TOTAL DİZ ARTROPLASTİSİNDE KORKU VE ANKSİYETENİN YAŞAM KALİTE VE İŞLEVSEL SONUÇLARA ETKİSİ

Amaç: Diz artroplastisi yapılan hastalarda yaklaşık olarak 1/5 oranında memnuniyetsizlik görülmektedir. Kötü so-nuçlarla ilişkili olan değişkenler ağrının şiddeti ve kronikliği, fizyolojik hastalıklar, kötü başa çıkma stratejileri ve ağ-rının dayanılmaz şiddette olmasıdır. Fizyolojik hastalıklar anksiyete ve depresyon şeklinde semptom gösterebilir. Neanksiyetenin ne de depresyonun diz artroplastisi uygulaması öncesinde yapısal mı yoksa diz ağrısının bir sonucu muolduğu açık değildir. Total diz artroplastisi günümüzde sıklıkla uygulanan büyük bir cerrahi haline gelmiştir. Genel-likle yaşlı hastalara uygulanan bu cerrahiye veya hastalığa bağlı hastalarda korku ve anksiyete gelişebilmektedir. Buçalışmada total diz artroplastisi yapılan hastaların ameliyat öncesindeki korku ve anksiyete durumlarının ameliyatsonrası yaşam kalitesi ve işlevsel sonuçlarına etkisi araştırıldı.Yöntem: 2003-2011 yılları arasında 217 hastaya uygulanan total diz artroplastisi ameliyatından ulaşılan 112 hastaretrospektif olarak Pain Anxiety Symptom Score(PASS), WOMAC ve SF-36(Short Form-36) skorlama sistemleri ile de-ğerlendirildi. 112 hastanın (ort. yaş: 71,7, 86 kadın, 26 erkek) ameliyat öncesi dönemdeki korku ve anksiyete durum-ları PASS skorlama sistemi ile elde edildi. Ameliyat öncesi ve ameliyat sonrası yaşam kalitesi ve işlevsel durumları iseWOMAC ve SF-36 ile elde edildi. PASS skoru için sınır değer 100 alındı ve hastalar 2 gruba ayrıldı. Ameliyat öncesi veameliyat sonrası SF-36 skorları ve WOMAC skorları bu iki grup arasında karşılaştırıldı.Bulgular: PASS’a göre ayrılan her iki grupta ameliyat öncesine göre ameliyat sonrası dönemde SF-36’nın bütünparametrelerinde ve WOMAC skorlarında istatistiksel olarak anlamlı iyileşme saptandı. Anksiyete durumlarına göreWOMAC ve SF-36’daki değişim miktarları karşılaştırıldığında SF-36’nın sosyal işlev ve mental sağlık parametrele-rindeki iyileşme miktarının farklı olduğu gözlendi. PASS skorları 100’ün üzerinde olan hasta grubunda (70 hasta)SF-36’nın sosyal işlev parametresindeki iyileşme miktarının daha fazla olduğu gözlendi. PASS skorları 100’ün altındaolan hasta grubunda ise(42 hasta) SF- 36’nın mental sağlık parametresindeki iyileşme miktarının daha fazla olduğugözlendi.Çıkarımlar: Total diz artroplastisi hastalarının yaşam kalitelerinde ve işlevsel durumlarında belirgin iyileşme sağla-maktadır. Hastaların ameliyat öncesi dönemdeki korku ve anksiyetesi total diz artroplastisinin işlevsel sonuclarınaetki etmemektedir. Ancak SF-36’nın sosyal ve mental parametrelerini etkilediği görülmektedir.

Effect of Fear and Anxiety on Quality of Life and Functional Results in Total Knee Arthroplasty

Aim: Approximately 1/5 of the patients with knee arthroplasty have dissatisfaction. The variables associated with poor outcomes are severity and chronicity of pain, physiological diseases, poor coping strategies, and intolerable severity of pain. Physiological diseases may present as symptoms of anxiety and depression. Neither anxiety nor depression is a result of structural or knee pain prior to knee arthroplasty application. Total knee arthroplasty has become a major surgical procedure that is frequently applied today. Generally, fear and anxiety may develop in elderly patients due to this surgery or disease. In this study, the effect of preoperative fear and anxiety on total quality and functional outcomes of patients with total knee arthroplasty were investigated. Method: Between 2003 and 2011, 112 patients with total knee arthroplasty were evaluated retrospectively using the Pain Anxiety Symptom Score (PASS), WOMAC and SF-36 (Short Form-36) scoring systems. The pre-operative fear and anxiety levels of 112 patients (mean age: 71.7, 86 women, 26 men) were obtained with PASS scoring system. Preoperative and postoperative quality of life and functional status were obtained by WOMAC and SF- 36. The limit value for the PASS score was 100 and the patients were divided into 2 groups. Preoperative and postoperative SF-36 scores and WOMAC scores were compared between these two groups. Results: According to the pre-operative period, statistically significant improvement was found in all parameters of SF-36 and WOMAC scores in both groups according to PASS. When the changes in WOMAC and SF-36 were compared according to the anxiety states, the improvement in SF-36 social function and mental health parameters were found to be different. In the patient group with PASS scores more than 100 (70 patients), the improvement in the social function parameter of SF-36 was higher. In patients with PASS scores below 100 (42 patients), the improvement in mental health parameters of SF-36 was higher. Conclusion: Total knee arthroplasty provides significant improvement in the quality of life and functional status of patients. Patients' fear and anxiety before surgery did not affect the functional outcome of total knee arthroplasty. However, it is observed that SF-36 affects social and mental parameters.

