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Güllü A, Tosun B. Effectiveness of the transitional care model in total knee arthroplasty patients: A randomized controlled trial. Int J Nurs Pract 2024:e13283. [PMID: 38989604 DOI: 10.1111/ijn.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/20/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
AIM This study has aimed to assess the effectiveness of the transitional care model (TCM) on functional status, perceived self-efficacy and healthcare utilization in patients undergoing total knee arthroplasty (TKA). METHOD This randomized controlled study was conducted between February and November 2021 in a public hospital. The study randomly assigned patients to either a 6-week 'TCM' program or usual care. The sample size was n = 70, with each group comprising 35 individuals. Patient outcomes, including self-efficacy, functional status and healthcare service readmission rates, were monitored for TKA patients. RESULTS Nursing care based on the 'TCM' was found to enhance functional status and increase the level of self-efficacy among TKA patients, leading to a decrease in healthcare service readmissions. CONCLUSIONS The study recommends preparing patients and their families for the preoperative and postoperative processes. It emphasizes the importance of providing necessary training and consultancy services under the leadership of orthopaedic nurses responsible for TKA patient care, guided by the principles of TCM.
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Affiliation(s)
- Ayla Güllü
- Faculty of Health Sciences, School of Nursing, Hasan Kalyoncu University, Gaziantep, Turkey
- Faculty of Health Sciences, School of Nursing, Hatay Mustafa Kemal University, Antakya, Turkey
| | - Betul Tosun
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
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Ten Noever de Brauw GV, Aalders MB, Kerkhoffs GMMJ, Zuiderbaan HA, Keijser LCM, Benner JL. The mind matters: Psychological factors influence subjective outcomes following unicompartmental knee arthroplasty-A prospective study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38796718 DOI: 10.1002/ksa.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE This study aimed to investigate how psychological factors, including pain catastrophizing (PC), anxiety and depression affect preoperative and postoperative subjective outcomes in patients undergoing unicompartmental knee arthroplasty (UKA). METHODS A prospective comparative study was performed among 150 patients undergoing medial or lateral UKA for isolated unicompartmental osteoarthritis. Patients were categorized based on their preoperative PC and Hospital Anxiety and Depression Scale, stratifying them into groups with PC, anxiety or depression, and those without these psychological factors. Patient-reported outcomes, including the Knee Injury and Osteoarthritis Outcome Score-Physical function Short form (KOOS-PS), 5-level EQ5D Visual Analogue Scale (EQ5D-VAS), Forgotten Joint Score (FJS) and Numeric Rating Scale for pain (NRS-pain) were compared between groups preoperatively and at 6-, 12-, and 24-month follow-up. RESULTS At 24 months, PC patients had inferior outcomes in KOOS-PS (66.9 ± 16.5 vs. 77.6 ± 14.7, p = .008), EQ5D-VAS (63.5 ± 19.9 vs. 78.9 ± 20.1, p = .003) and FJS (73.7 ± 14.3 vs. 84.6 ± 13.8, p = .003). Anxiety was associated with inferior KOOS-PS (65.4 ± 15.2 vs. 78.2 ± 14.5, p = <.001), EQ5D-VAS (64.2 ± 23.2 vs. 79.3 ± 19.4, p = .002), FJS (75.7 ± 16.8 vs. 84.6 ± 13.4, p = .008) and NRS-pain (27.4 ± 24.6 vs. 13.7 ± 19.3, p = .023) at 24 months. Depression consistently resulted in inferior outcomes in KOOS-PS, EQ5D-VAS, FJS and NRS-pain across all follow-up assessments (p = <.05). Additionally, patients with anxiety and depression experienced longer length of hospital stay compared to those without these psychological factors (anxiety: 2.3 ± 2.3 vs. 0.8 ± 0.8 days, p = .006; depression: 2.3 ± 2.4 vs. 0.8 ± 0.8 days, p = .017). CONCLUSIONS Preoperative PC, anxiety and depression are associated with inferior subjective outcomes both prior to and following UKA. Among these factors, depression seemed to exert the most substantial adverse impact on outcomes following UKA. Patients with anxiety and depression had an extended duration of hospitalization lasting over twice as long as patients without these psychological factors. It seems that inferior outcomes primarily stem from the suboptimal preoperative condition rather than an inherent inability to benefit from UKA. LEVEL OF EVIDENCE Level II, prospective study.
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Affiliation(s)
- Gaby V Ten Noever de Brauw
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Margot B Aalders
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen-North, The Netherlands
| | - Lucien C M Keijser
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
- Centre for Orthopedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
| | - Joyce L Benner
- Department of Orthopaedic Surgery, Northwest Clinics, Alkmaar, The Netherlands
- Centre for Orthopedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
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Kaveeshwar S, Schneider MB, Kung JE, Zhang T, Li SQ, Leong NL, Packer JD, Meredith SJ, Henn Iii RF. Patient-Reported Outcome Measurement Information System Depression and Anxiety in Elective Knee Surgery Patients. J Knee Surg 2024; 37:460-469. [PMID: 37734403 DOI: 10.1055/a-2179-3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Mental health has been shown to play an important role in patient-reported outcomes (PRO); however, there is a general lack of literature describing patient-reported outcome measurement information system (PROMIS) depression and anxiety computer adaptive tests in elective knee surgery patients. The purpose of our study was to assess the prevalence of depression and anxiety symptoms before and after elective knee surgery and to determine whether these symptoms influence postoperative functional outcomes. An institutional review board-approved prospective orthopaedic registry was retrospectively queried for patients undergoing elective knee surgery from June 2015 to November 2018. Electronic surveys collecting patient demographic information and PROs were administered pre- and postoperatively. Of the 663 patients that completed baseline questionnaires, 466 completed 2-year follow-up (70.3%). PROs included PROMIS depression, PROMIS anxiety, International Knee Documentation Committee Subjective Knee Form (IKDC), and PROMIS physical function (PF). Wilcoxon rank sum and Spearman's rank order correlation were utilized to determine associations between variables. Multivariable analysis was used to control for confounding variables. Average PROMIS depression and anxiety scores significantly improved 2 years after surgery. PROMIS depression and anxiety scores significantly correlated with each other. PROMIS depression and anxiety scores significantly correlated with PROMIS PF and IKDC scores. After controlling for confounders on multivariable analysis, worse 2-year PROMIS anxiety was predictive of less functional improvement and worse 2-year PF and IKDC, while worse 2-year PROMIS depression was predictive of less improvement in IKDC. This study confirms the important relationship between mental health and functional outcomes. Given that psychiatric comorbidities are potentially modifiable with treatment, proper recognition could potentially lead to better orthopaedic outcomes. In addition, the prevalence of depression and anxiety symptoms postoperatively, as documented by PROMIS computer adaptive tests, may act as a barrier to achieving optimal functional outcomes after elective knee surgery. LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Justin E Kung
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel Q Li
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn Iii
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Ma L, Lin S, Sun S, Ran X. Related factors to illness perception of individuals with diabetic foot ulcers: A structural equation modelling test. J Tissue Viability 2024; 33:11-17. [PMID: 38092619 DOI: 10.1016/j.jtv.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Diabetic foot is a common and severe complication of diabetes with limited movement, emotional distress, and poor quality of life. Illness perception was introduced to improve patients' psychological status and quality of life with diabetic foot ulcers. The aim of the study is to explore the related factors of illness perception, and to structure an illness perception model of patients with diabetic foot ulcers. METHODS We recruited 208 patients with diabetic foot ulcers from six hospitals from April 2021 to February 2022. A multicentered cross-sectional study was conducted to collect the data. Questionnaires included illness perception, coping behavior, emotional status, and quality of life. We performed multiple linear regression analysis with illness perception as the dependent variable, and evaluated the goodness of fit of the resulting structural equations models based on covariance structural analysis. RESULTS Illness perception was negatively related to coping behavior and quality of life, and it was positively correlated with yield-coping behavior, anxiety, and depression. The pain, diabetes duration, quality of life, yield-coping strategy, and sex were the factors that affected illness perception in patients with DFUs (P<0.05). The resulting model was found to exhibit goodness of fit. CONCLUSION Illness perception had an especially strong and direct impact on quality of life, depression, and anxiety. Therefore, it is significant to improve illness perception in patients with DFUs, and provide positive support based on cognitive behavioral therapy to improve illness perception, quality of life, and emotional status.
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Affiliation(s)
- Lin Ma
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Shuang Lin
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Shiyi Sun
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xingwu Ran
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Li P, Xie J, Ning N, Chen J. Predictors Associated with Forgotten Knee in Patients with Total Knee Arthroplasty Based on Multivariable Linear Regression. Orthop Surg 2024; 16:149-156. [PMID: 38049379 PMCID: PMC10782253 DOI: 10.1111/os.13959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVE Existing studies have conflicting results about the predictors of forgotten joints in patients with total knee arthroplasty (TKA), and the relationship between psychosocial factors and forgotten knees is unknown. The purpose of this study was to confirm predictors for the forgotten joint in TKA patients. METHODS This was an observational, prospective longitudinal study. A total of 205 patients who underwent TKA and a 6-month follow-up were included between August 2020 and September 2021. Demographic characteristics, clinical characteristics, and psychosocial variables were collected before TKA surgery (T0). The forgotten joint score (FJS) was taken before TKA surgery (T0) and at 1 month (T1), 3 months (T3), and 6 months (T6) after TKA surgery. The psychosocial variables were also completed at T6. Bivariate and multivariable linear regressions (LR) were performed to screen the predictors associated with FJS (T6). RESULTS Patients who underwent TKA in our study had a mean FJS of 20.3 ± 12.2 before surgery, 15.9 ± 10.3 at 1 month, 28.7 ± 12.6 at 3 months, and 40.3 ± 12.5 at 6 months. The predictors were sex, combined musculoskeletal disorders (MSD), operation time, FJS (T3), range of motion (ROM) (T6), pain score (T6), Groningen orthopaedic social support scale (GO-SSS) score (T6), and the generalized anxiety disorder scale (GAD) score (T6). The data satisfied the assumptions of multivariable linear regressions. The multiple R2 of LR was 0.71, and the adjusted R2 was 0.70. The F-statistic of the LR model was 59.5 (p < 0.000). CONCLUSION Our study revealed the level of forgotten knee decreased slightly from preoperation to 1 month postoperatively and then increased from 1 month postoperatively to 6 months postoperatively in TKA patients. The main predictors associated with the FJS at 6 months after surgery were sex, combined MSD, operation time, FJS (T3), ROM (T6), pain score (T6), GO-SSS score (T6), and anxiety (T6).
