Postoperatif Ağrıda Psikolojik İyi Oluş: Bir Korelasyon Çalışması
Year 2023,
Volume: 8 Issue: 1, 68 - 79, 01.04.2023
Esra Makal Orğan
,
Sacide Yıldızeli Topçu
Abstract
Amaç: Bu araştırma, hastaların postoperatif ağrılarının psikolojik iyi oluşlarındaki rolünü belirlemeyi amaçlamaktadır.
Gereç ve Yöntem: Bu korelasyonel araştırma, cerrahi girişim uygulanan 63 gönüllü hasta ile yapıldı.
Bulgular: Psikolojik iyi oluş ile ameliyat sonrası ağrı düzeyi ve ayrıca hastaların yaşı arasında negatif bir ilişki vardı.
Sonuç ve öneriler: Artan ağrı şiddeti psikolojik iyi oluşun azalmasına neden olmuştur. Psikolojik iyi oluşun azalması hastaların kendi tedavi ve bakımlarına katılımını bozarak iyileşme sürecini olumsuz etkileyebilir. Hemşireler, ameliyat öncesi iyi psikolojik hazırlık ve ameliyat sonrası etkili ağrı kontrolü yoluyla hastaların psikolojik iyilik hallerini korumalarına yardımcı olabilir.
References
- 1- Málek, J., Ševčík, P., Bejšovec, D., Fricová J., Gabrhelík, T., … Vojtíšková, M. (2017).
Postoperative pain management (3rd ed.). Mladá fronta. https://management.ind.in/forum/attachments/f2/39049d1586398178-postoperative-pain-postoperative-pain.pdf Accessed 16 July 2021
- 2- Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., …Wu, C. L.(2016) . Guidelines on the management of postoperative pain. The Journal of Pain, 17(2), 131-157. doi: 10.1016/j.jpain.2015.12.008.
- 3- Pinto, A., Faiz, O., Davis, R., Almoudaris, A., & Vincent, C. (2016). Surgical complications and their impact on patients’ psychosocial well-being: A systematic review and meta-analysis. BMJ Open, 6(2), 1-23. doi:10.1136/bmjopen-2014-007224
- 4- Guimaraes-Pereira, L., Valdoleiros, I., Reis, P., & Abelha, F. (2016). Evaluating persistent postoperative pain in one tertiary hospital: Incidence, quality of life, associated factors, and treatment. Anesth Pain Med, 6(2), e36461. https://doi.org/10.5812/aapm.36461
- 5- Peng, F., Peng, T., Yang, Q., Liu, M., Chen, G., & Wang, M. (2020). Preoperative communication with anesthetists via anesthesia service platform (ASP) helps alleviate patients’ preoperative anxiety. Scientific Reports, 10(1), 1-8. https://doi.org/10.1038/s41598-020-74697-3
- 6- Querichelli, A.F.A., Santos, B.D.R., Spessoto, L.C.F., & Facio, F. (2020). Does psychological preparation improve pretreatment anxiety in patients with prostate cancer?. Revista da Associação Médica Brasileira, 66, 390-391. https://doi.org/10.1590/1806-9282.66.4.390
- 7- Dunn, L.K., Durieux, M.E., Fernández, L.G., Tsang, S., Smith-Straesser, E.E., Jhaveri H.F., … Naik, B.I. (2018). Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery. J Neurosurg Spine., 28(1), 119-126. https://doi.org/10.3171/2017.5.SPINE1734
- 8- Weinrib, A.Z., Azam, M.A., Birnie, K.A., Burns, L.C., Clarke, H., & Katz, J. (2017). The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. British Journal Of Pain, 11(4), 169-177. https://doi.org/10.1177%2F2049463717720636
- 9- Michaelides, A., & Zis, P. (2019). Depression, anxiety and acute pain: links and management challenges. Postgraduate Medicine, 131(7), 438-444. https://doi.org/10.1080/00325481.2019.1663705
- 10- Johnson, J.E. (2020). Psychological interventions and coping with surgery. In: Taylor SE, Singer JE, Baum A, eds. Handbook of Psychology and Health (Volume IV) (s. 167-187) Routledge.
