Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors
Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperat...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-05-01
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| Series: | Frontiers in Psychology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fpsyg.2020.01061/full |
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| author | Elizabeth Ditton Elizabeth Ditton Elizabeth Ditton Sarah Johnson Sarah Johnson Sarah Johnson Nicolette Hodyl Nicolette Hodyl Traci Flynn Traci Flynn Traci Flynn Michael Pollack Michael Pollack Michael Pollack Karen Ribbons Karen Ribbons Frederick Rohan Walker Frederick Rohan Walker Frederick Rohan Walker Frederick Rohan Walker Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson |
| author_facet | Elizabeth Ditton Elizabeth Ditton Elizabeth Ditton Sarah Johnson Sarah Johnson Sarah Johnson Nicolette Hodyl Nicolette Hodyl Traci Flynn Traci Flynn Traci Flynn Michael Pollack Michael Pollack Michael Pollack Karen Ribbons Karen Ribbons Frederick Rohan Walker Frederick Rohan Walker Frederick Rohan Walker Frederick Rohan Walker Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson |
| author_sort | Elizabeth Ditton |
| collection | DOAJ |
| description | Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centered outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centered TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centered TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centered outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarized, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilization of multivariate prediction models to inform individually tailored interventions targeting a range of health conditions. |
| first_indexed | 2024-12-13T01:01:07Z |
| format | Article |
| id | doaj.art-146a0235f14946c192cb64c2bb7e9e4c |
| institution | Directory Open Access Journal |
| issn | 1664-1078 |
| language | English |
| last_indexed | 2024-12-13T01:01:07Z |
| publishDate | 2020-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychology |
| spelling | doaj.art-146a0235f14946c192cb64c2bb7e9e4c2022-12-22T00:04:40ZengFrontiers Media S.A.Frontiers in Psychology1664-10782020-05-011110.3389/fpsyg.2020.01061510343Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience FactorsElizabeth Ditton0Elizabeth Ditton1Elizabeth Ditton2Sarah Johnson3Sarah Johnson4Sarah Johnson5Nicolette Hodyl6Nicolette Hodyl7Traci Flynn8Traci Flynn9Traci Flynn10Michael Pollack11Michael Pollack12Michael Pollack13Karen Ribbons14Karen Ribbons15Frederick Rohan Walker16Frederick Rohan Walker17Frederick Rohan Walker18Frederick Rohan Walker19Michael Nilsson20Michael Nilsson21Michael Nilsson22Michael Nilsson23Michael Nilsson24Michael Nilsson25Centre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, AustraliaCentre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaSchool of Electrical Engineering and Computing, The University of Newcastle, Callaghan, NSW, AustraliaCentre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaCentre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaSchool of Humanities and Social Science, The University of Newcastle, Callaghan, NSW, AustraliaCentre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, AustraliaJohn Hunter Hospital, Hunter New England Local Health District, New Lambton, NSW, AustraliaCentre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaCentre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaSchool of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, AustraliaNHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, AustraliaCentre for Rehab Innovations, The University of Newcastle, Callaghan, NSW, AustraliaHunter Medical Research Institute, New Lambton Heights, NSW, AustraliaSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, AustraliaSchool of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, AustraliaNHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, AustraliaLee Kong Chian School of Medicine, Nanyang Technological University, Singapore, SingaporeTotal knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centered outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centered TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centered TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centered outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarized, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilization of multivariate prediction models to inform individually tailored interventions targeting a range of health conditions.https://www.frontiersin.org/article/10.3389/fpsyg.2020.01061/fullkneearthroplastyrecoveryrehabilitationdepressionanxiety |
| spellingShingle | Elizabeth Ditton Elizabeth Ditton Elizabeth Ditton Sarah Johnson Sarah Johnson Sarah Johnson Nicolette Hodyl Nicolette Hodyl Traci Flynn Traci Flynn Traci Flynn Michael Pollack Michael Pollack Michael Pollack Karen Ribbons Karen Ribbons Frederick Rohan Walker Frederick Rohan Walker Frederick Rohan Walker Frederick Rohan Walker Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson Michael Nilsson Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors Frontiers in Psychology knee arthroplasty recovery rehabilitation depression anxiety |
| title | Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors |
| title_full | Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors |
| title_fullStr | Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors |
| title_full_unstemmed | Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors |
| title_short | Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors |
| title_sort | improving patient outcomes following total knee arthroplasty identifying rehabilitation pathways based on modifiable psychological risk and resilience factors |
| topic | knee arthroplasty recovery rehabilitation depression anxiety |
| url | https://www.frontiersin.org/article/10.3389/fpsyg.2020.01061/full |
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