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Affiliation(s)
- Peifang Li
- Department of Orthopedic Surgery, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Jingying Xie
- Department of Orthopedic Surgery, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Ning Ning
- Department of Orthopedic Surgery, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
| | - Jiali Chen
- Department of Orthopedic Surgery, West China HospitalSichuan University/West China School of Nursing, Sichuan UniversityChengduChina
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Chang HL, Hsu MF, Wong TH, Chung YC, Huang HL. Effects of a Hybrid Teaching Program on Lower Limb Muscle Strength, Knee Function, and Depression in Older Adults After Total Knee Replacement: A Randomized Controlled Trial. Res Gerontol Nurs 2024; 17:31-40. [PMID: 37738062 DOI: 10.3928/19404921-20230918-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The aim of the current study was to evaluate the effects of a nurse-led hybrid teaching program on lower limb strength, knee function, and depression in older adults after total knee replacement (TKR). This was a single-blind, randomized controlled trial. Fifty-two patients who underwent TKR were randomly assigned to either the experimental group (EG; n = 26), which received routine care plus 16 weeks of home rehabilitation through a hybrid teaching program, or the control group (CG; n = 26), which received routine care only. The intervention included pre-discharge face-to-face education, video instructions to follow at home after discharge, and four monthly telephone-based follow ups during the 16 weeks post-surgery. After the 16-week intervention, participants in the EG exhibited improved quadriceps strength, hamstring strength, and Knee Injury and Osteoarthritis Outcome Score (KOOS) compared to those in the CG. Generalized estimating equation analyses revealed a significant group-by-time interaction effect on quadriceps strength, overall KOOS score, and Geriatric Depression Scale-Short Form score. Findings suggest that a nurse-led hybrid teaching program enhances physical and psychological function after TKR when compared to routine care. This hybrid teaching program, involving exercise and postoperative education, proves to be a feasible and cost-effective intervention for improving outcomes in older adults following TKR. Health care teams should consider it as a viable home rehabilitation option for older adults who undergo TKR. [Research in Gerontological Nursing, 17(1), 31-40.].
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Ginnerup-Nielsen E, Bandak E, Bartholdy C, Henriksen M, Wæhrens EE. Validity of the Brief Illness Perception Questionnaire in people with knee pain: a Rasch analysis. Scand J Rheumatol 2024; 53:63-71. [PMID: 37751331 DOI: 10.1080/03009742.2023.2256089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE The Brief Illness Perception Questionnaire (B-IPQ) is a frequently used measure of illness perception (IP). The aim of this study was to explore the psychometric properties of the questionnaire when used in elderly people with knee pain. METHOD Based on data from the Frederiksberg Cohort on elderly people reporting knee pain (N = 836), the psychometric properties of the eight B-IPQ items (1 'Consequences', 2 'Timeline', 3 'Personal control', 4 'Treatment control', 5 'Identity', 6 'Concern', 7 'Coherence', and 8 'Emotions') were analysed using Rasch analysis to establish whether the questionnaire provides reliable and valid measures of IP. RESULTS Threshold disordering was found on the 1-10 rating scale in all items. When rescaling to a 0-2 rating scale, disordering was resolved in six items. Item goodness-of-fit analyses revealed that two items displayed underfit misfit and four items overfit misfit; hence, the B-IPQ does not present unidimensionality. The person separation index indicated that items separate respondents into only two IP levels. Finally, floor and ceiling effects were found, indicating that the B-IPQ may not fully describe the extent of IP in this population. CONCLUSION The 1-10 rating scale used in the Danish B-IPQ targeting knee pain is suboptimal, while a 0-2 scale improves the psychometric properties of the scale. The B-IPQ does not present unidimensionality and the use of a sum score is therefore not recommended when assessing IP. The B-IPQ may not cover the extent of IP in elderly people with knee pain.
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Affiliation(s)
- E Ginnerup-Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - E Bandak
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C Bartholdy
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - M Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - E E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Varış O, Peker G. Effects of preoperative anxiety level on pain level and joint functions after total knee arthroplasty. Sci Rep 2023; 13:20787. [PMID: 38012209 PMCID: PMC10682380 DOI: 10.1038/s41598-023-48291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023] Open
Abstract
This study examined the effect of preoperative anxiety level on postoperative pain, opioid and nonopioid analgesic use requirements and joint function in patients undergoing primary knee arthroplasty for knee osteoarthritis. 106 patients were included in the study. Situational anxiety score (STAI-S) and trait anxiety score (STAI-T) were divided into two groups as below and above 40. Visual analog scale (VAS), Lysholm scores, and anxiety levels were assessed preoperatively, at the third and sixth month postoperatively to investigate their effects on the use of opioid and non-opioid drugs during the postoperative period. For those with low situational and trait anxiety scores, the median duration of hospital stays was significantly shorter compared to those with high anxiety scores. In groups where anxiety levels were initially low, the median anxiety levels at the postoperative 3rd month were also observed to be lower compared to the other group. In the same groups, the median VAS values and the median Lysholm knee scores were significantly better both preoperatively and at the postoperative 3rd month compared to the other group. There was no significant difference in Lysholm score between the two groups at the 6th postoperative month. Similarly, in the preoperative period, groups with low anxiety levels had a significantly lower median usage of both opioids and non-opioids compared to the other group. These findings suggest that high preoperative anxiety may have a negative effect on functional outcomes in the early postoperative period, but this effect disappeared at 6 months. It can be concluded that reducing preoperative anxiety may have a positive effect on early outcomes. We believe that preoperative psychological evaluation and treatment can increase the satisfaction level in patients undergoing total knee arthroplasty (TKA).
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Affiliation(s)
- Onur Varış
- University of Healt Sciences, Trabzon Faculty of Medicine, Kanuni Training and Research Hospital, Trabzon, Turkey.
| | - Gökhan Peker
- University of Healt Sciences, Trabzon Faculty of Medicine, Kanuni Training and Research Hospital, Trabzon, Turkey
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Weinerman J, Vazquez A, Schurhoff N, Shatz C, Goldenberg B, Constantinescu D, Hernandez GM. The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review. Ann Med Surg (Lond) 2023; 85:5523-5527. [PMID: 37920654 PMCID: PMC10619579 DOI: 10.1097/ms9.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction The impact of anxiety and depression on outcomes in orthopaedic trauma surgery is a topic of growing research interest. Patients and methods Orthopaedic trauma patients often experience high rates of psychiatric disorders, with anxiety and depression being the most prevalent. Mental health disorders have been shown to increase the risk of negative surgical outcomes and morbidity. This narrative review seeks to summarize the current literature surrounding the impacts of anxiety and depression on orthopaedic trauma surgery outcomes. Discussion There is a bidirectional relationship between chronic pain and mental health disorders, involving overlapping brain regions and neurotransmitter pathways. Anxiety and depression have been identified as predictors of negative surgical outcomes in orthopaedic trauma patients. Screening tools like the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-7 (GAD-7), and Medical Outcomes Study 36-item Short Form (SF-36) can assess mental health status and help tailor interventions. Psychological distress, chronic pain, and traumatic limb amputation are factors that contribute to adverse mental health outcomes in orthopaedic trauma patients. Opioid use for pain management is common in orthopaedic surgery, but it can worsen symptoms of depression and lead to dependency. Non-opioid pain management strategies may improve postoperative outcomes by reducing the impact of opioid-exacerbated depression. Conclusion Mental health interventions, both preoperative and postoperative, are crucial in optimizing surgical outcomes and improving patient quality of life. Multidisciplinary approaches that address both physical and mental health are recommended for orthopaedic trauma patients. Further research is needed to develop effective interventions for improving mental health outcomes in this patient population.
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Affiliation(s)
- Jonathan Weinerman
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Arianna Vazquez
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Nicolette Schurhoff
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Connor Shatz
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Brandon Goldenberg
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | - David Constantinescu
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | - Giselle M. Hernandez
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
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Zheng C, Hou Z, Wang T, Yi L, Chen Y. Impact of multimodal analgesia on postoperative anxiety and depression following total knee arthroplasty. J Orthop Surg Res 2023; 18:712. [PMID: 37735386 PMCID: PMC10515006 DOI: 10.1186/s13018-023-04192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Postoperative pain after total knee arthroplasty (TKA) can cause negative emotions, such as anxiety and depression, which can severely affect a patient's long-term quality of life. OBJECTIVE This study aimed to investigate the impact of multimodal analgesia (MMA) on postoperative anxiety and depression following total knee arthroplasty. METHODS This study included 161 patients who underwent TKA from October 2020 to October 2022 in the First Affiliated Hospital of Wannan Medical College, including 79 cases in the control group and 82 cases in the multimodal analgesia group (MMA). The MMA group were administered acetaminophen 0.5 g/d orally 3 days before the surgery, and an ultrasound-guided fascia iliac compartment block (FICB) with 0.25% ropivacaine 30 ml in the inguinal region ipsilateral to the surgery was performed 1 h before surgery. After the surgery, 100 ml solution includes 100 mg ropivacaine, 2.5 mg morphine, and 0.25 mg epinephrine for intra-articular and periarticular injection. Postoperative conventional intravenous analgesia was used in the control group, including 100 mg ropivacaine, 2.5 mg morphine, and 0.25 mg epinephrine for intra-articular and periarticular injection. Patients were scored for pain, anxiety, and depression in the ward at 3 and 7 days postoperatively, and postoperative patients were scored using telephone callbacks at 3 months postoperatively. RESULTS It was found that the visual analog scale (VAS) scores for pain at rest at 3 days, 7 days, and 3 months postoperatively were significantly lower in the MMA group than in the control group (P < 0.05). The scores for pain with movement were significantly lower in the MMA group than in the control group at 3 days and 7 days postoperatively (P < 0.01), but they were similar at 3 months postoperatively. Compared to the control group, the MMA group had significantly higher American Knee Society scores (AKS) at 3 days, 7 days, and 3 months postoperatively (P < 0.05). Compared to the control group, the MMA group had significantly higher Lower Extremity Functional Scale and Hospital Anxiety and Depression Scale scores (HADS) (P < 0.05) at 3 days and 7 days postoperatively; compared to the control group, the MMA group had a significantly shorter hospital stay (P < 0.01). CONCLUSION Multimodal analgesia can alleviate postoperative anxiety and depression in the short term, reduce perioperative pain, improve postoperative recovery, and shorten the length of hospital stay.
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Affiliation(s)
- Changjian Zheng
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China
| | - Zijun Hou
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China
| | - Tingting Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China
| | - Lingmei Yi
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China
| | - Yongquan Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Jinghu, Wuhu, 241001, Anhui, China.