- 11- Khalil, H., Shajrawi, A., Dweik, G., Zaghmouri, A., & Henker, R. (2020). The impact of preoperative pain-related psychological factors on pain intensity post-surgery in Jordan. Journal of Health Psychology, 1359105320937067. https://doi.org/10.1177%2F1359105320937067
12- Hernandez, R., Bassett, S.M., Boughton, S.W., Schuette, S.A., Shiu, E.W., & Moskowitz, J.T., (2018). Psychological well-being and physical health: Associations, mechanisms, and future directions. Emotion Review, 10(1), 18-29. https://doi.org/10.1177%2F1754073917697824
- 13- Medvedev, O.N., & Landhuis, C.E. (2018). Exploring constructs of well-being, happiness and quality of life. PeerJ, 6, e4903. https://doi.org/10.7717/peerj.4903
- 14- World Health Organization. Promoting mental health: concepts, emerging evidence, practice: a report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne, 2005. Accessed July 16, 2021.
https://www.who.int/mental_health/evidence/en/promoting_mhh.pdf
- 15- Schotanus-Dijkstra, M., Drossaert, C. H., Pieterse, M. E., Boon, B., Walburg, J. A., & Bohlmeijer, E. T. (2017). An early intervention to promote well-being and flourishing and reduce anxiety and depression: a randomized controlled trial. Internet interventions, 9, 15-24. Doi: https://doi.org/10.1016/j.invent.2017.04.002
- 16- Topcu, S.Y. (2018). Relations among pain, pain beliefs, and psychological well-being in patients with chronic pain. Pain Management Nursing, 9(6):637-644. https://doi.org/10.1016/j.pmn.2018.07.007
- 17- Svensson, M., Nilsson, U., & Svantesson, M. (2016). Patients’ experience of mood while waiting for day surgery. J Clin Nurs,. 25(17-18), 2600–2608. doi: 10.1111/jocn.13304.
- 18- Forsberg, A. (2020). Associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among Swedish orthopaedic patients. Int J Orthop Trauma Nurs., 39:100769. https://doi.org/10.1016/j.ijotn.2020.100769
- 19- Kulkarni, A. R., Pusic, A.L., & Hamill, J. B. (2017). Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open, 11, 1-13. doi: 10.1016/j.jpra.2016.08.005.
- 20- Bhalang, K., Steiger, B., Lukic, N., Wojczyńska, A.Z., Hovijitra, R.S., & Ettlin, D.A. (2020). The Pain–to–Well Being Relationship in Patients Experiencing Chronic Orofacial Pain. Frontiers in Neurology, 11, 557415. https://dx.doi.org/10.3389%2Ffneur.2020.557415
- 21- Gloria, K., Jen, K., Szarowski-Cox, J., Hidetoshi, H., & Tzu, A. (2018). Coping styles effect on stress and psychological wellbeing among ındividuals with chronic pain. J Depress Anxiety 7(1), 1-9. https://doi.org/10.4172/2167-1044.1000295
- 22- McParland, J.L., Andrews, P., Kidd, L., Williams, L., & Flowers, P. (2021). A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain. Health Psychology And Behavioral Medicine, 9(1), 25-47. https://doi.org/10.1080/21642850.2020.1863809
- 23- Schittek, G.A., Schwantzer, G., Zoidl, P., Orlob, S., Holger, S., Eichinger, M., … Kiesling, A.S. (2020). Adult patients' wellbeing and disturbances during early recovery in the post anaesthesia care unit. A cross-sectional study. Intensive and Critical Care Nursing, 61, 102912. https://doi.org/10.1016/j.iccn.2020.102912
- 24- Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., … Biswas-Diener, R. (2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97, 143–156. https://doi.org/10.1007/s11205-009-9493-y
- 25- Telef, B. B. (2013). Psikolojik iyi oluş ölçeği: Türkçeye uyarlama, geçerlik ve güvenirlik çalışması. Hacettepe Üniversitesi Eğitim Fakültesi Dergisi, 28(3), 374-384.
