Psychological determinants of problematic outcomes following Total Knee Arthroplasty
Psychological determinants of problematic outcomes following Total Knee Arthroplasty
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DOI：
10.1016/j.pain.2009.02.011
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发表时间：
2009-05-01
期刊：
影响因子：
7.4
通讯作者：
Dunbar, Michael
中科院分区：
文献类型：
--
作者：
Sullivan, Michael;Tanzer, Michael;Dunbar, Michael
本研究的主要目的是探讨疼痛相关的心理因素在预测全膝关节置换术（TKA）后疼痛和残疾中的作用。研究样本包括75名（46名女性，29名男性）计划接受TKA的膝关节骨关节炎患者。在手术前完成疼痛严重程度、疼痛灾难化、抑郁和疼痛相关的运动恐惧的测量。参与者在手术后6周完成了疼痛严重程度和自我报告残疾的测量。与以前的研究一致，横断面分析显示，术前疼痛严重程度，疼痛灾难化，抑郁症和疼痛相关的运动恐惧的措施之间存在显着的相关性。前瞻性分析显示，术前疼痛严重程度和疼痛灾难化是术后疼痛严重程度的唯一预测因子（6周随访）。在单变量分析中，疼痛相关的运动恐惧是术后功能困难的预测因子，但在控制术前合并症（例如背痛）时并非如此。这项研究的结果增加了越来越多的文献，强调心理变量在预测手术后健康结果中的预后价值。研究结果支持了这样的观点，即术后疼痛严重程度的心理决定因素不同于术后残疾的心理决定因素。研究结果表明，专门针对疼痛相关心理风险因素的干预措施可能会改善术后结果。(C)2009年国际疼痛研究协会。Elsevier B.V.出版，保留所有权利。
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. (C) 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.