Screening preoperative anxiety – when does it relate to the quality of life among patients before total joint replacement? Preliminary reports
More details
Hide details
Department of Medical Psychology and Medical Communication, Second Faculty of Medicine, Medical University of Warsaw, Poland
Submission date: 2018-08-16
Final revision date: 2019-04-12
Acceptance date: 2019-04-12
Online publication date: 2019-06-05
Publication date: 2019-06-04
Health Psychology Report 2019;7(2):139-148
Anxiety among patients undergoing joint replacement increases the risk of post-surgery complications and mental health problems, and impairs health-related quality of life (HRQoL). Since clinical procedures require adequate, but possibly simple and cost-saving tools, an augmenting application of a one-item visual analogue scale for anxiety (VAS-A) has been observed. The purpose of the present study is to validate the VAS-A using the State-Trait Anxiety Inventory (STAI) and consider both as HRQoL predictors among patients waiting for total joint replacement.

Participants and procedure:
Patients (n = 68, 34% male), hospitalized for total hip or knee replacement, participated before surgery in this cross-sectional study. They completed the Nottingham Health Profile (NHP) to assess their HRQoL, the VAS-A and STAI for anxiety, and the Visual Analogue Scale for pain as a control variable.

Although the VAS-A correlated with the STAI score (r = .29, p = .019 for the state anxiety subscale), this conven-ient measure did not relate to the NHP results (NHP total score β = –0.03, p = .799), while the STAI results did, especially the trait subscale (β = 1.29, p < .001, CI 0.82 to 1.75).

The value of the VAS-A regarding HRQoL is limited while trait anxiety seems a disregarded factor significantly referring to HRQoL. Its assessment, in addition to the evaluation of temporary emotional states, might provide benefits in the clinical management of patients within surgery, orthopedic and rehabilitation care. Intervention possibilities for those with altered trait anxiety are discussed.