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Wilson JM, Madden VJ, Pester BD, Yoon J, Papianou LN, Meints SM, Campbell CM, Smith MT, Haythornthwaite JA, Edwards RR, Schreiber KL. Change in Pain During Physical Activity Following Total Knee Arthroplasty: Associations With Improved Physical Function and Decreased Situational Pain Catastrophizing. Innov Aging 2023; 7:igad045. [PMID: 38094929 PMCID: PMC10714905 DOI: 10.1093/geroni/igad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Knee osteoarthritis is one of the primary causes of chronic pain among older adults and because of the aging population, the number of total knee arthroplasties (TKAs) performed is exponentially increasing. While pain reduction is a goal of TKA, movement-evoked pain is rarely assessed pre- and post-TKA. We characterized the distributions of change in pain, function, and situational catastrophizing in patients from presurgery to 3 months postsurgery and explored associations among these pre-post changes. Research Design and Methods This prospective study longitudinally assessed movement-evoked pain, function, and situational catastrophizing in patients with knee osteoarthritis (N = 92) using in-person performance-based tests (6-min walk test [6MWT], stair-climb test [SCT]) prior to and 3 months after TKA. Patients also completed the Western Ontario McMaster Universities Scales (WOMAC) pain and function subscales, and Pain Catastrophizing Scale, presurgery and 3- and 6-months postsurgery. Results Movement-evoked pain and function on performance tests significantly improved from pre- to post-TKA. Improved SCT function was associated with reduced SCT pain and catastrophizing. Similarly, reduced pain during the SCT was associated with reduced catastrophizing during the SCT. However, 6MWT function was not associated with 6MWT pain or catastrophizing; yet reduced pain during the 6MWT was associated with reduced catastrophizing during the 6MWT. Reduced movement-evoked pain during both performance tests was consistently associated with improved WOMAC function and pain, whereas improved function on performance tests was inconsistently associated with WOMAC function and pain. Notably, greater movement-evoked pain on both performance tests at 3-month post-TKA was associated with worse WOMAC function and pain at 6 months, whereas better function on performance tests at 3 months was associated with better WOMAC function, but not related to WOMAC pain at 6 months. Discussion and Implications Findings highlight the importance of situation-specific and in vivo assessments of pain and catastrophizing during physical activity.
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Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria J Madden
- Pain Unit, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bethany D Pester
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - JiHee Yoon
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren N Papianou
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha M Meints
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert R Edwards
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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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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Arasegawa Y, Muramatsu K, Inoue K, Ueda T, Jyouichi K, Kinoshita D. The Relationship of Patient Characteristics and Prolonged Pain after Treatment of Carpometacarpal Joint Arthritis of the Thumb. J Hand Surg Asian Pac Vol 2023; 28:53-60. [PMID: 36803472 DOI: 10.1142/s242483552350008x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background: The carpometacarpal (CMC) joint of the thumb is the second most common site of osteoarthritis in the hand. Clinical severity stage of CMC joint arthritis has not been correlated with the pain level of the patient. Recently, the association of joint pain with patient psychological factor, such as depression or case-specific personality, has been investigated. This study was designed to determine the impact of psychological factors to residual pain after treatment of CMC joint arthritis, using pain catastrophizing scale (PCS) and the Yatabe-Guilford (YG) personality test. Methods: Twenty-six patients (7 males and 19 females) with 26 hands were included. Thirteen patients classified as Eaton stage 3 underwent suspension arthroplasty and 13 patients as Eaton stage 2 underwent conservative treatment using a custom fitted orthosis. Clinical evaluation was assessed using Visual Analogue Scale (VAS) and the quick Disabilities of the Arm, Shoulder and Hand Questionnaire Score (QuickDASH) at initial evaluation, at 1 month and at 3 months after treatment. We compared both groups using the PCS and YG test. Results: The PCS showed significant difference in the VAS scores only at initial evaluation in both surgical and conservative treatment. There was a significant difference in VAS at 3 months between the two groups in both surgical and conservative treatment and in QuickDASH at 3 months in conservative treatment. Conclusions: The YG test has been used mainly in psychiatry. Although this test has not yet been used worldwide, its usefulness has been recognised and applied clinically, especially in Asia. Patient characteristics are strongly associated with residual pain of the CMC joint arthritis of the thumb. The YG test is a useful tool to analyse pain-related patient characteristics and can be utilised to determine the therapeutic modalities and most effective rehabilitation programme for pain control. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Yoshito Arasegawa
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Keiichi Muramatsu
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Kiyotaka Inoue
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Takeshi Ueda
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Kouhei Jyouichi
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Daisuke Kinoshita
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
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14
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Baxter NA, Hoch C, Reid JJ, Scott DJ, Gross CE. Pain Catastrophizing Scale Associated With Other Patient-Reported Outcome Measures in Plantar Fasciitis and Chronic Ankle Instability Patients. Foot Ankle Int 2022; 43:1340-1345. [PMID: 35794824 DOI: 10.1177/10711007221106472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Pain Catastrophizing Scale (PCS) is a measure of how patients emotionally respond to pain. It is composed of 3 subscales-rumination, magnification, and helplessness-which address intrusive thoughts of pain, expectations of negative outcomes, and inability to cope with pain. Our purpose is to compare baseline PCS scores with other baseline patient-reported outcome measures (PROMs) in patients with plantar fasciitis (PF) or chronic ankle instability (CAI). METHODS We retrospectively reviewed 201 patients who reported at least 1 pretreatment PCS subscore and were diagnosed with PF or CAI between 2015 and 2020 in a single fellowship-trained foot and ankle surgeon's clinic. Demographics, comorbidities, treatments, other baseline PROMs (i.e., visual analog scale [VAS], Pain Disability Index [PDI], 12-Item Short Form Survey [SF-12], 8-Item Somatic Symptom Scale [SSS-8]), and postoperative outcomes were recorded. RESULTS The PCS total score and its subscores significantly correlated with the total score and/or subscores of each PROM. Higher PCS total score significantly correlated with worse VAS (P<.001), SF-12 mental (P=.007), PDI total (P<.001), and SSS-8 (P<.001) scores. Only the PCS magnification subscore was significantly greater among patients who did (n=41) undergo surgery (P=.043). Those who had previously undergone foot and/or ankle surgery had significantly higher PCS rumination (P=.012), magnification (P=.006), helplessness (P=.008), and total (P=.003) scores. Likewise, those with a history of substance abuse also had significantly higher PCS scores (P=.005; P=.003; P=.006; P=.003). CONCLUSION The correlations between PCS scores and other baseline PROMs indicate that strong pain catastrophizers with PF or CAI may be at risk for poor treatment outcomes. PCS scores could be used to help with treatment for such high-risk patients.
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Affiliation(s)
- Nicholas A Baxter
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Caroline Hoch
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jared J Reid
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel J Scott
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher E Gross
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
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15
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Schaffer JC, Kuhns B, Reuter J, Sholtis C, Karnyski S, Goldblatt JP, Bronstein RD, Maloney MD, Baumhauer J, Mannava S. Clinically Depressed Patients Having Anterior Cruciate Ligament Reconstruction Show Improved but Inferior Rate of Achieving Minimum Clinically Important Difference for Patient-Reported Outcomes Measurement Information System Compared With Situationally Depressed or Nondepressed Patients. Arthroscopy 2022; 38:2863-2872. [PMID: 35550418 DOI: 10.1016/j.arthro.2022.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether the preoperative diagnosis of depression predicted worse postoperative outcomes, including physical therapy (PT) compliance, return-to-sport, and patient-reported outcomes using the Patient-Reported Outcomes Measurement Information System (PROMIS) after anterior cruciate ligament (ACL) reconstruction. METHODS A multisurgeon series of consecutive patients who had undergone ACL reconstruction with minimum 2-year follow-up were included. Chart review was conducted to determine depression diagnosis status, demographic data, rehabilitation PT compliance, return to sports, and patient-reported outcome data using PROMIS. Patients who met the PROMIS threshold for mild depression but did not carry a clinical diagnosis of depression were classified as "situationally depressed." RESULTS Ninety-five of 115 consecutive patients (81%) met inclusion criteria with an average follow-up of 34 ± 1.9 months. Fourteen patients (15%) had a preoperative diagnosis of depression, whereas 21 (22%) were considered situationally depressed. Clinically depressed patients had a greater rate of PT noncompliance (33.2% ± 17.6% vs 21.9% ± 12.6%; P = .02) and a lower postoperative PROMIS Physical Function (50.8 ± 7.7 vs 57.8 ± 11.0; P = .03 compared with patients without depression. Situationally depressed patients had lower preoperative physical function (35.4 vs 42.5; P = .04) with no differences in postoperative outcomes scores compared to the non-depressed cohort.19/21 (90.5%) of situationally depressed patients had postoperative resolution of their depressive symptoms. CONCLUSIONS Situationally depressed patients without a clinical diagnosis of depression can expect significant improvements in both pain and function, as well as a resolution of their depressed mood based on PROMIS scores as they progress through recovery after ACL reconstruction. Clinically depressed patients also experience significant improvements; however, their rate of achieving the minimum clinically important difference for PROMIS outcomes may be less than their nondepressed or situationally depressed counterparts. LEVEL OF EVIDENCE III, prognostic comparative trial.
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Affiliation(s)
- Joseph C Schaffer
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Benjamin Kuhns
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A.
| | - John Reuter
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Connor Sholtis
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Steven Karnyski
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - John P Goldblatt
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Robert D Bronstein
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Michael D Maloney
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Judith Baumhauer
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
| | - Sandeep Mannava
- Department of Orthopaedics & Rehabilitation, University of Rochester Medical Center, Rochester, New York, U.S.A
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16
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Fu M, Chen S, Xu R, Chen J, Chen X, Gan W, Huang H, Duan G. Effects of Intravenous Analgesia Using Tramadol on Postoperative Depression State and Sleep Quality in Women Undergoing Abdominal Endoscopic Surgery: A Randomized Controlled Trial. Drug Des Devel Ther 2022; 16:1289-1300. [PMID: 35531319 PMCID: PMC9075899 DOI: 10.2147/dddt.s357773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose This study aimed to explore the effects of intravenous analgesia using tramadol on postoperative depression, anxiety, and sleep in women undergoing abdominal endoscopic surgery. Patients and Methods Two hundred female patients (100 in each group) who underwent abdominal endoscopic surgery were recruited to randomly receive intravenous analgesia with sufentanil combined with tramadol (tramadol group) or sufentanil (control group). The primary outcome was the incidence of postoperative depression, which was assessed at 1, 2, and 3 days after surgery using the 13-item Beck Depression Inventory. The secondary outcomes were the incidence of anxiety and sleep quality, which were assessed using the 20-item Self-Rating Anxiety Scale and Richards–Campbell Sleep Questionnaire. Results The incidence of depression (Beck depression scale≥4) during the 3-day follow-up in the control group was 51%, which was significantly higher than that in the tramadol group of 28% (relative risk [RR]=0.55; 95% confidence interval [CI], 0.38–0.79; P=0.001). No difference was found in the incidence of anxiety state (Self-Rating Anxiety Scale≥40) between the tramadol and control groups (7%vs 5%; RR=1.40; 95% CI, 0.46–4.25; P=0.552). All of the Richards–Campbell sleep scales of patients in the tramadol group at 1 (77.4±15.2 vs 64.2±20.1, P<0.001), 2 (84.1±14.9 vs 71.8±18.8, P<0.001), and 3 days (87.0±12.2 vs 70.3±21.0, P<0.001) after surgery were higher than those in the control group. Conclusion Intravenous analgesia using tramadol can effectively improve the postoperative depression and sleep status of women undergoing abdominal endoscopic surgery. Tramadol is recommended for use in postoperative analgesia when improving postoperative mood, and sleep is needed in clinical practice.
