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Psychological determinants of problematic outcomes following Total Knee Arthroplasty

Sullivan, Michaela,*; Tanzer, Michaelb; Stanish, Williamc; Fallaha, Micheld; Keefe, Francis J.e; Simmonds, Maureenf; Dunbar, Michaelc

doi: 10.1016/j.pain.2009.02.011
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ABSTRACT The primary objective of the present study was to examine the role of pain-related psychological factors in predicting pain and disability following Total Knee Arthroplasty (TKA). The study sample consisted of 75 (46 women, 29 men) individuals with osteoarthritis of the knee who were scheduled for TKA. Measures of pain severity, pain catastrophizing, depression, and pain-related fears of movement were completed prior to surgery. Participants completed measures of pain severity and self-reported disability 6 weeks following surgery. Consistent with previous research, cross-sectional analyses revealed significant correlations among measures of pre-surgical pain severity, pain catastrophizing, depression and pain-related fears of movement. Prospective analyses revealed that pre-surgical pain severity and pain catastrophizing were unique predictors of post-surgical pain severity (6-week follow-up). Pain-related fears of movement were predictors of post-surgical functional difficulties in univariate analyses, but not when controlling for pre-surgical co-morbidities (e.g. back pain). The results of this study add to a growing literature highlighting the prognostic value of psychological variables in the prediction of post-surgical health outcomes. The results support the view that the psychological determinants of post-surgical pain severity differ from the psychological determinants of post-surgical disability. The results suggest that interventions designed to specifically target pain-related psychological risk factors might improve post-surgical outcomes.

aDepartment of Psychology, McGill University, 1205 Docteur Penfield, Montréal, Que., Canada H3A 1B1

bDepartment of Surgery, McGill University, Montréal, Qc, Canada

cDepartment of Surgery, Dalhousie University, Halifax, NS B3H 3A7, Canada

dDepartment of Surgery, Université de Montréal, Montréal, Qc H1T 2M4, Canada

eDuke Pain Prevention and Treatment Research Program, Duke University, Durham, NC 27710, USA

fSchool of Physical and Occupational Therapy, McGill University, Montréal, Qc H3G 1Y5, Canada

*Corresponding author. Tel.: +1 514 398 5677; fax: +1 514 343 4896.

E-mail address:michael.sullivan@mcgill.ca

ARTICLE INFO

Article history:

Received July 30, 2008

Received in revised form January 6, 2009

Accepted February 17, 2009.

© 2009 Lippincott Williams & Wilkins, Inc.
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