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Resilience and recovery from total knee arthroplasty (TKA): a pathway for optimizing patient outcomes

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Abstract

Identifying and promoting resilience factors may offer novel strategies for optimizing the recovery of patients following orthopedic surgery. Prior research has suggested that self-efficacy, positive affect, vigor, and vitality may function as resilience factors in the face of chronic pain. The present study examines these resilience factors in a prospective, cognitive-affective-behavioral pathway to recovery. Patients (n = 110) undergoing unilateral, total knee replacement surgery completed self-report assessments of study variables. Self-efficacy was assessed 2 ½ weeks prior to surgery, positive affect the day after surgery, vitality and vigor one-month following surgery, and post-operative pain at one- and three-months following surgery. Control variables included gender, pain, and depressive symptoms prior to surgery. Path analysis revealed significant coefficients from pre-operative self-efficacy to positive affect during hospitalization (β = .246, p = .017), as well as to vitality (β = .323, p = .001) and vigor (β = .387, p < .001) at one-month following surgery. Both indicators of energy predicted better post-operative recovery (one-month: vitality β = -.254, p = .016; vigor β = -.329, p = .002); three-months: vitality β = -.192, p = .047, vigor β = -.201, p = .044). Findings support a cognitive-affective-behavioral pathway to recovery.

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Funding

This research was supported by funding from the Kent-Summa Center for the Treatment and Study of Traumatic Stress.

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Authors and Affiliations

  1. Department of Psychological Sciences, Kent State University at Stark, 6000 Frank Ave NW, Canton, OH, 44720, USA

    Julie K. Cremeans-Smith

  2. Department of Orthopedics, Cleveland Clinic, Cleveland, OH, USA

    Kenneth Greene

  3. Department of Psychological Sciences, Kent State University, Kent, OH, USA

    Douglas L. Delahanty

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  1. Julie K. Cremeans-Smith
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  2. Kenneth Greene
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  3. Douglas L. Delahanty
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Correspondence to Julie K. Cremeans-Smith.

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Procedures were approved by the Institutional Review Boards of Kent State University and Summa Health System. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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The authors have no conflicts of interest to disclose.

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Cremeans-Smith, J.K., Greene, K. & Delahanty, D.L. Resilience and recovery from total knee arthroplasty (TKA): a pathway for optimizing patient outcomes. J Behav Med 45, 481–489 (2022). https://doi.org/10.1007/s10865-022-00287-5

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