https://dergipark.org.tr/en/pub/hunefd/issue/7791/101929 Accessed 16 July 2021
- 26- Richard, H. M., Cerza, S. P., De La Rocha, A., & Podeszwa, D. A. (2020). Preoperative mental health status is a significant predictor of postoperative outcomes in adolescents treated with hip preservation surgery. J Child Orthop, 14(4), 259-265. doi: 10.1302/1863-2548.14.200013.
- 27- Mancuso, C. A., Duculan, R., Cammisa, F.P., Sama, A. A., Hughes, A. P., Lebl, D. R., & Girardi, F. P. (2018). Successful lumbar surgery results in improved psychological well-being: A longitudinal assessment of depressive and anxiety symptoms. The Spine Journal, 18(4), 606-613. doi: 10.1016/j.spinee.2017.08.260.
- 28- Belford, K., Gallagher, N., Dempster, M., Wolfenden, M., Hill, J., Blaney, J., … Beverland, D.(2020). Psychosocial predictors of outcomes up to one year following total knee arthroplasty. The Knee, 27(3), 1028-1034. https://doi.org/10.1016/j.knee.2020.03.006
- 29- Yang, M.M., Hartley, R.L., Leung, A.A., Ronksley, P.E., Jetté, .N, Casha, S., … Riva-Cambrin, J. (2019). Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open, 9(4), e025091. http://dx.doi.org/10.1136/bmjopen-2018-025091
- 30- Moloney, N.A., Pocovi, N.C., Dylke, E.S., Graham, P.L., & De Groef, A. (2021). Psychological factors are associated with pain at all time frames after breast cancer surgery: a systematic review with meta-analyses. Pain Medicine 22(4), 915-947. https://doi.org/10.1093/pm/pnaa363
- 31- Karaaslan, O., Kantekin, C.U., Hacimusalar, Y., & Talih, G. (2019). The effect of health anxiety on postoperative analgesia requirement and anesthesia recovery in patients undergoing laparoscopic cholecystectomy. Family Practice and Palliative Care 4(1), 7-10. https://dx.doi.org/10.22391/fppc.435395
- 32- Kandemir, E., Aşkın, T., Kandemir, T., Tuncel, G.O., & Ünver, S. (2019). The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations. Ortadogu Tıp Derg, 11(2): 136-142. doi: https://doi.org/10.21601/ortadogutipdergisi.460385
- 33- Yüksel, A., Tambağ, H., & Karakoyun, A. (2019). The Relationship between Pain Beliefs and Psychiatric Symptoms of Patients with Fibromyalgia Syndrome. Duzce Medical Journal 21(3), 238-242. https://doi.org/10.18678/dtfd.641962
- 34- Ravindra, A., Barlow, J.D., Jones, G.L., & Bishop, J.Y (2018). A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors. J Shoulder Elbow Surg 27(10), 1824-9. https://doi.org/10.1016/j.jse.2018.06.019
- 35- Schnabel, A., Yahiaoui-Doktor, M., Meissner, W., Zahn, P.K., & Pogatzki-Zahn, E.M. (2020). Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients. Pain Reports, 5(4), e831. https://dx.doi.org/10.1097%2FPR9.0000000000000831
- 36- Sakel, K. (2019). Age Differences in Religiousness and Psychological Well-Being. Master’s thesis, Bowling Green State University. Ohio: 2019. https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=bgsu1560159172515105&disposition=inline Accessed 16 July 2021
- 37- Schug, S.A., & Bruce, J.(2017). Risk stratification for the development of chronic postsurgical pain. Pain Reports 2(6), e627. http://dx.doi.org/10.1097/PR9.0000000000000627
- 38- Alexiou, K.I., Roushias, A., Varitimidis, S.E., & Malizos, K.N. (2018). Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clinical Interventions in Aging, 13, 143–150. https://doi.org/10.2147/CIA.S150067
Psychological Well-Being in Postoperative Pain: A Correlational Study
Year 2023,
Volume: 8 Issue: 1, 68 - 79, 01.04.2023
Esra Makal Orğan
,
Sacide Yıldızeli Topçu
Abstract
Background: This study aims to determine the role of postoperative pain experienced by patients in their psychological well-being.
