The role of preoperative self-efficacy and outcome expectancies in predicting short-term functional recovery and length of hospital stay after total hip replacement or total knee replacement: a prospective, observational study.

Abstract

Background: A substantial group of patients who have undergo a total hip replacement (THR) or total knee replacement (TKR) shows a delayed short-term functional recovery and prolonged length of hospital stay (LoS). Knowledge about preoperative predictors is crucial to select these high risk patients prior to surgery. There has been a growing awareness of the predictive value of preoperative psychosocial factors on functional recovery and LoS after THR or TKR. However, the predictive value of preoperative self-efficacy and outcome expectancies on functional recovery during hospital stay and LoS has not yet been determined in patients after THR or TKR.

Objectives: Primary: To investigate the predictive value of preoperative self-efficacy and outcome expectancies on postoperative functional recovery during hospital stay, measured with the Modified Iowa Assistance Scale, after THR or TKR. Secondary: To investigate the predictive value of preoperative self-efficacy and outcome expectancies on LoS after THR or TKR. Design: Prospective, longitudinal, observational design.

Methods: Patients, diagnosed with hip or knee osteoarthritis, undergoing a primary, elective THR or TKR at a general district hospital with an age greater than 18 years and knowledge of the Dutch language were recruited. Preoperatively, patients completed the Dutch translation of the Self-Efficacy for Rehabilitation Outcome Scale and the Hip or Knee Replacement Expectations Survey. Besides, demographic, anthropometric, medical and functional indices were registered. Postoperatively, functional recovery during hospital stay, objectified by Modified Iowa Levels of Assistance Scale, and LoS in postoperative days were recorded. Predictive value of candidate predictors was determined by multiple regression analysis.

Results: Sixty-six patients awaiting THR and 48 patients awaiting TKR were recruited into this study. The mean age of patients awaiting THR was 67.9 years (SD=9.2) and 28.8 % were male. The mean age of patients awaiting TKR was 69.5 years (SD=9.2) and 37.5% were male. In the multiple regression analysis, preoperative self-efficacy was a significant predictor of functional recovery after THR, indicating that a higher self-efficacy is associated with a decrease in days to be functional recovered.

Conclusion: The results of this longitudinal prospective observational study suggest that preoperative self-efficacy is a significant predictor of functional recovery after THR. Future research is needed to compare the predictive value of pre- and postoperative self-efficacy and outcome expectancies on functional recovery during hospital stay and LoS.