Background Patients’ psychological health may influence recovery and functional outcomes after total knee arthroplasty (TKA). Pain catastrophizing, known to be associated with poor function following TKA, encompasses rumination, magnification, and helplessness that patients feel toward their pain. Resilience, however, is an individual's ability to adapt to adversity and may be an important psychological construct that supersedes the relationship between pain catastrophizing and recovery. In this study we sought to identify whether pre-operative resilience is predictive of 3-month postoperative outcomes after adjusting for pain catastrophizing and other covariates. Methods Patients undergoing TKA between January 2019 and November 2019 were included in this longitudinal cohort study. Demographics and questionnaires [Brief Resilience Scale (BRS), Pain Catastrophizing Scale (PCS), Knee injury and Osteoarthritis Outcome Score, Junior (KOOS, JR.) and Patient-Reported Outcomes Measurement Information System Physical and Mental Health (PROMIS PH and MH, respectively)] were collected preoperatively and 3 months postoperatively. Multivariable regression was used to test associations of preoperative BRS with postoperative outcomes, adjusting for PCS and other patient-level sociodemographic and clinical characteristics. Results The study cohort included 117 patients with a median age of 67.0 years (Q1–Q3: 59.0–72.0). Fifty-three percent of patients were women and 70.1% were white. Unadjusted analyses identified an association between resilience and post-operative outcomes and the relationship persisted for physical function after adjusting for PCS and other covariates; in multivariable linear regression analyses, higher baseline resilience was positively associated with better postoperative knee function (β = 0.24, p = 0.019) and better general physical health (β = 0.24, p = 0.013) but not general mental health (β = 0.04, p = 0.738). Conclusions Our prospective cohort study suggests that resilience predicts postoperative knee function and general physical health in patients undergoing TKA. Exploring interventions that address preoperative mental health and resilience more specifically may improve self-reported physical function outcomes of patients undergoing TKA.
BackgroundPatients undergoing total knee arthroplasty (TKA) have psychological comorbidities that influence recovery and functional outcomes. Resilience is a psychological construct defined as an individual's ability to adapt to adversity. Pain catastrophizing encompasses rumination, magnification, and helplessness that patients feel toward their pain. Pain catastrophizing is associated with poor function following surgery. Studies assessing the influence of resilience on postoperative outcomes have shown inconsistent findings and have not accounted for the influence of pain catastrophizing. We sought to identify (1) whether baseline pain catastrophizing and resilience are predictive of postoperative knee function, general physical health, and general mental health three months after TKA and (2) whether baseline pain catastrophizing and resilience are associated with preoperative knee function, general physical health, and general mental health.MethodsPatients undergoing TKA between January 2019 and November 2019 were included in this longitudinal cohort study. Demographics and questionnaires [Brief Resilience Scale (BRS), Pain Catastrophizing Scale (PCS), Knee injury and Osteoarthritis Outcome Score, Junior (KOOS, JR.) and Patient-Reported Outcomes Measurement Information System Physical and Mental Health (PROMIS PH and MH, respectively)] were collected preoperatively and 3 months postoperatively. Multivariable regression was used to test associations of preoperative BRS and PCS with postoperative outcomes.ResultsThe study cohort included 117 patients with a median age of 67.0 years (Q1-Q3: 59.0-72.0). Fifty-three percent of patients were women and 70.1% were white. In multivariable linear regression analyses, baseline pain catastrophizing did not demonstrate a significant association with postoperative 3-month knee function, (β = -0.08, p = 0.543), general physical health (β = -0.11, p = 0.313), or general mental health (β = 0.01, p = 0.919). Baseline resilience positively associated with postoperative knee function (β = 0.24, p = 0.019) and general physical health (β = 0.24, p = 0.013).ConclusionsOur prospective analysis suggests that resilience predicts postoperative knee function and general physical health in patients undergoing TKA. Given the inconsistent findings in this area of research, future studies should continue to delineate preoperative constructs that impact patients following surgery. Exploring interventions targeting the preoperative mental health of patients undergoing TKA may improve outcomes in this cohort.
