Effect of psychopathology on patient-perceived outcomes of total knee arthroplasty within an indigent population.
Effect of psychopathology on patient-perceived outcomes of total knee arthroplasty within an indigent population.
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DOI：
10.2106/jbjs.k.00888
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发表时间：
2012-06-20
期刊：
影响因子：
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通讯作者：
Bucholz, Robert
中科院分区：
文献类型：
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作者：
Ellis, Henry B;Howard, Krista J;Bucholz, Robert
背景：除手术技术和植入物外，其他因素也会影响全膝关节置换术后的患者结局。本研究的目的是分析精神病理学对贫困人口全膝关节置换术后的改善率的影响。方法：154例因关节炎接受初次全膝关节置换术的连续贫困患者入选并可进行随访。根据患者健康问卷评估的躯体化、抑郁和/或惊恐或焦虑障碍的存在，将患者归类为精神病理学患者。在术前和术后1年完成结局指标。单变量分析，控制性别和年龄，被用来比较的改善率在那些没有psychopathology.RESULTS：五十四例患者（35%）被诊断为至少有一个轴-I心理障碍的患者表现出精神病理学与率。精神病理学组在基线和术后1年的心理健康简表-36总分均显著较低（均为p < 0.001）。精神病理学组在疼痛残疾问卷调查中的基线感知残疾水平显著较高（p < 0.001），在西安大略和麦克马斯特大学骨关节炎指数中的评分较低（p = 0.004）;然而，两组在这两个量表上的改善没有显著差异（p > 0.05）。在基线和一年随访评估时，两组之间的膝关节协会评分存在显著差异（分别为p = 0.003和p = 0.001），但两个对照组之间的总改善率无显著差异（p > 0.05）结论：不仅精神病理学在贫困人口中很普遍，但精神病理学可能导致全膝关节置换术后一年患者感知结果评分较低。尽管精神病理学患者的结局评分可能更差，但我们的研究表明，这些患者仍然受益，功能改善程度相同。
BACKGROUND: Factors other than surgical technique and implants impact patient outcomes following a total knee arthroplasty. The purpose of this study was to analyze the effects of psychopathology on the rate of improvement following total knee arthroplasty in an indigent population.METHODS: One hundred and fifty-four consecutive indigent patients undergoing a primary total knee arthroplasty for arthritis were enrolled and available for follow-up. Patients were classified as having psychopathology on the basis of the presence of somatization, depression, and/or a panic or anxiety disorder as assessed with the Patient Health Questionnaire. Outcome measures were completed preoperatively and one year postoperatively. Univariate analyses, controlled for sex and age, were used to compare the rates of improvement in patients who exhibited psychopathology with the rates in those without psychopathology.RESULTS: Fifty-four patients (35%) were diagnosed with at least one Axis-I psychological disorder. The psychopathology group showed significantly lower Short Form-36 mental component summary scores both at baseline and one year postoperatively (p < 0.001 for both). The psychopathology group also reported significantly higher levels of perceived disability at baseline on the Pain Disability Questionnaire (p < 0.001) and worse scores on the Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.004); however, the improvement on both of these scales did not differ significantly between the two groups (p > 0.05). The Knee Society Score differed significantly between the two groups at both baseline and the one-year follow-up evaluation (p = 0.003 and p = 0.001, respectively), but there was no significant difference in the total rate of improvement between the two comparison groups (p > 0.05).CONCLUSIONS: Not only is there a high prevalence of psychopathology in the indigent population, but psychopathology may result in lower patient-perceived outcome scores at one year after a total knee arthroplasty. Even though outcome scores may be worse for patients with psychopathology, our study showed that these patients still benefit, with the same degree of improvement in function.