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Affiliation(s)
- Mengyue Fu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shi Chen
- Department of Anesthesiology, Chongqing Beibu Maternity Hospital, Chongqing, People’s Republic of China
| | - Rui Xu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jie Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xuehan Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wanxia Gan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China
| | - He Huang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Guangyou Duan; He Huang, Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People’s Republic of China, Email ;
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17
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Master H, Bley JA, Coronado RA, Robinette PE, White DK, Pennings JS, Archer KR. Effects of physical activity interventions using wearables to improve objectively-measured and patient-reported outcomes in adults following orthopaedic surgical procedures: A systematic review. PLoS One 2022; 17:e0263562. [PMID: 35167599 PMCID: PMC8846530 DOI: 10.1371/journal.pone.0263562] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/24/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To synthesize evidence on physical activity interventions that used wearables, either alone or in combination with education or rehabilitation, in adults following orthopaedic surgical procedures. METHODS PubMed, CINAHL, PsycINFO and EMBASE were searched for randomized controlled trials of wearable-based interventions from each database's inception to August 2021 in patients undergoing orthopaedic surgery. Relevant outcomes included physical activity, physical function, pain, psychological distress, or general health. PEDro scale scoring ranges from 0 to 10 and was used to appraise studies as high (≥7), moderate (5-6), or poor (<5) quality. RESULTS Of 335 articles identified, 6 articles met eligibility criteria. PEDro scores ranged from 2 to 6, with 3 studies of moderate quality and 3 of poor quality. Studies included patients undergoing total knee (number; n = 4) or total knee or hip (n = 1) arthroplasty and lumbar disc herniation surgery (n = 1). In addition to wearables, intervention components included step diary (n = 2), motivational interviewing (n = 1), goal setting (n = 2), tailored exercise program (n = 2), or financial incentives (n = 1). Interventions were delivered in-person (n = 2), remotely (n = 3) or in a hybrid format (n = 1). Intervention duration ranged from 6 weeks to 6 months. Compared to controls, 3 moderate quality studies reported greater improvement in steps/day; however, 1 moderate and 2 poor quality studies showed no between-group difference in physical function, pain, or quality of life. No serious adverse events related to the use of wearable were reported. CONCLUSIONS The effects of physical activity interventions using wearables, either delivered in-person or remotely, appear promising for increasing steps per day after joint arthroplasty; however, this finding should be viewed with caution since it is based on 3 moderate quality studies. Further research is needed to determine the therapeutic effects of using wearables as an intervention component in patients undergoing other orthopaedic surgical procedures. TRIAL REGISTRATION PROSPERO Registration Number: CRD42020186103.
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Affiliation(s)
- Hiral Master
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jordan A. Bley
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Rogelio A. Coronado
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Payton E. Robinette
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Daniel K. White
- Department of Physical Therapy, University of Delaware, Newark, Delaware, United States of America
| | - Jacquelyn S. Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kristin R. Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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18
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Hirschmann J, Kozato A, Sharma V, Villagra C, Wetmore J, Jandorf L, Pang JH, Reynolds M, Dodge L, Mejía S, Safer JD. An Analysis of Chaplains' Narrative Chart Notes Describing Spiritual Care Visits with Gender Affirmation Surgical Patients. Transgend Health 2022; 7:92-100. [PMID: 36644021 PMCID: PMC9829152 DOI: 10.1089/trgh.2020.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose The benefit of spiritual care for patients is well described, but little is known about the role of spiritual care in transgender and nonbinary patients recovering from gender affirming surgeries (GASs). Methods A single-center retrospective chart review was performed on patients who underwent GAS in 2017. Demographic information, surgery type, and chaplains' narrative notes were examined. Results A total of 145 chaplain visits were identified in 103 inpatient stays among 98 patients at the Mount Sinai Center for Transgender Medicine and Surgery in New York. Analysis was performed on narrative notes authored by a single chaplain, which included 132 visits among 78 transfeminine and 11 transmasculine patients. Fifty-four patients (61%) expressed gratitude for the chaplain visit and/or hospital experience overall. Seven patients (8%) described movement between religious denominations over the course of their lives, and 7 (8%) described supportive belief systems. Fifty-seven patients (64%) had a family member or friend present during the perioperative process, 13 (15%) described support systems, and 9 (10%) described supportive practices, activities, and/or coping methods. Twenty-one patients (24%) expressed concerns about current symptoms or the recovery process, and 32 (36%) received a prayer or blessing from the chaplain. Fifty-two patients (58%) consented to a follow-up call. Conclusion Almost 50% of patients expressed gratitude for the chaplain's visit and more than half consented to a follow-up call from the chaplain, suggesting a chaplain can provide a welcome layer of support to postoperative GAS patients. The authors recommend integrating spiritual care into perioperative care.
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Affiliation(s)
- Jo Hirschmann
- Mount Sinai Center for Transgender Medicine and Surgery, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Address correspondence to: Jo Hirschmann, MAHL, Mount Sinai Center for Transgender Medicine and Surgery, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, 10 Nathan D. Perlman Place, New York, NY 10003, USA,
| | - Aki Kozato
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vansh Sharma
- Department of Psychiatry, Center for Spirituality and Health, Center for Stress, Resilience and Personal Growth, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cristina Villagra
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Wetmore
- Mount Sinai Health System, New York, New York, USA
| | - Lina Jandorf
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Henry Pang
- Mount Sinai Center for Transgender Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Leanne Dodge
- Department of Spiritual Care and Education, Mount Sinai Beth Israel, New York, New York, USA
| | - Silvia Mejía
- Department of Spiritual Care and Education, Mount Sinai Beth Israel, New York, New York, USA
| | - Joshua D. Safer
- Mount Sinai Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Wang ST, Ni GX. Depression in Osteoarthritis: Current Understanding. Neuropsychiatr Dis Treat 2022; 18:375-389. [PMID: 35237034 PMCID: PMC8883119 DOI: 10.2147/ndt.s346183] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
Depression, one of the most common comorbidities with osteoarthritis (OA), affects patient prognosis and quality of life. It also increases the overall burden of disease. This subgroup of patients has not been effectively managed in clinical settings. The study aimed to direct physicians' attention to the co-occurrence of depression and OA. Therefore, this review summarizes the relevant literature published over the past 10 years. The focus is on the prevalence of and risk factors for depression in OA, the effects of depression on OA development and treatment response, comorbidity mechanisms, screening, and non-pharmacological treatment. The research on the etiology of depression has been driven largely by epidemiological studies. Recent studies have shown that high levels of pain, poor levels of function, high numbers of OA sites, and slow gait might be associated with depression. However, the pathophysiology of OA and depression comorbidities remains unclear. In addition to immune inflammation and structural changes in the brain, which have been documented in brain imaging studies, psychosocial factors may also play a role. The evidence indicates that depression can be treated with early intervention; however, adjustments may need to be made for individuals with comorbid depression in OA. It is recommended that health care providers pay more attention to depressive symptoms in patients with OA. Clinicians should develop and implement an individualized and comprehensive treatment plan for patients based on a mental health assessment and in teams with other professionals to optimize treatment outcomes.
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Affiliation(s)
- Shen-Tao Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, People’s Republic of China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, People’s Republic of China
- Correspondence: Guo-Xin Ni, Tel +86-10-62989780, Fax +86-10-62989670, Email
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20
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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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21
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Kazarian GS, Anthony CA, Lawrie CM, Barrack RL. The Impact of Psychological Factors and Their Treatment on the Results of Total Knee Arthroplasty. J Bone Joint Surg Am 2021; 103:1744-1756. [PMID: 34252068 DOI: 10.2106/jbjs.20.01479] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ There is a growing body of evidence implicating psychosocial factors, including anxiety, depression, kinesiophobia, central sensitization, and pain catastrophizing, as negative prognostic factors following total knee arthroplasty (TKA). ➤ Symptoms of anxiety and depression likely represent risk factors for negative outcomes in patients undergoing TKA. However, few studies have assessed the impact of preoperative interventions for these conditions on postoperative outcomes. ➤ The Tampa Scale of Kinesiophobia and the Central Sensitization Inventory have demonstrated value in the diagnosis of kinesiophobia and central sensitization. Higher preoperative indices of kinesiophobia and central sensitization predict worse patient-reported outcomes postoperatively. ➤ Although evidence is limited, cognitive-behavioral therapy for kinesiophobia and duloxetine for central sensitization may help to diminish the negative impact of these preoperative comorbidities. It is important to note, however, that outside the realm of TKA, cognitive-behavioral therapy has been recognized as a more effective treatment for central sensitization than medical treatment. ➤ Awareness of these issues will allow surgeons to better prepare patients regarding postoperative expectations in the setting of a comorbid psychosocial risk factor. Further research into the role of preoperative assessment and possible treatment of these conditions in patients undergoing TKA is warranted.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Christopher A Anthony
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.,Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
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22
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Knapp P, Layson JT, Mohammad W, Pizzimenti N, Markel DC. The Effects of Depression and Anxiety on 90-day Readmission Rates After Total Hip and Knee Arthroplasty. Arthroplast Today 2021; 10:175-179. [PMID: 34458530 PMCID: PMC8379358 DOI: 10.1016/j.artd.2021.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/05/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022] Open
Abstract
Background Patients undergoing total joint arthroplasty have higher rates of anxiety, depression or anxiety and depression than the general population and higher costs of care, which lead to higher levels of postoperative dissatisfaction and readmission rates. We evaluated the readmission rates of patients undergoing total hip or knee arthroplasty with diagnoses of anxiety, depression, or both. Methods Our hospital's prospectively collected data from Michigan's statewide total joint database were reviewed from 2013 to 2018. Rates of anxiety, depression or anxiety and depression were determined based on preoperative anxiolytic or antidepressant medications using National Drug Codes. Results A total of 4107 cases were included. Of which 4.28% had a readmission within the 90-day global period, and 12% had a history of depression or anxiety or both. For the entire cohort, those on anxiolytic medication were 153% more likely to be readmitted than those not on medication (P = .017). When comparing total hip arthroplasty (THA) or total knee arthroplasty (TKA), patients taking anxiolytic medication and undergoing TKA were 120% more likely to undergo readmission within 90 days (P = .021). Patients on depression medication alone were not at increased risk of readmission in the TKA cohort (P = .991). For THA, neither diagnosis appeared a risk factor for readmission (P = .852). Conclusions Patients with depression, anxiety, or both undergoing TKA were at a statistically significant risk of readmission within 90 days compared with patients without these diagnoses. Anxiety and depression were both risk factors for readmission, but anxiety appeared to have a more significant impact. Patients undergoing THA on the other hand did not appear to share this risk profile.