OBJECTIVES/SPECIFIC AIMS: The aim of the present study is to explore the relationships between resilience, pain catastrophizing, and functional outcomes in pre-and post-operative TKR patients. The primary outcome is the ability of the Brief Resilience Scale (BRS) to predict function using the Knee injury and Osteoarthritis Outcome Score Joint Replacement (KOOS, JR.) and overall health on the Patient-Reported Outcome Measurement Information System Global Health (PROMIS GH). METHODS/STUDY POPULATION: Recruited patients will provide informed consent during in-person office visits. At the pre-surgery intake appointment, patients will provide demographic information and complete baseline questionnaires assessing resilience, pain catastrophizing, knee stiffness, pain, and function, and impression of overall health. In-person or electronic follow-up assessments will be administered post-surgery at 6-week, 3-month, and 6-month appointments. RESULTS/ANTICIPATED RESULTS: We aim to recruit 150 patients for this study. We do not expect a difference in sociodemographic characteristics of the patient sample. P-values will be based on t-tests and correlations calculated by comparing only non-missing values. Each outcome measure will be examined at each time point and trajectories will be calculated to determine the change in each outcome over time. Using latent class growth modeling we will examine individual change over time for each outcome (BRS, PCS, PROMIS GH, and KOOS JR.), and the association of resilience and pain with change in function (KOOS, JR. total score) and overall health (PROMIS GH). DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, this is the only known study that will compare resilience, pain catastrophizing and longitudinal health outcomes in a single paradigm. Results will hopefully inform the design and implementation of future studies that will assess the impact of preoperative treatment of vulnerable patients. The ultimate goal is to improve functional recovery by using pre-identified psychological constructs as intervention points. Ideally, the same measures would be implemented, however, details of this plan will be established following completion of this study.
OBJECTIVES/GOALS: Patient beliefs and goals can facilitate discussion of recovery expectations, patient-provider collaboration and maximization of goal achievement. In this study, we sought to address an evidence gap and examine the association of preoperative self-assessment of goals with preoperative and 6-week knee function and gait speed among total knee arthroplasty (TKA) patients. METHODS/STUDY POPULATION: We conducted a secondary analysis of data from the VERITAS randomized, controlled trial conducted from 11/2016-03/2018 that included adults age ≥ 18 years with scheduled and completed unilateral TKA followed by post-surgical physical therapy. Patients rated their ability to perform various activities of daily living goals scaled from 0 (unable to perform) to 10 (full performance). Patients were categorized by pre-surgical (baseline) goal rating: low = 0-2, intermediate = 3-4, and high = 5-10. Outcomes including gait speed and the KOOS were assessed within 10 days prior to surgery and 6-weeks post-surgery. Descriptive statistics and outcomes were compared for patients by preoperative goal rating using Chi-square or Fisher’s exact tests and ANOVA or Kruskal-Wallis tests as appropriate. RESULTS/ANTICIPATED RESULTS: Of 288 patients (mean age 65±8; 62.5% women; 82% white), 102 had a low goal rating (GR), 86 intermediate, and 99 high. Patients with low GR preoperatively generally had lower baseline mean scores than intermediate and high GR patients, respectively, on the KOOS (33.9/35.6/39.8; p<0.001) and lower gait speed (m/s) compared to intermediate and high GR patients at baseline (0.9/1.1/1.0; p = 0.009). The low, intermediate, and high GR groups, respectively, showed no difference across mean KOOS scores (61.0/61.2/61.9; p = 0.63) or gait speed (m/s) (1.0/1.0/1.0, p = 0.33) at 6 weeks postoperative. DISCUSSION/SIGNIFICANCE OF IMPACT: In this study, adults who perceived greater difficulty with a pre-selected activity goal, exhibited lower function prior to TKA but showed no differences in function 6-weeks after surgery. Follow-up studies will describe the association between goal-setting preoperatively and patient goal attainment and satisfaction following surgery.
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