Effects of psychological predictors on hospital discharge duration after total knee arthroplasty

Abstract

This study aims to evaluate the effects of somatosensorial amplification, kinesiofobia, health anxiety and depression on hospital discharge durations after knee arthroplasty. 193 patients with total knee arthroplasty were included in the study. Patients were divided into two groups due to discharge durations. Group 1 included patients who were discharged in 1 to 4 days; Group 2 included patients who were discharged in 5 to 7 days. Functional outcome was measured with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For psychiatric evalution; a Sociodemographic form, Somatosensory Amplification Scale, Health Anxiety Inventory, Hospital Anxiety and Depression Scale and The Tampa Scale of Kinesiophobia were used. There wasn’t any significant difference in terms of WOMAC scores between Group 1 and 2 postoperatively. (Pain; p=0.666, Stiffness; p=0.349, Functionality; p= 0.145). There was a significant difference in terms of Health Anxiety Inventory and Somatosensorial Amplification scores between Group 1 and 2 (p=0.006; p=0.031). In correlation analysis Somatosensorial Amplification score was positively correlated with hospital discharge duration. There was a significant difference in terms of Tampa kinesiophobia scores between Group 1 and 2 (p<0.001). In correlation analysis there was a positive correlation between Tampa kinesiaphobia score and hospital discharge durations (r: 0.618; p: 0.000). Multiple regression analysis indicated that Tampa Scale of Kinesisophobia was the major predictive factor for hospital discharge durations. Health anxiety, Somatosensory amplification and mostly Kinesiophobia were related with longer hospitalization periods due to worse functional outcomes after total knee arthroplasty. Maladaptive psychological strategies about false bodily sensations lead a worse outcome for knee arthroplasty patients. Therapeutic programs aiming false cognitive factors would result with improved functional recovery.

Keywords

• somatosensory amplification
• kinesiophobia
• health anxiety
• total knee arthroplasty
• WOMAC

References

1. 1. Masaracchio M, Hanney WJ, Liu X, Kolber M, Kirker K. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS One 2017;12(6):e0178295.
2. 2. Dailiana ZH, Papakostidou I, Varitimidis S, Liaropoulos L, Zintzaras E, Karachalios T, et al. Patient reported quality of life after primary major joint arthroplasty: a prospective comparison of hip and knee arthroplasty. BMC Musculoskelet Disord 2015; 16:366.
3. 3. Kremers HM, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of Total Hip and Knee Replacement in the United States. Bone Joint Surg Am 2015;97:1386-97.
4. 4. Weinstein AM, Rome BN, Reichmann WM, Collins JE, Burbine SA, Thornhill TS, et al. Estimating the burden of total knee replacement in the United States. Bone Joint Surg Am. 2013 Mar 6;95(5):385-92.
5. 5. Ceyhan E, Gursoy S, Akkaya M, Ugurlu M, Koksal I, Bozkurt M. Toward the Turkish National Registry System: A Prevalence Study of Total Knee Arthroplasty in Turkey. The Journal of Arthroplasty 2016;31:1878-84.
6. 6. Barsoum WK, Murray TG, Klika AK, Green K, Miniaci SL, Wells BJ. Predicting patient discharge disposition after total joint arthroplasty in the United States. J Arthroplasty 2010;25: 885–92.
7. 7. Konopka JF, Hansen VJ, Rubash HE, Freiberg AA. Risk Assessmen t Tools Used to Predict Outcomes of Total Hip and Total Knee Arthroplasty. Orthop Clin N Am 2015;46: 351–62.
8. 8. Bugada D, Allegri M, Gemma M, Ambrosoli AL, Gazzerro G, Chiumiento F, et al. Effects of anaesthesia and analgesia on long-term outcome after total knee replacement: A prospective, observational, multicentre study. Eur J Anaesthesiol 2017;34(10):665-72.

