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Psychological distress and contentment after primary total knee replacement
Örebro universitet, Institutionen för medicinska vetenskaper.ORCID-id: 0000-0002-1807-9656
2020 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The overall aim of this thesis was to study patients with anxiety/depression symptoms before and after primary total knee replacement, particularly in terms of improvements in patients-reported outcomes, and particularly among those who were discontent with the surgery. This could hopefully improve patients' contentment after TKR.

Study I investigated the prevalence of knee symptom improvement among patients with preoperative anxiety and/or depression in comparison to patients who did not have anxiety/depression. Study II investigated changes in the prevalence of anxiety and depression one year after primary TKR. Study III investigated how TKR surgeons in Sweden informed their patients preoperatively, and what kind of information they gave. Study IV used face-to-face interviews to capture experiences of discontentment one year after TKR among patients without documented complications.

The main findings were that: 1. All patients improved in outcome measures one year after TKR, regardless of presurgical psychological state. 2. Among the 15% of patients with anxiety symptoms before surgery, 59% had improved in these symptoms one year after surgery; while among the 10% with depression symptoms before surgery, 60% had improved one year after surgery. 3. Knee surgeons in Sweden have considerable awareness of the importance of preoperative patient information, the impact of patient expectations, and psychiatric illness. However, they need to improve their preoperative routines when it comes to providing written information, asking about the patient’s expectations, and psychiatric assessment. 4. The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking relational support.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University , 2020. , s. 99
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 217
Nyckelord [en]
Anxiety, contentment, depression, discontentment, psychological distress, patients’ expectations, total knee replacement
Nationell ämneskategori
Kirurgi
Identifikatorer
URN: urn:nbn:se:oru:diva-81287ISBN: 978-91-7529-346-2 (tryckt)OAI: oai:DiVA.org:oru-81287DiVA, id: diva2:1425943
Disputation
2020-09-11, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2020-04-23 Skapad: 2020-04-23 Senast uppdaterad: 2020-08-31Bibliografiskt granskad
Delarbeten
1. Preoperative psychological distress no reason to delay total knee arthroplasty: a register‑based prospective cohort study of 458 patients
Öppna denna publikation i ny flik eller fönster >>Preoperative psychological distress no reason to delay total knee arthroplasty: a register‑based prospective cohort study of 458 patients
2020 (Engelska)Ingår i: Archives of Orthopaedic and Trauma Surgery, ISSN 0936-8051, E-ISSN 1434-3916, Vol. 140, nr 11, s. 1809-1818Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: Total knee arthroplasty (TKA) is effective in alleviating pain and improving function in patients with knee arthritis. Psychological factors are known to affect patient satisfaction after TKA. It is important to determine the effectiveness of TKA in patients with presurgical anxiety and/or depression to avoid excluding them from surgery.

Materials and methods: A prospective cohort study was conducted on all patients who underwent TKA during 2016-2018. Patients were divided into four groups: with anxiety, without anxiety, with depression, and without depression. Outcome measures comprised both generic and knee-specific instruments. Each patient group was compared regarding changes in outcome measures one year after surgery. Between-group comparison was also performed.

Results: Of the 458 patients with complete data, 15.3% and 9.6% had experienced presurgical anxiety and depression, respectively. All patient groups displayed statistical (P < 0.001) and clinical improvement in all outcome measures. Patients with presurgical anxiety and/or depression generally displayed less improvement, though the only significant mean differences concerned the Knee Injury and Osteoarthritis Outcome Score (KOOS)-sport score in the non-anxiety and non-depression groups (P = 0.006 and 0.03, respectively), a higher proportion of clinically improved KOOS pain in the non-anxiety group (P = 0.03), and the general health state in the anxiety and depression groups (P = 0.004 and 0.04, respectively).

Conclusions: All patients improved in outcome measures 1 year after TKA, regardless of presurgical psychological state. Patients with presurgical anxiety and/or depression benefit greatly from surgery and should not be discriminated against based on presurgical psychological distress, though this fact should not eliminate the preoperative psychological assessment of patients.

