Effectiveness of psychological support in patients undergoing primary total hip or knee arthroplasty: a controlled cohort study

Abstract

Background: We hypothesised that psychological support would have a significant improvement on the mental and physical recovery of patients undergoing primary total hip or knee arthroplasty.

Materials and methods: 200 patients were consecutively alternately assigned (1:1) to receive routine care (control group) or, in addition, psychological support from a professional psychologist (experimental group). The psychological support was provided at the pre-operative visit, during the hospitalisation period and at the rehabilitation centre.

Results: Upon discharge, based on the 'Hospital Anxiety and Depression Scale, a state of anxiety was observed in 12.8 % and 78.9 % of the patients in the experimental and in the control group, respectively (p < 0.0001). A state of depression was observed in 12.8 % and 73.7 % of the patients in the experimental and in the control group, respectively (p < 0.0001). With regard to the 'Physical Component Scale' of the SF-36 questionnaire, a similar temporal trend of values was observed in the two study groups, significantly increasing over time in both groups, taking into consideration both the joint population and the two hip and knee populations separately (p < 0.0001). With regard to the 'Mental Component Scale' of the SF-36 questionnaire, in both the joint population and the two hip and knee populations separately, an exact opposite temporal trend was observed in the experimental group compared to the control group (p < 0.0001), with generally higher scores in the experimental group (p < 0.0001). In patients with hip arthroplasty, the average time to reach the physiotherapy objective (i.e., the patient ability to walk 50 metres independently and to climb 10 steps) was 6.7 ± 1.8 days (range 4-12) in the experimental group and 7.9 ± 2.2 days (range 0-13) in the control group (p = 0.0015).

Conclusions: In summary, there was a lower incidence of anxiety and depression and better mental well-being in the group of patients who received the psychological support. Within the hip arthroplasty group, the patients who received the psychological support reached the physiotherapy objective 1.2 days earlier than the patients in the control group (p = 0.0015).

Level of evidence: Level 3, Non-randomized prospective controlled cohort.

Keywords: Depression scale; Hip arthroplasty; Hospital anxiety; Knee arthroplasty; Psychological support; SF-36.

Fig. 1

Temporal trend of the ‘Physical Component Scale’ (PCS) and the ‘Mental Component Scale’ (MSC) of the SF-36 questionnaire for the hip population ((a) and (c), respectively) and for the knee population ((b) and (d), respectively). The solid lines indicate the experimental group while the dashed lines indicate the control group. Means are shown as circles while the bars represent the 95 % confidence interval. An evident overlapping between the bars indicates lack of significant statistical difference