High Resiliency Linked to Short-Term Patient Reported Outcomes and Return to Duty Following Arthroscopic Knee Surgery

Abstract

Introduction Resilience is a psychometric construct of a patient’s ability to recover from adversity and has been used to predict outcomes but its use in orthopedics has been limited. The purpose of this study was to examine the association between resilience and outcomes. Materials and Methods We performed a retrospective analysis of prospectively collected data of patient who underwent sports knee surgery at a single institution performed by 6 orthopedic surgeons from January 2017 to December 2017. We included active-duty patients with complete preoperative outcomes and a minimum of 6 month follow-up. All patients completed the Brief Resilience Scale (BRS), Veteran’s Rand-12 (VR-12), Patient-Reported Outcomes Measurement Information System 43 (PROMIS-43), International Knee Documentation Committee function score (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Patients were divided into low resilience (LR) and high resilience (HR) groups based on a score of less than 24 for low and greater than or equal to 24 according to BRS. Outcomes were then compared. Results We identified 50 active-duty patients who had complete preoperative and postoperative outcomes at a minimum of 6 months. Mean preoperative and postoperative BRS were significantly different (25.8 HR v 18.6 LR, p < 0.001). We found a difference in postop KOOS in pain, sports, and short form (pain 70.9 HR v 55.7 LR, p = 0.03; sports 50.3 HR v 32.2 LR, p = 0.03; short form (72.1 HR v 62.5 LR, p = 0.04). Similarly, there was a significant difference in postoperative IKDC score (58.0 HR v 44.0 LR, p = 0.03). Similarly we found significant differences in postoperative PROMIS-43 (anxiety 44.4 HR v 60.3 LR, p = 0.004; depression 41.6 HR v 58.1 LR, p = 0.004; fatigue 45.1 HR v 58.6 LR, p = 0.001; sleep 52.6 HR v 62.5 LR, p = 0.02; social participation 36.2 HR v 47.6 LR, p < 0.001). Postoperative VR-12 mental was also statistically different between the two groups (53.5 HR v 41.6 LR; p = 0.01). In addition, 2.3% of the HR group changed MOS as a result of their sports knee surgery compared to 22.2% of the LR group. Conclusions Active-military patients with high preoperative resilience appear to have significantly better early postoperative outcomes following sports knee surgery in terms of PROMIS-43, KOOS, and IKDC. There was also a lower rate of changing MOS secondary to sports knee surgery in patients with high resilience.

Impact of Patient Resilience on Outcomes of Open Brostrom-Gould Lateral Ligament Repair

“…Furthermore, high resilience groups have also been shown to have better early postoperative outcomes and return to duty in military personnel undergoing arthroscopic knee procedures. 31 Drayer et al found, in this previous study, a correlation between resilience and PROMIS PI of r = −0.19, significantly weaker than the correlation found in our study of r = −0.38. This difference could potentially be attributed to Drayer et al using a static version of the PROMIS instruments, which might not as accurately detect changes in pain levels when compared with the computerized adaptive PROMIS instruments used in our study and that of Coronado et al In this context, our results add to the growing evidence supporting the generalizability of resilience and its impact on the outcomes of surgical intervention across a wide variety of orthopaedic procedures.…”

“… 1 It has also been used in high-demand populations such as athletes and the active duty military population. 30 , 31 The population means of BRS scores for patients undergoing orthopaedic surgery are currently unknown. 5 …”

Impact of patient resilience on early recovery from rotator cuff repair

“…found that in military patients who undergo arthroscopic knee surgery, highly resilient patients had higher postoperative functional scores at six-month follow-up. 18 However, Chavez et al. found that highly resilient patients demonstrated no difference in knee functional scores from low- or normally resilient patients after arthroscopic knee surgery.…”

“…14–17 In both shoulder surgery and arthroscopy literature, patient resilience scores have been shown to correlate with postoperative patient-reported outcome measures. 18,19 Most surgeons recognize rotator cuff repair for its challenging and lengthy postoperative rehabilitation. 20–22 Therefore, we hypothesized that preoperative resilience would correlate with postoperative pain and functional recovery from rotator cuff repair.…”

Associating Outcomes After Hip Arthroscopy With Patient Resilience

“… 25 To date, a number of studies have demonstrated that patients’ mental health and other psychometric traits play a critical role in outcomes after various orthopaedic procedures. 6 , 7 , 19 , 24 , 28 , 33 …”