9. 9. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012;2:e000435.
10. 10. Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, et al. A cross-sectional survey on prevalence and risk factors for persistent postsurgical pain 1 year after total hip and knee replacement. Reg Anesth Pain Med 2012;37:415-22.
11. 11. Kim DH, Pearson-Chauhan KM, McCarthy RJ, Buvanendran A. Predictive Factors for Developing Chronic Pain After Total Knee Arthroplasty. The Journal of Arthroplasty 2018;33: 3372-8.
12. 12. Franklin PD, Karbassi JA, Li W, Yang W, Ayers DC. Reduction in narcotic use after primary total knee arthroplasty and association with patient pain relief and satisfaction. J Arthroplasty 2010;25:12e6.
13. 13. Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study. PLoS One 2013;8:e73917.
14. 14. Köteles F, Simor P. Modern Health Worries, Somatosensory Amplification and Subjective Symptoms: A Longitudinal Study Int J Behav Med 2013;20:38–41.
15. 15. Barsky AJ, Orav EJ, Ahern DK, Rogers MP, Gruen SD, Liang MH. Somatic style and symptom reporting in rheumatoid arthritis. Psychosomatics 1999;40:396–403.
16. 16. Ak I, Sayar K, Yontem T. Alexithymia, somatosensory amplification and counterdependency in patients with chronic pain. The Pain Clinic. 2004;16: 43–51.
17. 17. Güney-Deniz H, Kınıklı GI, Caglar O, Atilla B, Yuksel I. Does kinesiophobia affect the early functional outcomes following total knee arthroplasty? Physiotherapy Theory and Practice 2017;33:448–53.
18. 18. Barsky AJ, Goodson JC, Lane RS, Cleary PD. The amplification of somatic symptoms. Psychosom Med 1988;50(5):510–9.
19. 19. Doering BK, Szécsi J, Bárdos G, Köteles F. Somatosensory Amplification Is a Predictor of Self-Reported Side Effects in the Treatment of Primary Hypertension: a Pilot Study. Int J Behav Med 2016;23: 327–32.
20. 20. Korkmaz H, Korkmaz S, Yildiz S, Gundogan B, Murad Atmaca M. Determination of health anxiety, anxiety, and somatosensory amplification levels in individuals with normal coronary angiography. Psychiatry Research 2017;252: 114–7.
21. 21. Le Borgne M, Boudoukha AH, Petit A, Roquelaure Y. Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain? Scand J Pain 2017;17(1):309-15.
22. 22. Köteles F, Doering BK. The many faces of somatosensory amplification: the relative contribution of body awareness, symptom labeling, and anxiety. J Health Psychol 2016;21(12):2903-11.
23. 23. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;15:1833–40
24. 24. Barsky A, Wyshak G, Klerman G. The somatosensory amplification scale and its relationship to hypochondriasis. J Psychiatr Res 1990;24:323–34.
25. 25. Gulec H, Sayar K, Gulec MY. Bedensel Duyumları Abartma Olcegi Turkce Formunun Gecerlik ve Guvenirligi. Dusunen Adam 2007;20(1):16-24.
26. 26. Salkovskis PM, Rimes KA, Warwick HM, Clark DM. The health anxiety inventory: development and validation of scales for the measurementof health anxiety and hypochondriasis. Psychological Medicine 2002;32: 843–85.
27. 27. Aydemir O, Kirpinar I, Sati T, Uykur B, Cengisiz C. Archives of Neuropsychiatry 2013;50(4):325-31.
28. 28. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983;67: 361–70.
29. 29. Aydemir O, Guvenir T, Kuey L, Kultur S. Hastane Anksiyete Depresyon Ölçeği Türkçe Formunun geçerliliği ve güvenilirliği. Türk Psikiyatri Derg 1987;8:280-7.
30. 30. French DJ, France CR, Vigneau F, French JA, Evans RT. Fear of movement/(re)injury in chronic pain: A psychometric assessment of the original English version of the Tampa scale for kinesiophobia (TSK). Pain 2007;127(1-2):42-51.
31. 31. Yilmaz OT, Yakut Y, Uygur F, Ulug N. (2011). Tampa Kinezyofobi Ölçeği’nin Türkçe versiyonu ve test-tekrar test güvenirliği. Fizyoter Rehabil 2011;22(1), 44-9.
32. 32. Alattas SA, Smith T, Bhatti M, Wilson-Nunn D, Donell S. Greater pre-operative anxiety, pain and poorer function predict a worse outcome of a total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25: 3403-10.
33. 33. Hanusch BC, O'Connor DB, Ions P, Scott A, Gregg PJ. Effects of psychological distress and perceptions of illness on recovery from total knee replacement. Bone Joint J 2014;96-B(2):210-6.
34. 34. Aksoy MS, Bozkurt M, Sayıt E, Unlu S, Karadag H. Does spinal anesthesia increase the pain and anxiety after total knee arthroplasty? A randomized prospective study. Joint Dis Rel Surgery 2013;24(1):30-2.
35. 35. Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res 2007; 16:85-95.
36. 36. Ucar M, Sarp U, Karaaslan O, Gul AI, Tanik N, Arik HO. Health anxiety and depression in patients with fibromyalgia syndrome. Journal of International Medical Research 2015; 43(5) 679-85.
37. 37. Seto H, Nakao M. Relationships between catastrophic thought, bodily sensations and physical symptoms. BioPsychoSocial Medicine 2017; 11:28.
38. 38. Yılmaz B, Komur B, Aktas E, Sonnur Yılmaz F, Copuroglu C, Ozcan M, Cıftdemir M, Copuroğlu. Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression. Open Orthop J 2015;23(9):530-5.
39. 39. Nakao M, Barsky AJ. Clinical application of somatosensory amplification in psychosomatic medicine. BioPsychoSocial Medicine 2007;1(17): 1–7.
40. 40. Nakao M, Barsky AJ, Nishikitani M, Yano E, Murata K. Somatosensory amplification and its relationship to somatosensory, auditory and visual evoked and event-related potentials (P300). Neuroscience Letters 2007;415(2): 185–9.
41. 41. Köteles F, Witthöft M. Somatosensory amplification – An old construct from a new perspective Journal of Psychosomatic Research 2017;101: 1–9.
42. 42. Kosturek A, Gregory RJ, Sousou AJ, Trief P. Alexithymia and somatic amplification in chronic pain. Psychosomatics 1998;39(5):399-404.
43. 43. Hagiwara Y, Yabe Y, Yamada H, Watanabe T, Kanazawa K, Koide M, et al. Effects of a wearable type lumbosacral support for low back pain among hospital workers: A randomized controlled trial. J Occup Health. 2017;28;59(2):201-9.
44. 44. Vlaeyen JW, Linton SJ. Fear- avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000; 85: 317-32.
45. 45. Panchout FD, Metivier JC, Fouquet B. Kinesiophobia negatively influences recovery of joint function following total knee arthroplasty Eur J Phys Rehabil Med 2015; 51:1561.
46. 46. Monticone M, Ferrante S, Rocca B, Salvaderi S, Fiorentini R, Restelli M, et al. Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2013;94: 231–9.
47. 47. Brown ML, Plate JF, Von Thaer S, Fino NF, Smith BP, Seyler TM, Lang JE. Decreased range of motion after total knee arthroplasty is predicted by the Tampa Scale of Kinesiophobia. Journal of Arthroplasty 2015;31: 793–7.