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Affiliation(s)
- Paul Knapp
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, MI, USA
| | - James T Layson
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, MI, USA
| | - Waleed Mohammad
- Section of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, MI, USA
| | - Natalie Pizzimenti
- Ascension-Providence Orthopaedic Residency, The MORE Foundation, Novi, MI, USA
| | - David C Markel
- Section of Orthopaedic Surgery, Ascension Providence Hospital and The Core Institute, Novi, MI, USA
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23
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Goh GS, Khow YZ, Tay DK, Lo NN, Yeo SJ, Liow MHL. Preoperative Mental Health Influences Patient-Reported Outcome Measures and Satisfaction After Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:2878-2886. [PMID: 33812719 DOI: 10.1016/j.arth.2021.03.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/21/2021] [Accepted: 03/08/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A higher prevalence of mental health conditions has been reported in patients undergoing revision total knee arthroplasty (rTKA). This study investigated the effect of preoperative mental health on patient-reported outcome measures (PROMs) and satisfaction after rTKA. METHODS A total of 245 patients who underwent rTKA in 2004-2018 were identified from our institutional joint registry. The most common indications were aseptic loosening (n = 111), infection (n = 70), and instability (n = 35). 36-item Short-Form health survey (SF-36) mental component summary (MCS) was used to stratify the cohort into: Low-MCS (SF-36 MCS <50; n = 112) and control (SF-36 MCS ≥50; n = 133) groups. Knee Society score, Oxford knee score, SF-36 physical score, and a satisfaction questionnaire were used to compare the low-MCS and control at 6 months and 2 years. RESULTS All PROMs were poorer in the low-MCS group at 6 months and 2 years. However, both groups demonstrated a comparable improvement in each PROM and a similar proportion attained the minimal clinically important difference. Fewer patients in the low-MCS group were satisfied at 2 years (72.2% vs 84.5%, P = .045). Lower preoperative SF-36 MCS was independently associated with increased odds of dissatisfaction (OR 1.037, 95% CI 1.004-1.070, P = .027). Although the change in SF-36 MCS was greater in the low-MCS group, the final value remained lower at 2 years. CONCLUSION While patients with poor mental health had inferior PROMs preoperatively and postoperatively, a similar percentage experienced a clinically meaningful improvement at 2 years. Perioperative optimization of psychological factors should still be emphasized as these patients were at a higher risk of dissatisfaction after rTKA.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Darren K Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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24
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Götz JS, Benditz A, Reinhard J, Schindler M, Zeman F, Grifka J, Greimel F, Leiss F. Influence of Anxiety/Depression, Age, Gender and ASA on 1-Year Follow-Up Outcomes Following Total Hip and Knee Arthroplasty in 5447 Patients. J Clin Med 2021; 10:jcm10143095. [PMID: 34300261 PMCID: PMC8305027 DOI: 10.3390/jcm10143095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: There are many factors influencing the outcome after total joint arthroplasty (TJA). In particular, patient-related factors such as age, gender, ASA (American Society of Anesthesiologists), or preoperative anxiety/depression have become increasingly important. The aim of this study was to examine the association of these parameters with 1-year postoperative outcomes after total knee and total hip arthroplasty (TKA, THA). Methods: A retrospective cohort of 5447 TJA patients was evaluated by pre- and postoperative analysis of EQ-5D, EQ-VAS and WOMAC Score. Furthermore, major focus was put on the association between age, gender, ASA, preoperative anxiety/depression and outcome parameters. Results: 53.3% (2903/5447) of all patients were identified with anxiety/depression at time of surgery. In the analysis, patients without anxiety/depression showed statistically significantly (p < 0.05) better EQ-5D, EQ-VAS and WOMAC scores. In addition, patients with ASA 2 or 3 and age over 70 years showed statistically significantly (p < 0.01) worse EQ-5D and WOMAC scores. Gender did not influence the postoperative EQ-5D and WOMAC results, but men had significantly better EQ-VAS scores than women in this study. Conclusion: Preoperative anxiety/depression symptoms show worse clinical outcomes 1 year postoperatively after TJA. Other outcome-influencing factors are higher age and ASA 2 or 3. In the future, such patients should be identified, and as far as applicable, a treatment of anxiety/depression or comorbidities should be implemented preoperatively of the surgical procedure to improve clinical outcomes.
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Affiliation(s)
- Julia Sabrina Götz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Melanie Schindler
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
- Correspondence:
| | - Franziska Leiss
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
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25
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van der Oest MJW, Hoogendam L, Wouters RM, Vermeulen GM, Slijper HP, Selles RW, Vranceanu AM, Porsius JT. Associations between positive treatment outcome expectations, illness understanding, and outcomes: a cohort study on non-operative treatment of first carpometacarpal osteoarthritis. Disabil Rehabil 2021; 44:5487-5494. [PMID: 34232069 DOI: 10.1080/09638288.2021.1936661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE More positive outcome expectations and illness perceptions are associated with better outcomes for patients with several osteoarthritic orthopedic conditions. However, it is unknown whether these factors also influence outcomes of non-operative treatment for first carpometacarpal osteoarthritis (CMC-1 OA). Therefore, we assess the role of pre-treatment outcome expectations and illness perceptions in reports of pain and hand function 3 months after non-operative treatment for CMC-1 OA. MATERIALS AND METHODS We conducted a cohort study with 219 patients treated non-operatively for CMC-1 OA between September 2017 and October 2018. Patients were included in the study if they completed measures of pain and hand function, illness perceptions (scale: 0-10), and expectations (scale: 3-27) as part of routine outcome measurements. Pain and hand function were measured before treatment and 3 months after starting treatment using the Dutch version of the Michigan Hand Outcomes Questionnaire. Multivariable linear regression analysis was used to assess the influence of outcome expectations and illness perceptions on pain and hand function. RESULTS Both positive outcome expectations (B = 0.64; 95% CI [0.1-1.2]) and a better illness understanding (an illness perception subdomain; B = 1.53; 95% CI [0.2-2.9]) at baseline were associated with less pain at 3 months. For hand function, similar estimates were found. CONCLUSIONS We found that positive outcome expectations and a better illness understanding, were associated with a better outcome of non-operative treatment for CMC-1 OA.IMPLICATIONS FOR REHABILITATIONNon-operative treatment can often be successful for patients with arthritis of the thumb.Outcome expectations and illness perceptions are associated with pain and hand function 3 months after non-operative treatment for thumb base osteoarthritis.Improving the outcome expectations and illness perceptions of patients through better education could improve the outcome of non-operative treatment.
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Affiliation(s)
- Mark J W van der Oest
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands
| | - Guus M Vermeulen
- Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Harm P Slijper
- Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Jarry T Porsius
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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26
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Abstract
The psychosocial benefits of participating in sports have long been appreciated. However, athletes are often faced with circumstances that make them susceptible to psychological challenges unique to the athletic population. One such circumstance is injury in sport, which can be a source of notable distress and may precipitate the emergence of new or exacerbation of underlying psychological disorders. In athletes who are injured, particularly those undergoing surgical intervention, psychological factors play a substantial role in the recovery process. A more comprehensive understanding of the complex interplay between psychological and physical health in the setting of an injury is essential to optimize patient care. The aim of this review was to highlight the impact of psychological factors on measurable outcomes after orthopaedic surgical interventions and to explore interventions that can be implemented to improve surgical outcomes and the overall care of injured athletes.
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27
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Hamilton DF, Shim J, Howie CR, Macfarlane GJ. Patients follow three distinct outcome trajectories following total knee arthroplasty. Bone Joint J 2021; 103-B:1096-1102. [PMID: 34058868 DOI: 10.1302/0301-620x.103b6.bjj-2020-1821.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Although total knee arthroplasty (TKA) is a highly successful procedure, about 20% of patients remain dissatisfied postoperatively. This proportion is derived from dichotomous models of the assessment of surgical success or failure, which may not reflect the spectrum of outcomes. The aim of this study was to explore differing responses to surgery, and assess whether there are distinct groups of patients with differing patterns of outcome. METHODS This was a secondary analysis of a UK multicentre TKA longitudinal cohort study. We used a group-based trajectory modelling analysis of Oxford Knee Score (OKS) in the first year following surgery with longitudinal data involving five different timepoints and multiple predictor variables. Associations between the derived trajectory groups and categorical baseline variables were assessed, and predictors of trajectory group membership were identified using Poisson regression and multinomial logistic regression, as appropriate. The final model was adjusted for sociodemographic factors (age, sex) and baseline OKS. RESULTS Data from 731 patients were available for analysis. Three distinct trajectories of outcome were identified: "poor" 14.0%, "modest" 39.1%, and "good" 46.9%. The predicted probability of membership for patients assigned to each trajectory group was high (0.89 to 0.93). Preoperative mental, physical health, and psychosocial factors determined which trajectory is likely to be followed. Poor responders were characterized by a comparatively small number of factors, preoperative expectations of pain and limitations, coping strategies, and a lower baseline physical health status, while the good responders were characterized by a combination of clinical, psychosocial, mental health, and quality of life factors. CONCLUSION We identified three distinct response trajectories in patients undergoing TKA. Controlling for baseline score, age, and sex, psychosocial factors such as expectations of pain and limited function and poor coping strategies differentiated the trajectory groups, suggesting a role for preoperative psychosocial support in optimizing the clinical outcome. Cite this article: Bone Joint J 2021;103-B(6):1096-1102.
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Affiliation(s)
- David F Hamilton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna Shim
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Colin R Howie
- Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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28
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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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29
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Londhe SB, Shah RV, Patwardhan M, Doshi AP, Londhe SS, Subhedar K. Understanding the apprehension and concern haunting patients before a total knee arthroplasty. ARTHROPLASTY 2021; 3:14. [PMID: 35236475 PMCID: PMC8796401 DOI: 10.1186/s42836-021-00069-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this prospective study was to understand the fear and apprehension factors that play on patient’s mind before total knee arthroplasty. Methods This retrospective cohort study included 500 consecutive patients (375 females and 125 males) who were scheduled to undergo total knee arthroplasty the next day. The patients were asked to list the most important fear in their mind regarding the operation in descending order of importance. They were given a questionnaire form which contained several capture points, including age, gender, educational background, occupation, and provision of help at home. Preoperative pain was measured by using the visual analog score, and its influence on the patients’ fear and apprehension factors was also measured. Results In this study, 58% of patients (50 males, 40%; 240 females, 64%) were fearful of the pain that they would experience after surgery and during the postoperative physiotherapy. The female patients showed more fear of pain than their male counterparts (P < 0.05). 18% of the patients (40 males, 32%; 50 females, 13%) listed whether they will be able to walk and perform activities of daily living after surgery as the most important fear. The male patients had more fear of returning to normal walking (P < 0.05). 20% of the patients (30 males, 24%; 70 females, 19%) were fearful about getting adequate home help after discharge from hospital (P > 0.05). 4% of patients were concerned about withstanding such a major operation. There was no difference between male and female patients (P > 0.05). Conclusion The majority of the patients experience apprehension of pain in the perioperative period of TKA. Preoperative counseling benefits pain management by alleviating the patient’s concerns about the fear of postoperative pain and apprehension of returning to normal walking. Supplementary Information The online version contains supplementary material available at 10.1186/s42836-021-00069-5.
