Psychological Factors Affecting Rehabilitation and Outcomes Following Elective Orthopaedic Surgery

Flanigan, David C.; Everhart, Joshua S.; Glassman, Andrew H.

doi:10.5435/jaaos-d-14-00225

Cited by 112 publications

(97 citation statements)

References 39 publications

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“…27 However, it is possible that our results are not generalizable to all patients with ACL injury, particularly if they were not physically active before injury. There may be other factors, 42 including general mental health, not measured in our study that could also impact on satisfaction. In addition, it is possible that poor surgery or poor objective outcome could negatively influence patients' satisfaction after ACL reconstruction.…”

Section: Limitationsmentioning

confidence: 95%

Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity

Ardern

Österberg

Sonesson

et al. 2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: To assess whether patient-reported outcomes (psychological factors, appraisals of knee function, and physical activity participation) were associated with satisfaction with knee function after anterior cruciate ligament (ACL) reconstruction. Methods: Participants who were aged 18 to 45 years and a minimum 12 months post primary ACL reconstruction completed a questionnaire battery evaluating knee self-efficacy, knee-related quality of life, self-reported function, and physical activity participation. Participants responses to the question "If you were to spend the rest of your life with your knee just the way it has been in the last week, would you feel.... (7-point ordinal scale; 1 = happy, 7 = unhappy)" were categorized as satisfied, mostly satisfied, or dissatisfied and used as the primary outcome. Ordinal regression was used to examine associations between independent variables and the primary outcome. Results: A total of 177 participants were included at an average of 3 years after primary ACL reconstruction. At follow-up, 44% reported they would be satisfied, 28% mostly satisfied, and 28% dissatisfied with the outcome of ACL reconstruction. There were significant differences in psychological responses and appraisal of knee function between the 3 groups (P = .001), and significantly more people in the satisfied group had returned to their preinjury activity (58%) than in the mostly satisfied (28%) and dissatisfied (26%) groups (P = .001). Multivariable analysis demonstrated that the odds of being satisfied increased by a factor of 3 with higher self-efficacy, greater knee-related quality of life, and returning to the preinjury activity. Conclusions: People who had returned to their preinjury physical activity and who reported higher knee-related self-efficacy and quality of life were more likely to be satisfied with the outcome of ACL reconstruction

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Section: Limitationsmentioning

confidence: 95%

Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity

Ardern

Österberg

Sonesson

et al. 2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Instead, most of the focus has been on other psychological factors, such as fear of reinjury, athletic identity, self-efficacy, and locus of control, which are not true clinical diagnoses[2,10,14,15,20,22,25,28]. Although psychological impediments may interfere with ACLR rehabilitation, they rarely have implications outside of sport[2,16,18].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, depression is associated with significant general comorbidities and is the major risk factor for suicide in ACLR patient age groups[31-36]. While past ACLR literature has called for patients reporting depressive symptoms to seek care from a sports psychologist[2], recent studies have advocated for depression screening tools and referral to mental health professionals, where therapy and pharmacologic treatment may be necessary[15,26]. …”

Section: Introductionmentioning

confidence: 99%

Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstruction

Wu¹,

Liu²,

Dines³

et al. 2016

WJO

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While most patients with an anterior cruciate ligament (ACL) injury indicate satisfaction with surgical intervention, a significant proportion still do not return to pre-injury level of function or sport. Psychiatric comorbidities, such as depression, have recently been associated with poor clinical outcomes after ACL reconstruction (ACLR). To date, no article has yet examined how depression affects ACLR outcomes and how potential screening and intervention for psychological distress may affect postoperative activity level. The purpose of this review is to delineate potential relationships between depression and ACLR outcome, discuss clinical implications and identify future directions for research.

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“…5,18,20,21 A recent review by Christino et al 14 illustrated how self-efficacy can have as equivalent an impact as knee stability in return to sport after ACL reconstruction. Defined as “the belief in one’s ability to succeed…persevere through challenges, and maintain commitment to a cause,” 14 an athlete’s degree of self-efficacy dictates their perceived quality of life and overall general wellness.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Assessment of Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement

Tjong

Cogan

Riederman

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Hip arthroscopy for femoroacetabular impingement (FAI) is known to produce excellent outcomes, yet some patients do not return to their preinjury level of sport participation. Much literature on return to sport has revolved around anterior cruciate ligament reconstruction and even shoulder instability, but none to date have used qualitative, semistructured patient interviews on patients with hip labral tears.Purpose:To understand the factors influencing the decision to return to sport after arthroscopic hip surgery for FAI.Study Design:Case series; Level of evidence, 4.Methods:An experienced interviewer conducted qualitative, semistructured interviews of patients aged 18 to 60 years who had arthroscopic hip surgery for FAI. All had preinjury participation in sport and a minimum 2-year follow-up with no revision surgery. Qualitative analysis was then performed to derive codes, categories, and themes. An assessment of preinjury and current sports participation by type, level of competition, and frequency along with patient-reported hip function was also obtained. In addition, current modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), Hip Outcome Score–sports-specific subscale (HOS-SSS), and a coping mechanism evaluation (Brief COPE) were also recorded.Results:A total of 23 patients were interviewed to reveal the overarching themes of internal motivation, external encouragement, and resetting expectations as the predominant factors influencing a patient’s decision to return to preinjury sport. Subjective outcome measurements (mHHS, iHOT-12, patient satisfaction) showed significant differences between patients who did and did not return to sport. Interestingly, the adaptive and maladaptive coping mechanisms matched and supported our themes in those patients who described fear and self-motivation as defining features influencing their cessation of or return to play, respectively.Conclusion:Self-motivation, aging, pain, encouragement from others, and adapting to physical limitations can largely affect a patient’s decision to return to sport after arthroscopic hip surgery for FAI. Innate coping mechanisms may also help to predict the course of and subsequently aid in a patient’s postoperative recovery.

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Psychological Factors Affecting Rehabilitation and Outcomes Following Elective Orthopaedic Surgery

Cited by 112 publications

References 39 publications

Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity

Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity

Depression and psychiatric disease associated with outcomes after anterior cruciate ligament reconstruction

A Qualitative Assessment of Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement

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