title: Symptoms of postsurgical distress following total knee replacement and their relationship to recovery outcomes.
abstract: OBJECTIVE
  Prior research has suggested that posttraumatic stress symptoms may occur in the context of medical events. Further, these symptoms are often comorbid with conditions associated with pain. Therefore, the current study examined the occurrence of distress following arthroplastic surgery and the relationship of these symptoms to postoperative recovery.
  
  
  METHODS
  Patients (N =110) undergoing unilateral, total knee replacement (TKR) surgery were assessed at three time points proximal to their surgery: approximately 2 weeks prior to surgery (T1), 1 month following surgery (T2) and 3 months following surgery (T3). Patients completed survey assessments of recovery outcomes (Western Ontario and McMaster Universities Osteoarthritis Index) and distress (The Impact of Event Scale [IES]) following surgery (T2 and T3).
  
  
  RESULTS
  A significant percentage (20%) of patients undergoing TKR reported noteworthy levels of postsurgical stress 1 and 3 months following surgery. Further, this distress was associated with a more difficult recovery following TKR, characterized by more severe pain and greater functional limitations. After controlling for potential confounding variables, regression analyses suggested that postsurgical stress was cross-sectionally related to pain perception and longitudinally predicted subsequent functional limitations and global assessments of recovery.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to examine postoperative distress (using the IES) following TKR. The present study adds to the growing body of literature documenting the impact of psychological processes on postoperative recovery.
authors.affiliation: Department of Psychology, Kent State University at Stark, N Canton, OH 44720, USA. jcremean@kent.edu
authors.forename: Julie K
authors.initials: JK
authors.lastname: Cremeans-Smith
authors.forename: Kenneth
authors.initials: K
authors.lastname: Greene
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Delahanty
mesh_terms: D000328:Adult; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D006801:Humans; D020370:Osteoarthritis, Knee / Q000601:surgery; D058748:Pain Perception; D010149:Postoperative Pain / Q000523:psychology; D011184:Postoperative Period; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome