Effect of Psychopathology on Patient-Perceived Outcomes of Total Knee Arthroplasty within an Indigent Population (original) (raw)
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Psychological Traits in Patients Waiting for Total Knee Arthroplasty. A Cross-sectional Study
The Journal of Arthroplasty, 2016
Background: To determine the prevalence of psychiatric distress in an Australian patient population waiting for total knee arthroplasty and to assess the associations between psychological distress and other baseline characteristics. Methods: This is a cross-sectional study of prospectively collected data from patients with knee arthritis participating in the New South Wales Osteoarthritis Chronic Care Program. Participants were divided into 2 groups based on the Depression Anxiety and Stress Score. The prevalence of psychological distress was compared to reported prevalence in the Australian community. Between-group comparisons of a number of variables were made, including demographic and socioeconomic data, health and psychiatric data, patient-reported knee and quality-of-life scores, and measured function. Results: Data from 3103 patients were available and 2809 patients were eligible for inclusion, with 1740 (62%) females. Mean patient age was 68 years, and mean body mass index was 33.8. We found 753 (26.8%, standard deviation: 0.44) of participants reported psychological distress. Those reporting distress were more likely to be female (P ¼ .025), younger (66.6 vs 68.8 years, P < .001), with a higher body mass index (34.5 vs 32.7, P < .001), and had more comorbidities (3.4 vs 2.8, P < .001). The distressed group had significantly worse knee pain (visual analog scale: 7.1 vs 6.2, P < .001; Knee Injury and Osteoarthritis Score pain component: 28.9 vs 41.2, P < .001), knee function, and general quality-of-health scores (P < .001). Conclusion: Psychological health is an important and often overlooked predictor of severity of symptoms and dysfunction in patients with knee arthritis. As it can affect the outcome for surgery, psychological health should be better assessed and treated before surgery to help reduce preoperative dysfunction and improve postoperative outcomes of total knee arthroplasty.
Psychological determinants of problematic outcomes following total knee arthroplasty
Pain, 2009
The primary objective of the present study was to examine the role of pain-related psychological factors in predicting pain and disability following Total Knee Arthroplasty (TKA). The study sample consisted of 75 (46 women, 29 men) individuals with osteoarthritis of the knee who were scheduled for TKA. Measures of pain severity, pain catastrophizing, depression, and pain-related fears of movement were completed prior to surgery. Participants completed measures of pain severity and self-reported disability 6 weeks following surgery. Consistent with previous research, cross-sectional analyses revealed significant correlations among measures of pre-surgical pain severity, pain catastrophizing, depression and pain-related fears of movement. Prospective analyses revealed that pre-surgical pain severity and pain catastrophizing were unique predictors of post-surgical pain severity (6-week follow-up). Pain-related fears of movement were predictors of post-surgical functional difficulties in univariate analyses, but not when controlling for pre-surgical co-morbidities (e.g. back pain). The results of this study add to a growing literature highlighting the prognostic value of psychological variables in the prediction of post-surgical health outcomes. The results support the view that the psychological determinants of post-surgical pain severity differ from the psychological determinants of post-surgical disability. The results suggest that interventions designed to specifically target pain-related psychological risk factors might improve post-surgical outcomes.
The Impact of Depression, Personality, and Mental Health on Outcomes of Total Knee Arthroplasty
Clinics in Orthopedic Surgery
Despite great advances in total knee arthroplasty (TKA) implants and techniques in recent years, approximately 20% of patients have reported little or no postoperative improvement in pain, physical function, and quality of life (QOL). 1,2) These results could not be explained completely by surgical and physical characteristics. Recent studies have demonstrated that preoperative psychological factors may play a role in postoperative dissatisfaction of patients. 3) Vissers et al. 2) demonstrated that patients with a better preoperative self-reported mental health score were more often satisfied. Giurea et al. 4) showed significant influence of 4 personality traits on patient satisfaction: life satisfaction, performance orientation, somatic distress, and emotional stability. In an investigation about the relationship between patients' diverse personalities and
Mental Health and Outcomes in Primary Total Joint Arthroplasty
The Journal of Arthroplasty, 2012
A consecutive series of 640 total joint arthroplasty patients was interviewed before surgery and at a minimum of 2 years following surgery. Statistical analyses were conducted to examine the effect of psychological distress and other patient characteristics on outcomes (Western Ontario and McMaster Universities Osteoarthritis Index, Short Form 36, and Quality of Well-Being index). Before and after surgery, distressed subjects had significantly lower scores than nondistressed subjects for most dependent measures (P range, .05 ≤ .001). All mean outcomes improved by follow-up in both groups (P ≤ .001) except mental health scores of nondistressed subjects. Stepwise regression analysis found that low baseline mental health score, non-Hispanic ethnicity, and fewer years since procedure were the strongest predictors of worse Western Ontario and McMaster Universities Osteoarthritis Index scores at follow-up. Although the magnitude of improvement is similar to nondistressed subjects, distressed patients do not achieve comparable functional and psychosocial outcomes. Keywords: total knee arthroplasty, total hip arthroplasty, mental health, outcomes.
