The relationship between pain with walking and self-rated health 12 months following total knee arthroplasty: a longitudinal study.
A subgroup of patients continue to report pain with walking 12 months after total knee arthroplasty (TKA). The association between walking pain and self-rated health (SRH) after TKA is not known. This prospective longitudinal study aimed to investigate the association between a comprehensive list of preoperative factors, postoperative pain with walking, and SRH 12 months after TKA.



Patients (N = 156) scheduled for TKA completed questionnaires that evaluated demographic and clinical characteristics, symptoms, psychological factors, and SRH. SRH was re-assessed 12 months after TKA. Clinical variables were retrieved from medical records. Pain with walking was assessed before surgery, at 6 weeks, 3, and 12 months after TKA. Subgroups with distinct trajectories of pain with walking over time were identified using growth mixture modeling. Multiple linear regression was used to investigate the relationships between pain with walking and other factors on SRH.



Higher body mass index, a higher number of painful sites at 12 months, recurrent pain with walking group membership, ketamine use, higher depression scores, and poorer preoperative self-rated health were associated with poorer SRH 12 months after TKA. The final model was statistically significant (p = 0.005) and explained 56.1% of the variance in SRH 12 months after surgery. SRH improved significantly over time. Higher C-reactive protein levels, higher number of painful sites before surgery, higher fatigue severity, and more illness concern was associated with poorer preoperative SRH.



In patients whose walking ability decreases over time, clinicians need to assess for unreleaved pain and decreases in SRH. Additional research is needed on interventions to improve walking ability and SRH.
Department of Surgery, Lovisenberg Diakonale Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway.|Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Pb 1072 Blindern, 0316, Oslo, Norway.
Maren Falch
MF
Lindberg
Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Pb 1072 Blindern, 0316, Oslo, Norway.|Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Pb 4956 Nydalen, 0424, Oslo, Norway.
Tone
T
Rustøen
School of Nursing, University of California, San Francisco, UCSF, Box 0610, San Francisco, CA, 94143, USA.
Christine
C
Miaskowski
Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Pb 4956 Nydalen, 0424, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Pb 1072 Blindern, 0316, Oslo, Norway.
Leiv Arne
LA
Rosseland
Department of Surgery, Lovisenberg Diakonale Hospital, Pb 4970 Nydalen, 0440, Oslo, Norway. anners.lerdal@medisin.uio.no.|Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Pb 1072 Blindern, 0316, Oslo, Norway. anners.lerdal@medisin.uio.no.
Anners
A
Lerdal
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010147:Pain Measurement / Q000592:standards / Q000639:trends*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000523:psychology; D011446:Prospective Studies; D057566:Self Report; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000523:psychology
Fatigue; Postoperative pain; Self-rated health; Total knee arthroplasty; Walking