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Affiliation(s)
- Sanjay Bhalchandra Londhe
- Orthopedic surgeon, Holy Spirit Hospital, Mahakali Caves Road, Andheri east, Mumbai, Maharashtra, 400093, India.
| | - Ravi Vinod Shah
- Orthopedic Surgeon, Criticare Superspeciality Hospital, Andheri East, Mumbai, Maharashtra, India
| | - Meghana Patwardhan
- Interventional Pain & Palliative Care Physician, Criticare Superspeciality Hospital, Andheri East, Mumbai, Maharashtra, India
| | | | | | - Kavita Subhedar
- Criticare Superspeciality Hospital, Andheri East, Mumbai, India
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30
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Sveinsdóttir H, Zoëga S, Ingadóttir B, Blöndal K. Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study. Nurs Open 2021; 8:210-223. [PMID: 33318829 PMCID: PMC7729539 DOI: 10.1002/nop2.620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 11/12/2022] Open
Abstract
Aims To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3. Design Prospective, explorative two-site follow-up study. Methods Patients having selected surgeries from January-July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression. Results The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%-20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%-55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.
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Affiliation(s)
- Herdís Sveinsdóttir
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Sigríður Zoëga
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Brynja Ingadóttir
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Katrín Blöndal
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
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31
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Abstract
There is tremendous interpatient variability in the response to analgesic therapy
(even for efficacious treatments), which can be the source of great frustration
in clinical practice. This has led to calls for “precision
medicine” or personalized pain therapeutics (ie, empirically based
algorithms that determine the optimal treatments, or treatment combinations, for
individual patients) that would presumably improve both the clinical care of
patients with pain and the success rates for putative analgesic drugs in phase 2
and 3 clinical trials. However, before implementing this approach, the
characteristics of individual patients or subgroups of patients that increase or
decrease the response to a specific treatment need to be identified. The
challenge is to identify the measurable phenotypic characteristics of patients
that are most predictive of individual variation in analgesic treatment
outcomes, and the measurement tools that are best suited to evaluate these
characteristics. In this article, we present evidence on the most promising of
these phenotypic characteristics for use in future research, including
psychosocial factors, symptom characteristics, sleep patterns, responses to
noxious stimulation, endogenous pain-modulatory processes, and response to
pharmacologic challenge. We provide evidence-based recommendations for core
phenotyping domains and recommend measures of each domain.
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32
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Lindberg MF, Miaskowski C, Rustøen T, Cooper BA, Aamodt A, Lerdal A. Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty. Eur J Pain 2020; 25:680-692. [PMID: 33259681 PMCID: PMC7986219 DOI: 10.1002/ejp.1703] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/22/2020] [Indexed: 12/16/2022]
Abstract
Background One in five patients experience chronic pain 12 months following total knee arthroplasty (TKA). This longitudinal study used a person‐centred approach to identify subgroups of patients with distinct chronic pain profiles following TKA and identified preoperative characteristics associated with these profiles. Methods On the day before surgery, 202 patients completed questionnaires that assessed pain, interference with functioning, fatigue, anxiety, depression and illness perceptions. Average and worst pain were assessed prior to surgery, on postoperative day 4, at 6 week and at 3 and 12 months following surgery. Using growth mixture modelling, two subgroups with distinct average and worst pain profiles were identified. Results Patients in the “lower average” and “lower worst” pain classes had moderate preoperative pain scores that decreased over the remaining 9 months following TKA. Patients in the “higher average” and “higher worst” pain classes had relatively higher preoperative pain scores that increased during the first three months and then decreased slightly over the remaining 9 months. Patients in the higher pain classes had higher interference with function scores; used opioids prior to surgery more often, were more likely to receive a continuous nerve block and ketamine; had higher preoperative fatigue severity and interference scores; and had worse perceptions of illness than patients in the lower pain classes. Conclusions These risk factors may be used to identify subgroups of patients at higher risk for more severe pain after TKA. Future studies should test whether modifying these risk factors can improve patients’ outcomes after TKA. Significance statement The present study provides a novel and original analysis of pain profiles following total knee arthroplasty that may contribute to our understanding of the transition from acute to chronic pain. Our results may be used to identify patients at higher risk for poorer outcomes based on preoperative risk factors.
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Affiliation(s)
- Maren F Lindberg
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - 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
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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33
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Niederstrasser NG, Cook S. Investigating the True Effect of Psychological Variables Measured Prior to Arthroplastic Surgery on Postsurgical Outcomes: A P-Curve Analysis. THE JOURNAL OF PAIN 2020; 22:400-414. [PMID: 33098977 DOI: 10.1016/j.jpain.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 07/02/2020] [Accepted: 07/31/2020] [Indexed: 12/27/2022]
Abstract
Patients' presurgical psychological profiles have been posited to predict pain and function following arthroplastic surgery of the hip and knee. Nevertheless, findings are conflicting, and this may be rooted in biased reporting that makes the determination of evidential value difficult. This ambiguity may have negative consequences for researchers and governmental agencies, as these rely on findings to accurately reflect reality. P-Curve analyses were used to establish the presence of evidential value and selective reporting in a sample of studies examining the effect of presurgical psychological predictors on outcomes following knee and hip arthroplastic surgery. A systematic search of the literature revealed 26 relevant studies. The examined sets of studies indicate that there is evidential value for the effect of depression on pain intensity and function, anxiety on pain intensity and function, pain catastrophizing on pain intensity, as well as the combined effects of all psychological predictors on pain intensity and function. The presence of evidential value was inconclusive for the effect of optimism on pain intensity. There were no signs that any results were influenced by biased reporting. The results highlight the importance of patients' psychological profiles in predicting surgical outcomes, which represent a promising avenue for future treatment approaches. PERSPECTIVE: The effects of P-hacking are difficult to detect and might be at the root of conflicting findings pertaining to the predictive properties of presurgical psychological variables on postsurgical outcomes. P-Curve analysis allows the determination of evidential value underlying these relationships and detection of P-hacking to ensure that findings are not the result of selective reporting.
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Affiliation(s)
| | - Stephanie Cook
- School of Applied Social Sciences, De Montfort University, Leicester, UK
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34
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Li Y, Kong D, Wang W, Zhu Y, Liu X. Psychometric properties of the Chinese version of the recovery locus of control (RLOC) Scale among patients with myocardial infarction. Nurs Open 2020; 7:1815-1821. [PMID: 33072366 PMCID: PMC7544849 DOI: 10.1002/nop2.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/02/2020] [Accepted: 06/26/2020] [Indexed: 12/02/2022] Open
Abstract
Aim To translate the RLOC Scale into Chinese and test its psychometric properties in the Chinese patients with myocardial infarction (MI). Design A cross‐sectional design was used. Methods A convenience sample of 233 patients with MI who have undergone percutaneous coronary intervention and were ready for discharge were recruited in a level A tertiary hospital of Shandong Province from January 2019 to April 2019. Data were analysed using item analysis, internal consistency reliability and exploratory factor analysis. Results Two factors—external RLOC and internal RLOC—were extracted, accounting for 70.5% of the variance. Cronbach's alpha for the Chinese version of RLOC Scale was 0.80 and for the two factors was 0.92 and 0.76, respectively. The Chinese version of RLOC Scale showed satisfactory reliability and validity, which can be used to measure the ability of recovery locus of control in Chinese patients with MI.
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Affiliation(s)
- Yuli Li
- School of Nursing Cheeloo College of Medicine Shandong University Jinan China
| | - Dong Kong
- Nursing Department Shandong Provincial Hospital Shandong First Medical University Jinan China
| | - Wei Wang
- Department of Cardiology Shandong Provincial Hospital Shandong First Medical University Jinan China
| | - Yanhua Zhu
- Department of Cardiology Shandong Provincial Hospital Shandong First Medical University Jinan China
| | - Xiaoqin Liu
- Medical Intensive Care Unit Shandong Provincial Hospital Shandong First Medical University Jinan China
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35
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Goh GS, Zeng GJ, Chen JY, Lo NN, Yeo SJ, Liow MHL. Ten-Year Results of Unicompartmental Knee Arthroplasty in Patients With Psychological Distress. J Arthroplasty 2020; 35:2830-2836.e1. [PMID: 32475784 DOI: 10.1016/j.arth.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/18/2020] [Accepted: 05/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the influence of psychological distress on the outcomes of total knee arthroplasty has been described extensively, its effect on unicompartmental knee arthroplasty (UKA) is poorly defined. Furthermore, most studies in arthroplasty literature had short follow-ups of ≤1 year. We investigated the influence of psychological distress on long-term patient-reported outcomes and analyzed the change in mental health after UKA in a cohort with minimum 10 years of follow-up. METHODS Prospectively collected data of 269 patients undergoing UKA in 2004-2007 were reviewed. Patients were stratified into those with psychological distress (36-item Short-Form health survey [SF-36] Mental Component Summary [MCS] <50, n = 111) and those without (SF-36 MCS ≥50, n = 158). Clinical outcomes were obtained preoperatively, at 2 years, and 10 years. Multiple regression was used to control for age, gender, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, and baseline scores. The rate of expectation fulfillment and satisfaction was compared. RESULTS Psychologically distressed patients had poorer Knee Society Knee Score, Function Score, Oxford Knee Score, and SF-36 Physical Component Summary preoperatively, at 2 years, and 10 years. However, an equal proportion in each group attained the minimal clinically important difference for each score. Distressed patients had a comparable rate of satisfaction (91% vs 95%, P = .136) but lower fulfillment of expectations (89% vs 95%, P = .048). The percentage of distressed patients declined from 41% to 35% at follow-up. The mean SF-36 MCS improved by 6.9 points. CONCLUSION Although psychologically distressed patients had relatively greater pain and poorer function preoperatively and up to 10 years after UKA, a similar proportion of them experienced a clinically meaningful improvement in patient-reported outcomes.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gerald J Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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36
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Magan AA, Ahmed SS, Paton B, Konan S, Haddad FS. Does Multimodal Therapy Influence Functional Outcome After Total Knee Arthroplasty? Orthop Clin North Am 2020; 51:453-459. [PMID: 32950214 DOI: 10.1016/j.ocl.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Psychosocial health may influence the outcomes after total knee arthroplasty (TKA). We investigated the hypothesis that multimodal therapy influences the quality of life and function in patients diagnosed with osteoarthritis of the knee joint. Secondly, in patients who then proceed to have TKA post-multimodal therapy, does the response to the multimodal therapy influence the overall functional outcome of surgery? Patients diagnosed with osteoarthritis of the knee were enrolled in the study and prospectively followed-up. A total of 526 patients were enrolled and available for the study. All participants were enrolled for 12 classes of 60-minute duration over 6-weeks. Apart from an exercise program, the class also included physiotherapist-led education and a 'weight management' lecture by a dietitian. In summary, the multimodal therapy program improved the SF-12, OKS, pain scores (visual analogue scale) and WOMAC scores significantly. The multimodal therapy protocol can optimize patients' psychological scores prior to TKA and may enhance ultimate functional outcome.
