Resilience and pain catastrophizing among patients with total knee arthroplasty: a cohort study to examine psychological constructs as predictors of post-operative outcomes

Vesta C Nwankwo, William A Jiranek, Cynthia L Green, Kelli D Allen, Steven Z George, Janet Prvu Bettger, Vesta C Nwankwo, William A Jiranek, Cynthia L Green, Kelli D Allen, Steven Z George, Janet Prvu Bettger

Abstract

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.

Keywords: Arthroplasty knee resilience pain catastrophizing function physical mental health outcomes.

Conflict of interest statement

VCN was partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002553. This manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors have no competing interests. WAJ is a consultant and has received royalties for hip and knee products from Depuy Synthes, A Johnson & Johnson Company for work not related to this submitted article. WAJ has stock and/or stock options in Biomech Holdings LLC, a company not related to this research. KDA, SZG, JPG have received funding from the National Institutes of Health and Patient Centered Outcomes Research Institute for research not directly related to the submitted article. JPG has received funding from the Department of Veterans Affairs for research not directly related to the submitted article. KDA has received funding from the Department of Defense and the Department of Veterans Affairs for research not directly related to the submitted article. SZG has received payments from Rehab Essentials, Inc. that is not related to the submitted article. CLG, SZG, KDA, JPG have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Figures

Fig. 1
Fig. 1
Flow diagram of patients in study

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