Effectiveness of psychological support in patients undergoing primary total hip or knee arthroplasty: a controlled cohort study

Abstract

BackgroundWe hypothesised that psychological support would have a significant improvement on the mental and physical recovery of patients undergoing primary total hip or knee arthroplasty.Materials and methods200 patients were consecutively alternately assigned (1:1) to receive routine care (control group) or, in addition, psychological support from a professional psychologist (experimental group). The psychological support was provided at the pre-operative visit, during the hospitalisation period and at the rehabilitation centre.ResultsUpon discharge, based on the ‘Hospital Anxiety and Depression Scale, a state of anxiety was observed in 12.8 % and 78.9 % of the patients in the experimental and in the control group, respectively (p < 0.0001). A state of depression was observed in 12.8 % and 73.7 % of the patients in the experimental and in the control group, respectively (p < 0.0001). With regard to the ‘Physical Component Scale’ of the SF-36 questionnaire, a similar temporal trend of values was observed in the two study groups, significantly increasing over time in both groups, taking into consideration both the joint population and the two hip and knee populations separately (p < 0.0001). With regard to the ‘Mental Component Scale’ of the SF-36 questionnaire, in both the joint population and the two hip and knee populations separately, an exact opposite temporal trend was observed in the experimental group compared to the control group (p < 0.0001), with generally higher scores in the experimental group (p < 0.0001). In patients with hip arthroplasty, the average time to reach the physiotherapy objective (i.e., the patient ability to walk 50 metres independently and to climb 10 steps) was 6.7 ± 1.8 days (range 4–12) in the experimental group and 7.9 ± 2.2 days (range 0–13) in the control group (p = 0.0015).ConclusionsIn summary, there was a lower incidence of anxiety and depression and better mental well-being in the group of patients who received the psychological support. Within the hip arthroplasty group, the patients who received the psychological support reached the physiotherapy objective 1.2 days earlier than the patients in the control group (p = 0.0015).Level of evidenceLevel 3, Non-randomized prospective controlled cohort.

Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta‐analysis

“…Two studies, one utilizing guided imagery and the other emotional counselling, measured quality of life using the Short Form (36) Health Questionnaire (SF‐36), assessing physical and mental components of this outcome at both subacute and longer term time‐points. Both studies independently reported statistically significant improvements in physical components of quality of life at both time points in the intervention groups.…”

“…Both studies independently reported statistically significant improvements in physical components of quality of life at both time points in the intervention groups. Only one study found significant improvements in the mental component of quality of life.…”

Outpatient Total Joint Arthroplasty

“…Even patients without diagnosed anxiety disorder are often concerned about postoperative pain, being able to care for themselves, and mobility, especially if they live alone. A study of the effect of psychological support on patients indicated for primary TJA published by Tristano et al demonstrated that patients who received psychological support had a lower incidence of anxiety and depression than those who did not [10]. Additionally, THA patients who received psychological support reached their physical therapy goals 1.2 days sooner than those who did not receive any psychological support [10].…”

“…A study of the effect of psychological support on patients indicated for primary TJA published by Tristano et al demonstrated that patients who received psychological support had a lower incidence of anxiety and depression than those who did not [10]. Additionally, THA patients who received psychological support reached their physical therapy goals 1.2 days sooner than those who did not receive any psychological support [10]. Patients being considered for OTJA, who are required to manage their own pain control, physical therapy, and self-care, are even more likely to benefit from a strong psychological support.…”

“…In their retrospective study of 110 patients who underwent OTJA at a center accustomed to rapid rehab protocols and minimally invasive techniques, Berger et al found that inadequate pain control and completing surgery late in the day were most strongly associated with preventing same-day discharge [10]. They found no differences in BMI, average age, body weight, or medical comorbidities between patients who underwent OTJA and those who required inpatient stay [13].…”