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Affiliation(s)
- Ahmed A Magan
- Univerisity College London Hospital NHS Foundation Trust, London, UK.
| | - Syed S Ahmed
- Univerisity College London Hospital NHS Foundation Trust, London, UK
| | - Bruce Paton
- Univerisity College London Hospital NHS Foundation Trust, London, UK; The Institute of Sports, Exercise and Health, London, UK
| | - Sujith Konan
- Univerisity College London Hospital NHS Foundation Trust, London, UK
| | - Fares S Haddad
- Univerisity College London Hospital NHS Foundation Trust, London, UK; The Institute of Sports, Exercise and Health, London, UK; The Princess Grace Hospital, London, UK
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37
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Tolk JJ, Janssen RPA, Haanstra TM, van der Steen MMC, Bierma Zeinstra SMA, Reijman M. Outcome Expectations of Total Knee Arthroplasty Patients: The Influence of Demographic Factors, Pain, Personality Traits, Physical and Psychological Status. J Knee Surg 2020; 33:1034-1040. [PMID: 31272124 DOI: 10.1055/s-0039-1692632] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unfulfilled preoperative expectations have a strong influence on the outcome after total knee arthroplasty (TKA). More insight into determinants of the level of expectations is useful in identifying patients at risk for having expectations of the treatment result that are too high or too low. This information can be used in optimizing preoperative expectation management. The aim of the current study was to analyze to what extent preoperative outcome expectations of TKA patients are affected by psychological factors, demographic factors, pain, physical function, and general health status. We performed a cross-sectional analysis of 204 patients with symptomatic and radiographic knee osteoarthritis (OA), scheduled for primary TKA. Outcome expectations were measured using the hospital for special surgery knee replacement expectations survey. Independent variables included were age, sex, body mass index, and patient-reported outcome measures for pain, physical function, quality of life, anxiety, depression, catastrophizing, optimism, and pessimism. Multiple linear regression analyses were used to evaluate associations between these variables and preoperative outcome expectations. Female sex, higher age, higher depression score, and duration of complaints > 50 months showed to be significant predictors of lower expectations for the treatment outcome after TKA. Baseline pain and function scores were not related to the level of preoperative expectations. The present study aids in identifying patients at risk for having either too high or too low expectations. This knowledge can be utilized in individualized expectation management interventions.
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Affiliation(s)
- Jaap J Tolk
- Department of Orthopedic Surgery and Trauma, Máxima Medical Center, Eindhoven, the Netherlands
| | - Rob P A Janssen
- Department of Orthopedic Surgery and Trauma, Máxima Medical Center, Eindhoven, the Netherlands
| | - Tsjitske M Haanstra
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke M C van der Steen
- Department of Orthopedic Surgery and Trauma, Máxima Medical Center, Eindhoven, the Netherlands.,Department of Orthopedic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Sita M A Bierma Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Reijman
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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38
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Goh GS, Liow MHL, Chen JY, Tay DKJ, Lo NN, Yeo SJ. Do Patients With Psychological Distress Have Poorer Patient-Reported Outcomes After Total Hip Arthroplasty? J Arthroplasty 2020; 35:2465-2471. [PMID: 32446627 DOI: 10.1016/j.arth.2020.04.077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with psychological distress are likely to have poorer short-term functional outcomes after total knee arthroplasty. However, the influence of psychological distress on the outcomes of total hip arthroplasty (THA) is relatively understudied. Previous studies also had short follow-ups of 1 year or less. We examined the influence of psychological distress on patient-reported outcomes and satisfaction, and analyzed the change in mental health after THA at a minimum of 2 years. METHODS Prospectively collected data of 1384 patients undergoing primary THA in 2001-2015 were reviewed. Patients were assessed using the Oxford Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and 36-item Short-Form health survey Physical Component Summary and Mental Component Score (MCS). Patients were stratified into those with psychological distress (MCS < 50, n = 720) and those without (MCS ≥ 50, n = 664). Multiple regression analysis was used to control for age, gender, body mass index, and baseline scores. The rate of satisfaction and expectation fulfillment was also analyzed. RESULTS Distressed patients had a poorer Physical Component Summary at 6 months. However, there was no difference in patient-reported outcomes at 2 years. A higher proportion of distressed patients attained the minimal clinically important difference for Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index, while 92.2% of distressed patients and 92.9% of nondistressed patients were satisfied at 2 years (P = .724). There was no difference in MCS after 6 months. The percentage of distressed patients also declined from 41.8% to 27.3%. CONCLUSION Patients with psychological distress achieved a comparable level of function, quality of life, and satisfaction 2 years after THA. Undergoing THA may also lead to mental health improvement in a subgroup of distressed patients.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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39
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Lennon O, Ryan C, Helm M, Moore K, Sheridan A, Probst M, Cunningham C. Psychological Distress among Patients Attending Physiotherapy: A Survey-Based Investigation of Irish Physiotherapists' Current Practice and Opinions. Physiother Can 2020; 72:239-248. [PMID: 35110792 DOI: 10.3138/ptc-2019-0010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The primary purpose of this study was to investigate the current practice and opinions of members of the Irish Society of Chartered Physiotherapists (ISCP) with respect to the care of patients in psychological distress. Method: This was a cross-sectional, survey-based investigation of Irish physiotherapists. An electronic survey was sent by email to the ISCP membership. It consisted of closed- and open-ended questions, as well as opinion questions with Likert scale responses. Results: More than 80% of the respondents reported that they encountered patients with psychological distress at least once a week. A lack of education in the area of mental health emerged as a predominant theme. Reflecting on current practice, many discussed the importance of addressing underlying psychological issues before or in tandem with physical issues. Respondents who had engaged in further education in mental health, psychology, or both rated their confidence in recognizing the signs and symptoms of psychological distress higher (p < 0.001). Moreover, a greater proportion of these respondents routinely assessed for psychological distress in their clinical practice (p < 0.001). Conclusion: Physiotherapists regularly encounter patients whom they perceive to have high levels of psychological distress. Irish physiotherapists displayed positive attitudes toward patients' psychological well-being. However, additional education in mental health was a recognized need in the profession.
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Affiliation(s)
- Olive Lennon
- School of Public Health, Physiotherapy and Sports Science
| | - Cormac Ryan
- School of Public Health, Physiotherapy and Sports Science
| | - Maggie Helm
- School of Public Health, Physiotherapy and Sports Science
| | - Katrina Moore
- School of Public Health, Physiotherapy and Sports Science
| | - Ann Sheridan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Michel Probst
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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40
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Goh GS, Liow MHL, Tay YWA, Chen JY, Xu S, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ. The long-term impact of preoperative psychological distress on functional outcomes, quality of life, and patient satisfaction after total knee arthroplasty. Bone Joint J 2020; 102-B:845-851. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1562.r2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Methods Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS. Results There was no difference in the mean KSKS, KSFS, OKS, and SF-36 PCS at two years or ten years after TKA. Equal proportions of patients in each group attained the minimal clinically important difference for each score. Psychologically distressed patients had a comparable rate of satisfaction (91.8% (47/51) vs 97.1% (69/71); p = 0.193) and fulfilment of expectations (89.8% vs 97.1%; p = 0.094). The proportion of distressed patients declined from 41.8% preoperatively to 29.8% at final follow-up (p = 0.021), and their mean SF-36 MCS improved by 10.4 points (p < 0.001). Conclusion Patients with poor mental health undergoing TKA may experience long-term improvements in function and quality of life that are comparable to those experienced by their non-distressed counterparts. These patients also achieved a similar rate of satisfaction and expectation fulfilment. Undergoing TKA was associated with improvements in mental health in distressed patients, although this effect may be due to residual confounding. Cite this article: Bone Joint J 2020;102-B(7):845–851.
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Affiliation(s)
- Graham S. Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - You Wei Adriel Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Sheng Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hee-Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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41
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Ditton E, Johnson S, Hodyl N, Flynn T, Pollack M, Ribbons K, Walker FR, Nilsson M. Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors. Front Psychol 2020; 11:1061. [PMID: 32670136 PMCID: PMC7326061 DOI: 10.3389/fpsyg.2020.01061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/27/2020] [Indexed: 12/19/2022] Open
Abstract
Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centered outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated patients' real-world "quality of life" experiences. We propose a novel precision medicine approach to improving patient-centered TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centered TKA outcomes. Of particular importance to the model's predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centered outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarized, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilization of multivariate prediction models to inform individually tailored interventions targeting a range of health conditions.
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Affiliation(s)
- Elizabeth Ditton
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Sarah Johnson
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Electrical Engineering and Computing, The University of Newcastle, Callaghan, NSW, Australia
| | - Nicolette Hodyl
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Traci Flynn
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Humanities and Social Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Michael Pollack
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- John Hunter Hospital, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Karen Ribbons
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Frederick Rohan Walker
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Michael Nilsson
- Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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42
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Meints SM, Edwards RR, Gilligan C, Schreiber KL. Behavioral, Psychological, Neurophysiological, and Neuroanatomic Determinants of Pain. J Bone Joint Surg Am 2020; 102 Suppl 1:21-27. [PMID: 32251127 PMCID: PMC8272523 DOI: 10.2106/jbjs.20.00082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Samantha M. Meints
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher Gilligan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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43
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Marks R. Anxiety and Osteoarthritis Disability: Updated Overview and Commentary. Open Orthop J 2020. [DOI: 10.2174/1874325002014010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Introduction:
Osteoarthritis, a widespread highly painful often incapacitating joint disease continues to impose immense personal and societal challenges among adults of all ages, especially among older adults. In the absence of any effective cure or treatment, it has become essential to explore all correlates of this chronic disabling disease, especially those that might be preventable or modifiable. Anxiety, a potentially remediable state of mental distress - found linked to chronically disabling forms of arthritis, in various imperceptible ways, and which may have an immense bearing on the outcomes of osteoarthritis, has not received as much attention in the related literature as other topics, such as surgery.
Objective:
In line with previous promising work, this narrative review elected to explore the extent to which current researchers in the field are pursuing this topic, and if so, the degree to which prevailing peer-reviewed data sources support an important role for continued research in this realm, and in what regard.
Methods:
Primarily explored were the key databases housing relevant publications that emerged over Aug 1, 2018-Feb 26, 2020 using the keywords Osteoarthritis and Anxiety. Using a descriptive approach, the relative progress made over the past five previous years in this regard was assessed, in addition to what joints have been studied and with what frequency, and how the degree of interest compares to other currently researched osteoarthritis themes. The potential for intervening in the osteoarthritis pain cycle by addressing anxiety was also examined.
Results:
Findings show a high level of current interest in this topic, and that despite the paucity of prospective studies, studies on joints other than the knee and hip joints, some equivocal conclusions, small numbers of anxiety-related studies compared to other topics, and substantive design limitations, it appears that future research in this realm is strongly indicated.
Conclusion:
This topic if examined further is likely to produce highly advantageous results at all stages of the osteoarthritic disease process and in the context of primary, secondary, as well as tertiary measures to ameliorate osteoarthritis pain and disability.
