title: 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.
  
  
  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).
  
  
  METHODS
  Level 3, Non-randomized prospective controlled cohort.
authors.affiliation: Department of Prosthetic Surgery, Santa Corona Hospital, ASL 2 - Savonese, via XXV Aprile 38, 17027, Pietra Ligure, SV, Italy. trisve@libero.it.
authors.forename: V
authors.initials: V
authors.lastname: Tristaino
authors.affiliation: Health Science Department, Biostatistics Unit, University of Genoa, via Pastore 1, Genoa, 16132, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Lantieri
authors.affiliation: Department of Prosthetic Surgery, Santa Corona Hospital, ASL 2 - Savonese, via XXV Aprile 38, 17027, Pietra Ligure, SV, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Tornago
authors.affiliation: Department of Prosthetic Surgery, Santa Corona Hospital, ASL 2 - Savonese, via XXV Aprile 38, 17027, Pietra Ligure, SV, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gramazio
authors.affiliation: Department of Prosthetic Surgery, Santa Corona Hospital, ASL 2 - Savonese, via XXV Aprile 38, 17027, Pietra Ligure, SV, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Carriere
authors.affiliation: Department of Prosthetic Surgery, Santa Corona Hospital, ASL 2 - Savonese, via XXV Aprile 38, 17027, Pietra Ligure, SV, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Camera
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000517:prevention & control; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012944:Social Support; D016896:Treatment Outcome
keywords: Depression scale; Hip arthroplasty; Hospital anxiety; Knee arthroplasty; Psychological support; SF-36