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Reductions in Perceived Injustice are Associated with Reductions in Disability and Depressive Symptoms after Total Knee Arthroplasty

Yakobov, Esther PhD Candidate*; Scott, Whitney PhD; Stanish, William MD; Tanzer, Michael MD§; Dunbar, Michael MD; Richardson, Glen MD; Sullivan, Michael PhD*

doi: 10.1097/AJP.0000000000000551
Original Article: PDF Only

Introduction: Perceptions of injustice have been associated with problematic recovery outcomes in individuals suffering from a wide range of debilitating pain conditions. It has been suggested that, in patients with chronic pain, perceptions of injustice might arise in response to experiences characterized by illness-related pain severity, depressive symptoms, and disability. If symptoms severity and disability are important contributors to perceived injustice, it follows that interventions that yield reductions in symptom severity and disability should also contribute to reductions in perceptions of injustice. The present study examined the relative contributions of post-surgical reductions in pain severity, depressive symptoms and disability to the prediction of reductions in perceptions of injustice.

Methods: The study sample consisted of 110 individuals (69 women and 41 men) with osteoarthritis of the knee scheduled for total knee arthroplasty (TKA). Patients completed measures of perceived injustice, depressive symptoms, pain and disability at their pre-surgical evaluation, and at one year follow up.

Results: The results revealed that reductions in depressive symptoms and disability, but not pain severity, were correlated with reductions in perceived injustice. Regression analyses revealed that reductions in disability and reductions in depressive symptoms contributed modest but significant unique variance to the prediction of post-surgical reductions in perceived injustice.

Discussion: The present findings are consistent with current conceptualizations of injustice appraisals that propose a central role for symptom severity and disability as determinants of perceptions of injustice in patients suffering from persistent pain. The results suggest that the inclusion of psychosocial interventions that target depressive symptoms and perceived injustice might augment the impact of rehabilitation programs made available for individuals recovering from TKA.

*Department of Psychology, McGill University

Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK

Department of Surgery, Dalhousie University

§Department of Surgery, McGill University

The authors have no financial interests associated with the findings of this research. This research was supported by funds from the Canadian Institutes for Health Research and the Canada Research Chairs Program.

The authors declare no conflict of interest.

Reprints: Michael Sullivan, PhD, Department of Psychology, McGill University, 1205 Doctor Penfield Avenue, Montreal, QC H3A 1B1 (e-mail:

Received March 14, 2017

Accepted August 15, 2017

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