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Schlitt P, Freedman M, Tan TL, Minori J, Schroeder JT, Parvizi J. Predicting outcomes of total joint arthroplasty using the distress and risk assessment method. Hip Int 2020; 30:276-280. [PMID: 30945562 DOI: 10.1177/1120700019836403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Psychological distress is presumed to be an important factor that can adversely impact the outcome of orthopaedic procedures. The Distress and Risk Assessment Method (DRAM) is an evaluation tool which assesses psychological distress in patients with low back pain. The purpose of this prospective study was to assess the influence of preoperative psychological distress, as determined by the DRAM score, on the functional outcomes of total joint arthroplasty (TJA). MATERIALS AND METHODS A prospective study of 61 TJAs was performed at a single institution. The DRAM questionnaire and a variety of functional measures (12-Item Short Form Health Survey [SF-12], visual analogue scale [VAS], Oxford Hip Score [OHS], Oxford Knee Score [OKS], and Oswestry Disability Questionnaire [ODQ]) were administered to the patient at baseline, 1 month, and 6 months postoperatively. Mixed model regressions and Mann-Whitney tests were utilised to evaluate the relationship of the DRAM score with functional outcomes. RESULTS The summed quantitative DRAM score was predictive of functional outcomes. With each 1 point increase in psychological distress, VAS pain increased by 0.023 (p = 0.015), OKS decreased by 0.34 (p = 0.01), ODQ increased by 0.065 (p = 0.02), and MCS decreased by 0.14 (p = 0.015). In addition, patients with lower preoperative distress scores had higher rates of improvement than patients with higher preoperative distress scores for VAS pain (p = 0.034). DISCUSSION Psychological distress was associated with decreased baseline mental health and function in the early postoperative period, which has important implications for bundled payments. However, patients with psychological distress still demonstrated functional improvements and TJA should thus not be contraindicated in these patients.
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Affiliation(s)
| | | | - Timothy L Tan
- Rothman Institute at Thomas Jefferson University, PA, USA
| | - Joshua Minori
- Rothman Institute at Thomas Jefferson University, PA, USA
| | | | - Javad Parvizi
- Rothman Institute at Thomas Jefferson University, PA, USA
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45
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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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46
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Bierke S, Häner M, Karpinski K, Hees T, Petersen W. Midterm Effect of Mental Factors on Pain, Function, and Patient Satisfaction 5 Years After Uncomplicated Total Knee Arthroplasty. J Arthroplasty 2020; 35:105-111. [PMID: 31477540 DOI: 10.1016/j.arth.2019.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The effects of psychological factors on the short-term outcome after uncomplicated total knee arthroplasty (TKA) have been described in several studies. However, the effects of mental factors on the midterm (5-year) outcome have not been described in the literature. This study was performed to examine the influence of pain catastrophizing, anxiety, depression symptoms, and somatization dysfunction on the outcome of TKA during a 5-year follow-up. METHODS One hundred fifty patients were enrolled in this prospective study. The following mental parameters were assessed in all patients: pain catastrophizing (Pain Catastrophizing Scale), anxiety (State-Trait Anxiety Inventory), depressive symptoms and somatization dysfunction (Patient Health Questionnaire). The primary outcome measure was postoperative pain on a numerical rating scale. The secondary outcome measures were the Knee Injury and Osteoarthritis Outcome Score and patient satisfaction. Intergroup differences were tested using an independent t-test. Odds ratios were calculated to determine the probability of an unsatisfactory outcome. RESULTS At the 5-year follow-up, only depressive symptoms and somatization dysfunction had a significant effect on postoperative pain (numerical rating scale score). This significant effect was also observed for the different Knee Injury and Osteoarthritis Outcome Score subscales and patient satisfaction (P = .010-.020). Pain catastrophizing and anxiety had only a small effect on the clinical outcome at 5 years postoperatively. CONCLUSION The effects of psychopathological factors (depressive symptoms and somatization dysfunction) on the clinical outcome after uncomplicated TKA persist for up to 5 years. Preoperative screening for and subsequent treatment of these psychological disorders may improve patient-reported outcomes after TKA. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Sebastian Bierke
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Martin Häner
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Katrin Karpinski
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Tilman Hees
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
| | - Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Berlin, Germany
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47
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Carney S, Parker C, Schoo A, Isaac V, Kapakoulakis T. Exploring the relationship between body mass index, mental health and outcomes of a regional physiotherapy-led post-arthroplasty review clinic. Aust J Rural Health 2019; 28:180-183. [PMID: 31709661 DOI: 10.1111/ajr.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/23/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine whether 12-month hip and knee outcomes of a regional arthroplasty clinic were comparable to results from metropolitan-based clinics, and to explore a possible relationship between body mass index and depression to identify groups at risk of not achieving optimal outcomes. DESIGN A prospective observational study. SETTING A regional physiotherapy-led post-arthroplasty review clinic. PARTICIPANTS Patients after hip or knee replacement. INTERVENTIONS Patients underwent either total hip or total knee joint arthroplasty. MAIN OUTCOME MEASURES SF-12 Health Survey, Oxford Hip/Knee Scale, 10-minute walk test, knee range of motion, body mass index and the Hospital Anxiety and Depression Scale. RESULTS Physical outcomes were comparable to those reported by metropolitan-based clinics. People with a high body mass index showed most improvement in the severity of depression compared to those with a lower body mass index. CONCLUSION It is important to consider the long-term effects of obesity on arthroplasty outcomes.
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Affiliation(s)
| | | | - Adrian Schoo
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Vivian Isaac
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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48
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Hoogendam L, van der Oest MJW, Tsehaie J, Wouters RM, Vermeulen GM, Slijper HP, Selles RW, Porsius JT. Psychological factors are more strongly associated with pain than radiographic severity in non-invasively treated first carpometacarpal osteoarthritis. Disabil Rehabil 2019; 43:1897-1902. [PMID: 31702959 DOI: 10.1080/09638288.2019.1685602] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to investigate to what extent psychological factors are related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal joint. METHODS We included patients (n = 255) at the start of non-invasive treatment for osteoarthritis of the first carpometacarpal joint who completed the Michigan Hand Outcome Questionnaire. Psychological distress, pain catastrophizing behavior and illness perception was measured. X-rays were scored on presence of scaphotrapeziotrapezoid osteoarthritis. We used hierarchical linear regression analysis to determine to what extent pain levels could be explained by patient characteristics, X-ray scores, and psychological factors. RESULTS Patient characteristics and X-ray scores accounted for only 6% of the variation in pre-treatment pain levels. After adding the psychological factors to our model, 47% of the variance could be explained. CONCLUSIONS Our results show that psychological factors are more strongly related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal joint than patient characteristics and X-ray scores, which implies the important role of these factors in the reporting of symptoms. More research is needed to determine whether psychological factors will also affect treatment outcomes for patients treated non-invasively for osteoarthritis of the first carpometacarpal joint.IMPLICATIONS FOR REHABILITATIONPain is the most important complaint for patients with osteoarthritis of the first carpometacarpal joint.Psychological factors are strongly associated with pain levels prior to treatment.Pain catastrophizing behavior appears to be a promising target for complementary treatment in patients with osteoarthritis of the first carpometacarpal joint.
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Affiliation(s)
- Lisa Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands.,Hand and Wrist Center, Xpert Clinic, Rotterdam, The Netherlands
| | - Mark J W van der Oest
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands.,Hand and Wrist Center, Xpert Clinic, Rotterdam, The Netherlands
| | - Jonathan Tsehaie
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands.,Hand and Wrist Center, Xpert Clinic, Rotterdam, The Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands.,Center for Hand Therapy, Handtherapie Nederland, Utrecht, The Netherlands
| | | | - Harm P Slijper
- Hand and Wrist Center, Xpert Clinic, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jarry T Porsius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands.,Hand and Wrist Center, Xpert Clinic, Rotterdam, The Netherlands
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49
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Sun PO, Walbeehm ET, Selles RW, Jansen MC, Slijper HP, Ulrich DJO, Porsius JT. Influence of illness perceptions, psychological distress and pain catastrophizing on self-reported symptom severity and functional status in patients with carpal tunnel syndrome. J Psychosom Res 2019; 126:109820. [PMID: 31487574 DOI: 10.1016/j.jpsychores.2019.109820] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the influence of illness perceptions, pain catastrophizing and psychological distress on self-reported symptom severity and functional status in patients diagnosed with carpal tunnel syndrome (CTS). METHODS A total of 674 patients with CTS scheduled for surgery at an outpatient treatment center for hand and wrist conditions (September 2017 to August 2018) completed online questionnaires regarding demographic and psychosocial characteristics and self-reported CTS severity. Self-reported severity of CTS was measured with the functional status scale and the symptom severity scale of the Boston Carpal Tunnel Questionnaire. To measure psychosocial factors, the Patient Health Questionnaire-4, Pain Catastrophizing Scale and the Brief Illness Perception Questionnaire were used. Pearson correlation coefficients were calculated to assess univariable relations. Hierarchical linear regression models were used to examine the relation between psychosocial factors and self-reported severity, and the relative contribution of psychosocial factors to self-reported severity, adjusting for patient characteristics and comorbidities. RESULTS Medium-sized correlations (range 0.32-0.44) with self-reported severity were observed for psychological distress, pain catastrophizing, consequences, identity, concern and emotional representation. Furthermore, these factors (except for concern) were also associated with self-reported severity, when adjusted for baseline characteristics and comorbidities. Hierarchical linear regression models showed that these psychosocial factors explained an additional 20-25% of the variance in self-reported severity of CTS. CONCLUSION This study shows that psychological distress, pain catastrophizing and illness perceptions play an independent role in self-reported severity of CTS. Clinicians should take these psychosocial factors into account when they are consulted by patients with CTS.
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Affiliation(s)
- Pepijn O Sun
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Erik T Walbeehm
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinic, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Miguel C Jansen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Dietmar J O Ulrich
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jarry T Porsius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, The Netherlands; Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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50
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Rajapakshe S, Sutherland JM, Wing K, Crump T, Liu G, Penner M, Younger A, Veljkovic A, Redfern K. Health and Quality of Life Outcomes Among Patients Undergoing Surgery for End-Stage Ankle Arthritis. Foot Ankle Int 2019; 40:1129-1139. [PMID: 31215232 DOI: 10.1177/1071100719856888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is little research investigating which aspects of health-related quality of life change following ankle arthrodesis and total ankle replacement surgery. The objective of this study was to report on statistically and clinically relevant changes in multiple dimensions of health-related quality of life among patients undergoing ankle replacement or fusion surgery. METHODS This study was based on a prospective sample of ankle arthrodesis and total ankle replacement patients. Participants complete the Ankle Osteoarthritis Scale, EuroQoL's EQ-5D-3L, the Patient Health Questionnaire-9, and the pain intensity, interference with enjoyment of life, and general activity pain instrument. Instruments were completed preoperatively and postoperatively. Multivariate regression models were used to measure the change in health-related quality of life outcomes, adjusting for demographic, clinical, and health service utilization. RESULTS Participants achieved statistically significant improvements in health-related quality of life in each domain of measurement. The majority of participants reported clinically significant improvement in pain. Mild depressive symptoms were common, and clinically significant improvement in depression symptoms occurred in 22% of patients. Gains in health were more pronounced among participants reporting the worst preoperative health in all domains quality of life measured. CONCLUSIONS Pain showed a clinically important improvement among 64% of participants whereas 22% reported a clinically meaningful improvement in their depression symptoms postoperatively. Clinically significant gains in health-related quality of life were not experienced by all participants in all dimensions. Further research is warranted to better understand the failure of some patients to improve in dimensions of health studied. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Shanika Rajapakshe
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Redfern
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
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