables that influenced long-term outcome were preoperative fear of surgery and optimism. Fear of the long-term consequences of the operation was associated with more pain, poor global recovery, and worse quality of life 6 months later, whereas optimism was associated with better recovery and higher quality of life. CONCLUSIONS This study was the first to identify the joint contribution of somatic and psychologic factors to chronic pain, functional limitations, and quality of life 6 months after surgical interventions. It replicates previous findings that intense acute postoperative pain is a risk factor for long-term adverse outcome and also identified additional risk factors, namely, long duration of the operation, ASA status, and preoperative fear of surgery.
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Affiliation(s)
- Madelon L Peters
- Department of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht, The Netherlands.
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