PDF

___

Sullivan, M., et al., Psychological determinants of problematic outcomes following total knee arthroplasty. Pain, 2009. 143(1): p. 123-129.
Forsythe, M.E., et al., Prospective relation between catastroph- izing and residual pain following knee arthroplasty: two-year follow- up. Pain Research and Management, 2008. 13(4): p. 335-341.
Brander, V., et al., THE JOHN INSALL AWARD: Pain and Depression Influence Outcome 5 Years after Knee Replacement Surgery. Clinical orthopaedics and related research, 2007. 464: p. 21-26.
Scott, C., et al., Predicting dissatisfaction following total knee replacement. Bone & Joint Journal, 2010. 92(9): p. 1253-1258.
Brander, V.A., et al., Ranawat Award Paper: Predicting Total Knee Replacement Pain: A Prospective, Observational Study. Clinical orthopaedics and related research, 2003. 416: p. 27-36.
Faller, H., S. Kirschner, and A. König, Psychological distress predicts functional outcomes at three and twelve months after total knee arthroplasty. General Hospital Psychiatry, 2003. 25(5): p. 372-373.
Lingard, E.A. and D.L. Riddle, Impact of psychological distress on pain and function following knee arthroplasty. JBJS, 2007. 89(6): p. 1161-1169.
Ayers, D.C., et al., Total knee replacement outcome and coexist- ing physical and emotional illness. Clinical orthopaedics and related research, 2005. 440: p. 157-161.
Sullivan, M.J., S.R. Bishop, and J. Pivik, The pain catastrophizing scale: development and validation. Psychological assessment, 1995. 7(4): p. 524.
Riddle, D.L., et al., Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Clinical Orthopaedics and Related Research®, 2010. 468(3): p. 798-806.
Roth, M.L., et al., Demographic and psychosocial predictors of acute perioperative pain for total knee arthroplasty. Pain Research and Management, 2007. 12(3): p. 185-194.
Drewett, R.F., R.J. Minns, and T.F. Sibly, Measuring outcome of total knee replacement using quality of life indices. Annals of the Royal College of Surgeons of England, 1992. 74(4): p. 286.
Roos, E.M. and S. Toksvig-Larsen, Knee injury and Osteoarthritis Outcome Score (KOOS)–validation and comparison to the WOMAC in total knee replacement. Health and quality of life outcomes, 2003. 1(1): p. 17.
Wolfe, F., Determinants of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia. Rheumatology (Oxford, England), 1999. 38(4): p. 355-361.
Hawker, G.A., et al., Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoar- thritis pain (icoap). Arthritis care & research, 2011. 63(S11).
Angst, F., A. Aeschlimann, and G. Stucki, Smallest detectable and minimal clinically important differences of rehabilitation interven- tion with their implications for required sample sizes using WOMAC and SF‐36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Care & Research, 2001. 45(4): p. 384-391.
McCracken, L.M. and L. Dhingra, A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 2002. 7(1): p. 45-50.
Mccracken, L.M., et al., The assessment of anxiety and fear in persons with chronic pain: a comparison of instruments. Behaviour research and therapy, 1996. 34(11): p. 927-933.
McCracken, L.M., et al., Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance. Pain, 1999. 80(1): p. 283-289.
McCracken, L.M., C. Zayfert, and R.T. Gross, The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain, 1992. 50(1): p. 67-73.
Yang, K.A., et al., Validation of the short-form WOMAC function scale for the evaluation of osteoarthritis of the knee. Bone & Joint Journal, 2007. 89(1): p. 50-56.
Collins, N.J., et al., Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), KneeInjury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS‐PS), Knee Outcome Survey Activities of Daily Living Scale (KOS‐ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis care & research, 2011. 63(S11).
Küçükdeveci, A.A., Rehabilitasyonda yaşam kalitesi. Turkish Journal of Physical Medicine and Rehabilitation, 2005. 51(2).
Ware Jr, J.E., SF-36 health survey. 1999.
Gilbert, P., The relationship of shame, social anxiety and depres- sion: The role of the evaluation of social rank. Clinical Psychology & Psychotherapy, 2000. 7(3): p. 174-189.
Wilkinson, R.G., Health, hierarchy, and social anxiety. Annals of the New York Academy of Sciences, 1999. 896(1): p. 48-63.
Murphy, J.M., et al., Depression and anxiety in relation to social status: A prospective epidemiologic study. Archives of General Psychiatry, 1991. 48(3): p. 223-229.
Abdurrahman, G., et al., Kadın ve erkek genç erişkinler arasında fiziksel aktivite ve yaşam kalitesi farklılıklarının araştırılması. Ko- catepe Tıp Dergisi, 2011. 12(3).
Kain, Z.N., et al., Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediat- rics, 2006. 118(2): p. 651-658.
Blackburn, J., et al., Does preoperative anxiety and depression predict satisfaction after total knee replacement? The Knee, 2012. 19(5): p. 522-524.