Ort, förlag, år, upplaga, sidor
Springer, 2020
Nyckelord
Knee arthritis, Knee Injury and Osteoarthritis Outcome Score, Psychological distress, Total knee arthroplasty
Nationell ämneskategori
Kirurgi Ortopedi
Identifikatorer
urn:nbn:se:oru:diva-84930 (URN)10.1007/s00402-020-03537-w (DOI)000552939100001 ()32720002 (PubMedID)2-s2.0-850886415362-s2.0-85088641536 (Scopus ID)
Anmärkning

Funding Agency:

Örebro University

Tillgänglig från: 2020-08-18 Skapad: 2020-08-18 Senast uppdaterad: 2020-12-18Bibliografiskt granskad
2. Reduction in anxiety and depression symptoms one year after knee replacement: a register-based cohort study of 403 patients
Öppna denna publikation i ny flik eller fönster >>Reduction in anxiety and depression symptoms one year after knee replacement: a register-based cohort study of 403 patients
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-84931 (URN)
Tillgänglig från: 2020-08-18 Skapad: 2020-08-18 Senast uppdaterad: 2020-08-18Bibliografiskt granskad
3. How do orthopaedic surgeons inform their patients before knee arthroplasty surgery?: A cross-sectional study
Öppna denna publikation i ny flik eller fönster >>How do orthopaedic surgeons inform their patients before knee arthroplasty surgery?: A cross-sectional study
2018 (Engelska)Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 19, artikel-id 414Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Total knee arthroplasty (TKA) is a successful and common procedure. However, 6–28% of patients are dissatisfied postoperatively. The provision of preoperative patient information, inquiring about patients’ expectations, and taking a psychiatric history are essential parts of both preoperative evaluation and postoperative outcome. The aim of this study was to investigate how orthopaedic knee surgeons in Sweden inform their patients before surgery.

Methods: A questionnaire was distributed to all knee surgeons performing TKA in Sweden. Responses were received from 60 of the 65 orthopaedic departments performing TKA in Sweden (92%), covering 219 of the approximately 311 knee surgeons at the 65 departments (70%). The answers were analysed with descriptive statistics. A content analysis of the surgeons’ opinions was also performed using a thematic method.

Results: In terms of information provision, 58% of the surgeons always gave written information while 92% informed orally. Only 44% always asked about the patient’s expectations, and only 42% always informed patients about the 20% dissatisfaction rate after TKA. Additionally, 24% never operated on mild indication of arthrosis, 20% always took a psychiatric history, and half never or seldom consulted a psychiatrist. However, all the knee surgeons believed in a psychiatric impact on TKA outcome. Qualitative analysis revealed five common causes of patient dissatisfaction, which in descending frequency were: patients’ expectations, choice of patients to operate on, surgical factors, combinations of factors, and insufficient information provision to patients.

Conclusions: Knee surgeons in Sweden have considerable awareness of the importance of preoperative patient information, the impact of patient expectations, and psychiatric illness. However, they need to improve their preoperative routines when it comes to providing written information, asking about the patient’s expectations, and psychiatric assessment.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2018
Nyckelord
Expectation, Postoperative outcome, Preoperative information, Psychiatric history, TKA
Nationell ämneskategori
Ortopedi Reumatologi och inflammation
Identifikatorer
urn:nbn:se:oru:diva-70349 (URN)10.1186/s12891-018-2345-7 (DOI)000452237900003 ()30474569 (PubMedID)2-s2.0-85057119652 (Scopus ID)
Anmärkning

Funding Agencies:

Örebro Research Committee, Sweden

Orthopaedic Department, Karlskoga Hospital, Sweden 

Tillgänglig från: 2018-11-27 Skapad: 2018-11-27 Senast uppdaterad: 2024-01-17Bibliografiskt granskad
4. Patients’ experiences of discontentment one year after total knee arthroplasty: a qualitative study
Öppna denna publikation i ny flik eller fönster >>Patients’ experiences of discontentment one year after total knee arthroplasty: a qualitative study
2020 (Engelska)Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 21, nr 1, artikel-id 29Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are dissatisfied without known explanation. Satisfaction and dissatisfaction have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients' experiences. Qualitative knowledge might be useful in creating strategies to decrease the dissatisfaction rate.

METHODS: Of the 348 patients who responded to a letter asking if they were satisfied or dissatisfied with their surgery, 61 (18%) reported discontent. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients' experiences of discontentment 1 year after total knee arthroplasty.

RESULTS: The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and lacking of relational supports. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a lack of relational supports, and a lack of respect and continuity, support from health care, and information adapted to their needs.

CONCLUSION: Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient satisfaction after surgery.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2020
Nyckelord
Content analysis, Patient contentment, Patient satisfaction, Qualitative research, Surgery, Total knee arthroplasty
Nationell ämneskategori
Ortopedi
Identifikatorer
urn:nbn:se:oru:diva-79262 (URN)10.1186/s12891-020-3041-y (DOI)000513917100003 ()31937282 (PubMedID)2-s2.0-85077838536 (Scopus ID)
Anmärkning

Funding Agencies:

Örebro Research Committee, Sweden  

Orthopaedic Department, Karlskoga Hospital, Sweden

Tillgänglig från: 2020-01-20 Skapad: 2020-01-20 Senast uppdaterad: 2024-01-17Bibliografiskt granskad

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Mahdi, Aamir

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