Materials and Methods: This correlational study was conducted with 63 volunteer patients who underwent surgery.
Results: There was a negative correlation between psychological well-being and postoperative pain level, and also, age of the patients.
Conclusion and suggestions: The increased pain severity caused decreasing psychological well-being. Decreased psychological well-being may affect the healing process negatively by impairing the participation of patients in their own treatment and care. Nurses can help patients maintain their psychological well-being through good pre-operative psychological preparation and effective postoperative pain control.
References
- 1- Málek, J., Ševčík, P., Bejšovec, D., Fricová J., Gabrhelík, T., … Vojtíšková, M. (2017).
Postoperative pain management (3rd ed.). Mladá fronta. https://management.ind.in/forum/attachments/f2/39049d1586398178-postoperative-pain-postoperative-pain.pdf Accessed 16 July 2021
- 2- Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., …Wu, C. L.(2016) . Guidelines on the management of postoperative pain. The Journal of Pain, 17(2), 131-157. doi: 10.1016/j.jpain.2015.12.008.
- 3- Pinto, A., Faiz, O., Davis, R., Almoudaris, A., & Vincent, C. (2016). Surgical complications and their impact on patients’ psychosocial well-being: A systematic review and meta-analysis. BMJ Open, 6(2), 1-23. doi:10.1136/bmjopen-2014-007224
- 4- Guimaraes-Pereira, L., Valdoleiros, I., Reis, P., & Abelha, F. (2016). Evaluating persistent postoperative pain in one tertiary hospital: Incidence, quality of life, associated factors, and treatment. Anesth Pain Med, 6(2), e36461. https://doi.org/10.5812/aapm.36461
- 5- Peng, F., Peng, T., Yang, Q., Liu, M., Chen, G., & Wang, M. (2020). Preoperative communication with anesthetists via anesthesia service platform (ASP) helps alleviate patients’ preoperative anxiety. Scientific Reports, 10(1), 1-8. https://doi.org/10.1038/s41598-020-74697-3
- 6- Querichelli, A.F.A., Santos, B.D.R., Spessoto, L.C.F., & Facio, F. (2020). Does psychological preparation improve pretreatment anxiety in patients with prostate cancer?. Revista da Associação Médica Brasileira, 66, 390-391. https://doi.org/10.1590/1806-9282.66.4.390
- 7- Dunn, L.K., Durieux, M.E., Fernández, L.G., Tsang, S., Smith-Straesser, E.E., Jhaveri H.F., … Naik, B.I. (2018). Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery. J Neurosurg Spine., 28(1), 119-126. https://doi.org/10.3171/2017.5.SPINE1734
- 8- Weinrib, A.Z., Azam, M.A., Birnie, K.A., Burns, L.C., Clarke, H., & Katz, J. (2017). The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. British Journal Of Pain, 11(4), 169-177. https://doi.org/10.1177%2F2049463717720636
- 9- Michaelides, A., & Zis, P. (2019). Depression, anxiety and acute pain: links and management challenges. Postgraduate Medicine, 131(7), 438-444. https://doi.org/10.1080/00325481.2019.1663705
- 10- Johnson, J.E. (2020). Psychological interventions and coping with surgery. In: Taylor SE, Singer JE, Baum A, eds. Handbook of Psychology and Health (Volume IV) (s. 167-187) Routledge.
