2017 ISAKOS Biennial Congress ePoster #1008

 

Preoperative Pain Perceptions are Predictive of Physical Therapy Performance, Healthcare Resource Utilization, and Postoperative Symptoms After Anterior Cruciate Ligament Reconstruction: A Minimum 1 Year Follow-Up Study

Aaron Chafitz, Columbus, OH UNITED STATES
Joshua Scott Everhart, MD, MPH, Indianapolis, IN UNITED STATES
David C. Flanigan, MD, Columbus, OH UNITED STATES

Ohio State University, Columbs, OH, UNITED STATES

FDA Status Not Applicable

Summary

Fear of pain, anxiety-related to pain, pain coping strategies, and subjective pre-operative pain levels were able to predict outcome measures in ACL reconstruction patients such as post-operative symptoms, reinjury rates, use of healthcare resources, and physical therapy performance.

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Abstract

Background

Anterior cruciate ligament reconstruction requires extensive post-operative rehabilitation with high reported rates of persistent symptoms. There is emerging evidence that certain psychological traits including anxiety or fear of pain, individual differences in pain coping strategies, and severe subjective pain prior to surgery can adversely affect outcomes after elective orthopaedic surgery. The goal of this study is to investigate the predictive effect of preoperative pain perceptions phyiscal therapy performance, healthcare resource utilization, and persistent symptoms after anterior cruciate ligament (ACL) reconstruction.

Methods

A total of 72 patients (mean 29.5 years SD 13.4; 37 male, 35 female) who underwent ACL reconstruction completed a battery of preoperative self- administered survey instruments related to subjective pain (McGill pain questionnaire), subjective knee symptoms (IKDC subjective score), anxiety related to pain (pain catastrophizing scale or PCS), fear of reinjury or pain from movement (Tampa scale for kinesiophobia or TSK and Fear Avoidance Beliefs Questionnaire or FABQ), pain coping methods (brief COPE, and Pain Coping Methods or PCM). The association between these preoperative scores and number of post-operative pain scripts, office visits, office telephone encounters, re-injury and return to sport within 12 months as well as physical therapist documented poor perceived effort were analyzed.

Results

Increased preoperative McGill pain scores were predictive of a higher requested number of post-operative pain scripts (R-square 0.10, p=0.007), pain-related telephone encounters in the first month (p=0.002) and decreased return to sport (p=0.04). High pain catastrophizing scores (PCS) and kinesiophobia scoreswere associated with poor perceived effort in rehabilitation (p=0.002 and p=0.04), decreased rates of return to sport (p=0.001 and p=0.03), and increased re-injury rates (p=0.04 and p=0.02). Low pre-op IKDC scores were predictive of a higher number of post-operative pain scripts (p=0.02), and number of telephone encounters in the first year (p=0.005). Lower pain coping scores on the PCM emotional coping subscale were predictive of higher total number of pain scripts filled (p= 0.03) and number of telephone encounters in the first year (p= 0.03).

Conclusions

Preoperative pain perceptions are significantly associated with effort in physical therapy and functional outcomes such as return to sport after ACL reconstruction. Additionally, maladaptive pain perceptions appear to be predictive of higher healthcare resource utilization post-operatively as well as higher re-injury rates.