title: Rehabilitation following surgery: clinical and psychological predictors of activity limitations.
abstract: OBJECTIVE
  Activity limitations following surgery are common, and patients may have an extended period of pain and rehabilitation. Inguinal hernia surgery is a common elective procedure. This study incorporated fear-avoidance models in investigating cognitive and emotional variables as potential risk factors for activity limitations 4 months after inguinal hernia surgery.
  
  
  METHODS
  This was a prospective cohort study, predicting activity limitations 4 months postoperatively (Time 3 [T3]) from measures taken before surgery (Time 1, [T1]) and 1 week after surgery (Time 2 [T2]). The sample size at T1 was 135; response rates were 89% and 84% at T2 and T3 respectively. Questionnaires included measures of catastrophizing, fear of movement, depression, anxiety, optimism, perceived control over pain, pain, and activity limitations. Biomedical and surgical variables were recorded. Predictors of T3 activity limitations from T1 and T2 were examined in hierarchical multiple regression equations.
  
  
  RESULTS
  Over half of participants (57.7%) reported activity limitations due to their hernia at 4 months post-surgery. Higher activity limitation levels were significantly predicted by older age, higher preoperative activity limitations, higher preoperative anxiety, and more severe postoperative pain and depression scores.
  
  
  CONCLUSIONS
  Interventions to reduce preoperative anxiety and postoperative depression may lead to reduced 4-month activity limitations. However, the additional variance explained by psychological variables was low (ΔR² = 0.05). Our models, which included biomedical and surgical variables, accounted for less than 50% of the variance in activity limitations overall. Therefore, further investigation of psychological variables, particularly cognitions related specifically to activity behavior, would be merited.
authors.affiliation: School of Psychological Sciences, University of Manchester.
authors.forename: Rachael
authors.initials: R
authors.lastname: Powell
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.forename: W Cairns
authors.initials: WC
authors.lastname: Smith
authors.forename: Peter M
authors.initials: PM
authors.lastname: King
authors.forename: W Alastair
authors.initials: WA
authors.lastname: Chambers
authors.forename: Lorna
authors.initials: L
authors.lastname: McKee
authors.forename: Julie
authors.initials: J
authors.lastname: Bruce
mesh_terms: D000367:Age Factors; D001007:Anxiety / Q000150:complications / Q000523:psychology; D058443:Catastrophization / Q000150:complications / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000523:psychology; D005239:Fear / Q000523:psychology; D005260:Female; D006552:Hernia, Inguinal / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D010149:Postoperative Pain / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation*; D011446:Prospective Studies; D012307:Risk Factors; D012606:Scotland; D011795:Surveys and Questionnaires; D016896:Treatment Outcome