- 11- Khalil, H., Shajrawi, A., Dweik, G., Zaghmouri, A., & Henker, R. (2020). The impact of preoperative pain-related psychological factors on pain intensity post-surgery in Jordan. Journal of Health Psychology, 1359105320937067. https://doi.org/10.1177%2F1359105320937067
12- Hernandez, R., Bassett, S.M., Boughton, S.W., Schuette, S.A., Shiu, E.W., & Moskowitz, J.T., (2018). Psychological well-being and physical health: Associations, mechanisms, and future directions. Emotion Review, 10(1), 18-29. https://doi.org/10.1177%2F1754073917697824
- 13- Medvedev, O.N., & Landhuis, C.E. (2018). Exploring constructs of well-being, happiness and quality of life. PeerJ, 6, e4903. https://doi.org/10.7717/peerj.4903
- 14- World Health Organization. Promoting mental health: concepts, emerging evidence, practice: a report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne, 2005. Accessed July 16, 2021.
https://www.who.int/mental_health/evidence/en/promoting_mhh.pdf
- 15- Schotanus-Dijkstra, M., Drossaert, C. H., Pieterse, M. E., Boon, B., Walburg, J. A., & Bohlmeijer, E. T. (2017). An early intervention to promote well-being and flourishing and reduce anxiety and depression: a randomized controlled trial. Internet interventions, 9, 15-24. Doi: https://doi.org/10.1016/j.invent.2017.04.002
- 16- Topcu, S.Y. (2018). Relations among pain, pain beliefs, and psychological well-being in patients with chronic pain. Pain Management Nursing, 9(6):637-644. https://doi.org/10.1016/j.pmn.2018.07.007
- 17- Svensson, M., Nilsson, U., & Svantesson, M. (2016). Patients’ experience of mood while waiting for day surgery. J Clin Nurs,. 25(17-18), 2600–2608. doi: 10.1111/jocn.13304.
- 18- Forsberg, A. (2020). Associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among Swedish orthopaedic patients. Int J Orthop Trauma Nurs., 39:100769. https://doi.org/10.1016/j.ijotn.2020.100769
- 19- Kulkarni, A. R., Pusic, A.L., & Hamill, J. B. (2017). Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open, 11, 1-13. doi: 10.1016/j.jpra.2016.08.005.
- 20- Bhalang, K., Steiger, B., Lukic, N., Wojczyńska, A.Z., Hovijitra, R.S., & Ettlin, D.A. (2020). The Pain–to–Well Being Relationship in Patients Experiencing Chronic Orofacial Pain. Frontiers in Neurology, 11, 557415. https://dx.doi.org/10.3389%2Ffneur.2020.557415
- 21- Gloria, K., Jen, K., Szarowski-Cox, J., Hidetoshi, H., & Tzu, A. (2018). Coping styles effect on stress and psychological wellbeing among ındividuals with chronic pain. J Depress Anxiety 7(1), 1-9. https://doi.org/10.4172/2167-1044.1000295
- 22- McParland, J.L., Andrews, P., Kidd, L., Williams, L., & Flowers, P. (2021). A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain. Health Psychology And Behavioral Medicine, 9(1), 25-47. https://doi.org/10.1080/21642850.2020.1863809
- 23- Schittek, G.A., Schwantzer, G., Zoidl, P., Orlob, S., Holger, S., Eichinger, M., … Kiesling, A.S. (2020). Adult patients' wellbeing and disturbances during early recovery in the post anaesthesia care unit. A cross-sectional study. Intensive and Critical Care Nursing, 61, 102912. https://doi.org/10.1016/j.iccn.2020.102912
- 24- Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., … Biswas-Diener, R. (2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97, 143–156. https://doi.org/10.1007/s11205-009-9493-y
- 25- Telef, B. B. (2013). Psikolojik iyi oluş ölçeği: Türkçeye uyarlama, geçerlik ve güvenirlik çalışması. Hacettepe Üniversitesi Eğitim Fakültesi Dergisi, 28(3), 374-384.
https://dergipark.org.tr/en/pub/hunefd/issue/7791/101929 Accessed 16 July 2021
- 26- Richard, H. M., Cerza, S. P., De La Rocha, A., & Podeszwa, D. A. (2020). Preoperative mental health status is a significant predictor of postoperative outcomes in adolescents treated with hip preservation surgery. J Child Orthop, 14(4), 259-265. doi: 10.1302/1863-2548.14.200013.
