Multimodal prediction of pain and functional outcomes 6 months following total knee replacement: a prospective cohort study.
Multimodal prediction of pain and functional outcomes 6 months following total knee replacement: a prospective cohort study.
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全膝关节置换术后6个月疼痛及功能结果的多模式预测：一项前瞻性队列研究
DOI：
10.1186/s12891-022-05239-3
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发表时间：
2022-03-29
影响因子：
2.3
通讯作者：
Haythornthwaite JA
中科院分区：
文献类型：
--
作者：
Edwards RR;Campbell C;Schreiber KL;Meints S;Lazaridou A;Martel MO;Cornelius M;Xu X;Jamison RN;Katz JN;Carriere J;Khanuja HP;Sterling RS;Smith MT;Haythornthwaite JA
膝骨关节炎（OA）是最常见且致残的持续性疼痛疾病之一，在全球范围内患病率和影响都在不断增加。在美国，膝骨关节炎患病率的上升伴随着全膝关节置换术（TKA）年手术率的增加，全膝关节置换术是晚期膝骨关节炎的一种手术治疗选择。虽然全膝关节置换术的效果通常较好，但术后疼痛和功能状态的发展轨迹差异很大；有相当一部分患者在全膝关节置换术后报告仍有疼痛且功能受损。多项研究已经确定了一系列导致全膝关节置换术后效果不佳的生物心理社会风险因素（例如，合并症、负面情绪、感觉敏感性），但很少有前瞻性研究系统地评估了众多因素的独特及综合影响。
这项多中心纵向队列研究调查了全膝关节置换术后6个月疼痛和功能结果的预测因素。通过病史、患者报告问卷、功能测试和定量感觉测试，对248名接受全膝关节置换术的患者在术前评估了广泛相关的生物心理社会预测因素，并随后检验了它们的预测能力。
大多数患者在6个月时疼痛轻微或无疼痛，与疼痛相关的损伤极小，但约30%的患者报告疼痛强度评级为3/10或更高。全膝关节置换术后6个月时报告疼痛更严重和功能障碍更明显，可由术前较高水平的负面情绪、既往疼痛病史、阿片类药物使用和睡眠障碍来预测。有趣的是，在多变量线性回归模型中，与韧性相关的“积极”心理社会特征水平较低（即随和性较低、社会支持较少）是不良结果最强、最一致的预测因素之一。疼痛调节的适应不良模式（例如，疼痛的时间总和升高）虽然不是强有力的独特预测因素，但与心理社会风险因素相互作用，使得疼痛和功能障碍最严重的全膝关节置换术患者表现出较低的韧性和增强的疼痛时间总和。
这项研究强调了在理解术后疼痛发展轨迹时考虑心理社会因素（特别是积极导向的韧性变量）和感觉模式以及它们之间相互作用的重要性。
Knee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence and impact around the globe. In the U.S., the rising prevalence of knee OA has been paralleled by an increase in annual rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, post-operative trajectories of pain and functional status vary substantially; a significant minority of patients report ongoing pain and impaired function following TKA. A number of studies have identified sets of biopsychosocial risk factors for poor post-TKA outcomes (e.g., comorbidities, negative affect, sensory sensitivity), but few prospective studies have systematically evaluated the unique and combined influence of a broad array of factors. This multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity. The majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related “positive” psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA patients with the most pain and dysfunction exhibited lower resilience and enhanced temporal summation of pain. This study underscores the importance of considering psychosocial (particularly positively-oriented resilience variables) and sensory profiles, as well as their interaction, in understanding post-surgical pain trajectories.
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DOI：
10.1097/01.blo.0000092983.12414.e9
发表时间：
2003-11-01
影响因子：
4.2
作者：
Brander, VA;Stulberg, SD;Houle, T
通讯作者：
Houle, T
影响因子：
2.3
作者：
Bedson, John;Croft, Peter R.
通讯作者：
Croft, Peter R.
影响因子：
4.8
作者：
Bastien, Celyne H.;Vallieres, Annie;Morin, Charles M.
通讯作者：
Morin, Charles M.
DOI：
10.1002/art.40752
发表时间：
2019-04
期刊：
Arthritis & rheumatology (Hoboken, N.J.)
影响因子：
--
作者：
Carlesso LC;Segal NA;Frey-Law L;Zhang Y;Na L;Nevitt M;Lewis CE;Neogi T
通讯作者：
Neogi T
影响因子：
4.2
作者：
Brander, Victoria;Gondek, Stephen;Stulberg, S. David
通讯作者：
Stulberg, S. David