Mental Health Status Does Not Affect Patient Satisfaction After Knee Replacement
International Journal of Orthopaedics
AIM: To determine whether peri-operative mental health scores are associated with patient satisfaction after total knee arthroplasty (TKA). METHODS: We conducted a retrospective review of 205 primary TKAs to determine whether the Short Form-12 Mental Component Score (SF-12 MCS) is associated with Press Ganey satisfaction. Univariate logistic regression was used to test for an association between MCS and the likelihood of a 5-star rating for each question. RESULTS: Patients with low preoperative and postoperative MCS were less likely to give a 5-star rating for provider and staff communication, friendliness, and courteousness but had no association with satisfaction with overall care. A change in MCS in patients with a low preoperative MCS was associated with 5-star satisfaction with appointment scheduling. CONCLUSION: Patient mental health status is minimally associated with patient satisfaction. Thus, poor preoperative mental health status should not be a relative contraindication to TKA.
The Impact of Psychological Health on Patient Recovery After Arthroplasty
Frontiers in Psychiatry
PurposeThe purpose of this study was to determine the relationship between psychological health and postoperative recovery and satisfaction in patients undergoing total joint arthroplasty (TJA).MethodsWe prospectively enrolled patients undergoing TJA from July 2019 to December 2020. A psychological evaluation was conducted according to the Hospital Anxiety and Depression Scale (HADS). Based on the preoperative HADS scores, we grouped the patients into two groups: the symptomatic group and the asymptomatic group. Data on the Harris Hip Score (HHS), Knee Society Knee Scoring System (KSS), Forgotten Joint Score-12 (FJS-12), Short Form-12 (SF-12), and Numeric Rating Scale (NRS) for pain in these two groups were collected preoperatively and postoperatively. Then, these data were analyzed by Statistical Package for Social Sciences (SPSS) version 19.ResultsThe final cohort consisted of 80 patients. Patients undergoing TJA had significantly decreased HADS and NRS scores and improved HHS, KS...
Psychosocial Profiles of Indigent Patients with Severe Osteoarthritis Requiring Arthroplasty
The Journal of Arthroplasty, 2011
This study documents the prevalence of Axis I diagnoses (ie, depression, anxiety, and others) and their effects on preoperative pain, disability, function, and quality of life assessments in an indigent population undergoing total joint arthroplasty. Consecutive indigent patients scheduled for total joint arthroplasty were categorized by psychosocial testing as either psychologically distressed (PD) or nonpsychologically distressed. Of the subjects, 38% were found to be psychologically distressed. The PD group had significantly lower measures on 7 of the 8 components of the Short Form-36, the Harris hip score, and Knee Society score (P b .05). The PD group also scored significantly worse on both the Western Ontario MacMaster (P b .001) and the Pain Disability Questionnaire (P b .001). There is a high prevalence of psychopathology in the indigent population undergoing total joint arthroplasty, exhibiting poorer scores on pain, disability, function, and quality of life measures before surgery.
Prospective psychometric characterization of hip and knee arthroplasty patients
Nordic journal of psychiatry, 2018
Psychiatric conditions and psychopharmacological treatments have been demonstrated to be important risk-factors for prolonged hospital length of stay, readmission and morbidity, following fast-track total hip (THA) and total knee arthroplasty (TKA). The aim of the study was to provide a detailed description of the preoperative psychiatric characteristics of a well-defined patient population undergoing THA and TKA, using the 90-item Symptom Checklist (SCL-90-R). A pre-surgical population of 2183 patients completed the full SCL-90-R prior to THA/TKA from 2015 to 2016. The SCL-90-R scale and total scores of the pre-surgical sample were compared to the scores of an age- and gender stratified Danish sample of healthy controls. A Mokken scalogram analysis was conducted to assess the scalability of the SCL-90-R in both samples. The Mokken analysis yielded acceptable scalability coefficients above 0.30 in all subscales of the SCL-90-R except psycoticism (0.28). There was no clinically signi...
The European Research Journal
Objectives: This study aims to investigate the relationship between pain severity in the early postoperative period and preoperative psychometric factors in individuals undergoing total knee arthroplasty (TKA). Methods: This research was designed as a cross-sectional and descriptive study. Fifty participants undergoing TKA were inpatients at a private hospital's Orthopedics and Traumatology Clinic were included in the study. The same anesthesia protocol (spinal anesthesia) and the same surgical technique were performed on all patients. In data collection, Visual Analogue Scale (VAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatic Amplification Scale (SAS), Toronto Alexithymia Scale (TAS), Eysenck Personality Questionnaire Revised-Abbreviated (EPQR-A), and Sociodemographic Data Form were used. Results:The mean age of the participants in the study was 64.80 ± 8.70 years, and 45 of the cases (90.0%) were women. Considering the Single Factor ANOVA Analysis, o...