- 27- Mancuso, C. A., Duculan, R., Cammisa, F.P., Sama, A. A., Hughes, A. P., Lebl, D. R., & Girardi, F. P. (2018). Successful lumbar surgery results in improved psychological well-being: A longitudinal assessment of depressive and anxiety symptoms. The Spine Journal, 18(4), 606-613. doi: 10.1016/j.spinee.2017.08.260.
- 28- Belford, K., Gallagher, N., Dempster, M., Wolfenden, M., Hill, J., Blaney, J., … Beverland, D.(2020). Psychosocial predictors of outcomes up to one year following total knee arthroplasty. The Knee, 27(3), 1028-1034. https://doi.org/10.1016/j.knee.2020.03.006
- 29- Yang, M.M., Hartley, R.L., Leung, A.A., Ronksley, P.E., Jetté, .N, Casha, S., … Riva-Cambrin, J. (2019). Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open, 9(4), e025091. http://dx.doi.org/10.1136/bmjopen-2018-025091
- 30- Moloney, N.A., Pocovi, N.C., Dylke, E.S., Graham, P.L., & De Groef, A. (2021). Psychological factors are associated with pain at all time frames after breast cancer surgery: a systematic review with meta-analyses. Pain Medicine 22(4), 915-947. https://doi.org/10.1093/pm/pnaa363
- 31- Karaaslan, O., Kantekin, C.U., Hacimusalar, Y., & Talih, G. (2019). The effect of health anxiety on postoperative analgesia requirement and anesthesia recovery in patients undergoing laparoscopic cholecystectomy. Family Practice and Palliative Care 4(1), 7-10. https://dx.doi.org/10.22391/fppc.435395
- 32- Kandemir, E., Aşkın, T., Kandemir, T., Tuncel, G.O., & Ünver, S. (2019). The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations. Ortadogu Tıp Derg, 11(2): 136-142. doi: https://doi.org/10.21601/ortadogutipdergisi.460385
- 33- Yüksel, A., Tambağ, H., & Karakoyun, A. (2019). The Relationship between Pain Beliefs and Psychiatric Symptoms of Patients with Fibromyalgia Syndrome. Duzce Medical Journal 21(3), 238-242. https://doi.org/10.18678/dtfd.641962
- 34- Ravindra, A., Barlow, J.D., Jones, G.L., & Bishop, J.Y (2018). A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors. J Shoulder Elbow Surg 27(10), 1824-9. https://doi.org/10.1016/j.jse.2018.06.019
- 35- Schnabel, A., Yahiaoui-Doktor, M., Meissner, W., Zahn, P.K., & Pogatzki-Zahn, E.M. (2020). Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients. Pain Reports, 5(4), e831. https://dx.doi.org/10.1097%2FPR9.0000000000000831
- 36- Sakel, K. (2019). Age Differences in Religiousness and Psychological Well-Being. Master’s thesis, Bowling Green State University. Ohio: 2019. https://etd.ohiolink.edu/apexprod/rws_etd/send_file/send?accession=bgsu1560159172515105&disposition=inline Accessed 16 July 2021
- 37- Schug, S.A., & Bruce, J.(2017). Risk stratification for the development of chronic postsurgical pain. Pain Reports 2(6), e627. http://dx.doi.org/10.1097/PR9.0000000000000627
- 38- Alexiou, K.I., Roushias, A., Varitimidis, S.E., & Malizos, K.N. (2018). Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clinical Interventions in Aging, 13, 143–150. https://doi.org/10.2147/CIA.S150067