Anxiety Disorder Association of America (2016). Prevalence of anxiety in general population by Anxi-ety Disorder Association of America. Retrieved from http://www.adaa.org/about-adaa....
Aust, H., Eberhart, L., Sturm, T., Schuster, M., Nestoriuc, Y., Brehm, F., & Rüsch, D. (2018). A cross-sectional study on preoperative anxiety in adults. Journal of Psychosomatic Research, 111, 133–139. https://doi.org/10.1016/j.jpsy....
Ayers, D. C., Franklin, P. D., Trief, P. M., Ploutz-Snyder, R., & Freund, D. (2004). Psychological at-tributes of preoperative total joint replacement patients: implications for optimal physical outcome. Journal of Arthroplasty, 19, 125–130.
Busija, L., Pausenberger, E., Haines, T. P., Haymes, S., Buchbinder, R., & Osborne, R. H. (2011). Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Util-ities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care and Research, 63, 383–412.
Carr, A. (2003). Adult measures of quality of life: The Arthritis Impact Measurement Scales (AIMS/AIMS2), Disease Repercussion Profile (DRP), EuroQoL, Nottingham Health Profile (NHP), Patient Generated Index (PGI), Quality of Well-Being Scale (QWB), RAQoL, Short Form-36 (SF-36), Sickness Impact Profile (SIP), SIP-RA, and World Health Organization’s Quality of Life Instruments (WHOQoL, WHOQoL-100, WHOQoL-Bref). Arthritis Care & Research, 49, S113–S133. https://doi.org/10.1002/art.11....
Chew, E., Griva, K., & Cheung, P. P. (2016). Evaluation of coping strategies in established rheuma-toid arthritis patients: emergence of concealment in an Asian cohort. International Journal of Rheu-matic Diseases, 19, 1069–1077.
Chou, L. N., & Chen, M. L. (2019). Effects of elastic band exercise on lower limb rehabilitation of el-derly patients undergoing total knee arthroplasty. Rehabilitation Nursing, 44, 60–66. https://doi.org/10.1097/rnj.00....
Czyżewska, A., Glinkowski, W. M., & Walesiak, K. (2014). Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement. Archives of Medical Science, 10, 985–991.
Duivenvoorden, T., Vissers, M. M., Verhaar, J. A., Busschbach, J. J., Gosens, T., Bloem, R. M., Bierma-Zeinstra, S. M., & Reijman, M. (2013). Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis and Cartilage, 21, 1834–1840.
Elmallah, R. K., Chughtai, M., Adib, F., Bozic, K. J., Kurtz, S. M., & Mont, M. A. (2016). Determining Health-Related Quality-of-Life Outcomes Using the SF-6D Following Total Hip Arthroplasty. Journal of Bone and Joint Surgery, 99, 494–498.
Facco, E., Stellini, E., Bacci, C., Manani, G., Pavan, C., Cavallin, F., & Zanette, G. (2013). Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation. Minerva Anestesiologica, 79, 1389–1395.
Garnefski, N., Kraaij, V., Benoist, M., Bout, Z., Karels, E., & Smit, A. (2013). Effect of a cognitive behavioral self-help intervention on depression, anxiety, and coping self-efficacy in people with rheumatic disease. Arthritis Care and Research, 65, 1077–1084.
Gill, S. D., & McBurney, H. (2013). Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials. Archives of Physical Medicine and Rehabilitation, 94, 164–176.
Hayashi, K., Kako, M., Suzuki, K., Hattori, K., Fukuyasu, S., Sato, K., Kadono, I., Sakai, T., Hasega-wa, Y., & Nishida, Y. (2016). Gait speeds associated with anxiety responses to pain in osteoarthri-tis patients. Pain Medicine, 17, 606–613.
Ho, R. C. M., Fu, E. H. Y, Chua, A. N. C., Cheak, A. A., & Mak, A. (2011). Clinical and psychosocial factors associated with depression and anxiety in Singaporean patients with rheumatoid arthritis. International Journal of Rheumatic Diseases, 14, 37–47.
Hunt, S. M., McKenna, S. P., McEwen, J., Williams, J., & Papp, E. (1981a). The Nottingham Health Profile: Subjective health status and medical consultations. Social Science and Medicine, 15, 221–229.
Hunt, S. M., McKenna, S. P., & Williams, J. (1981b). Reliability of a population survey tool for meas-uring perceived health problems: a study of patients with osteoarthritis. Journal of Epidemiology and Community Health, 35, 297–300.
Hussein, D. A., McKenna, S. P., & Scott, D. L. (1997). The Nottingham Health Profile as a measure of disease activity and outcome in rheumatoid arthritis. British Journal of Rheumatology, 36, 69–73.
Jokar, F., Yousefi, H., Yousefy, A., & Sadeghi, M. (2017). Begin again and continue with life: A auali-tative study on the experiences of cardiac rehabilitation patients. Journal of Nursing Research, 25, 344–352.
Julian, J. (2011). Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care and Research, 63, S467–S472.
Kepka, S., Baumann, C., Anota, A., Buron, G., Spitz, E., Auquier, P., Guillemin, F., & Mercier M. (2013). The relationship between traits optimism and anxiety and health-related quality of life in pa-tients hospitalized for chronic diseases: data from the SATISQOL study. Health and Quality of Life Outcomes, 11, 134.
Khatib, Y., Jenkin, D., Naylor, J. M., & Harris, I. A. (2016). Psychological traits in patients waiting for total knee arthroplasty. A cross-sectional study. Journal of Arthroplasty, 31, 1661–1666.
Khatib, Y., Madan, A., Naylor, J. M., & Harris, I. A. (2015). Do psychological factors predict poor out-come in patients undergoing TKA? A systematic review. Clinical Orthopaedics and Related Re-search, 473, 2630–2638.
Kim, Y. S., Park, Y. S., Allegrante, J. P., Marks, R., Ok, H., Ok Cho, K., & Garber, C. E. (2012). Rela-tionship between physical activity and general mental health. Preventive Medicine, 55, 458–463.
Knight, R. G., Waal-Manning, H. J., & Spears, G. F. (1983). Some norms and reliability data for the State-Trait Anxiety Inventory and the Zung Self-Rating Depression scale. British Journal of Clinical Psychology, 22, 245–249.
Kvaal, K., Ulstein, I., Nordhus, I. H., & Engedal, K. (2005). The Spielberger State-Trait Anxiety Invento-ry (STAI): the state scale in detecting mental disorders in geriatric patients. International Journal of Geriatric Psychiatry, 20, 629–634.
Marks, R. (2009). Comorbid depression and anxiety impact hip osteoarthritis disability. Disability and Health Journal, 2, 27–35.
Millar, K., Jelicic, M., Bonke, B., & Asbury, A. J. (1995). Assessment of preoperative anxiety: compar-ison of measures in patients awaiting surgery for breast cancer. British Journal of Anaesthesia, 74, 180–183.
Montin, L., Leino-Kilpi, H., Katajisto, J. Lepistö, J., Kettunen, J., & Suominen T. (2007). Anxiety and health-related quality of life of patients undergoing total hip arthroplasty for osteoarthritis. Chronic Illness, 3, 219–227.
Neuprez, A., Delcour, J. P., Fatemi, F., Gillet, P., Crielaard, J. M., Bruyère, O., & Reginster, J. Y. (2016). Patients’ expectations impact their satisfaction following total hip or knee arthroplasty. PLoS One, 11, e0167911.
Owczarek, K. (2010). The concept of quality of life. Acta Neuropsychologica, 8, 207–213.
Ozcakir, S., Raif, S. L., Sivrioglu, K., & Kucukcakir, N. (2011). Relationship between radiological se-verity and clinical and psychological factors in knee osteoarthritis. Clinical Rheumatology, 30, 1521–1526.
Qi, A., Lin, C., Zhou, A., Du, J., Jia, X., Sun, L., Zhang, G., Zhang, L., & Liu, M. (2016). Negative emo-tions affect postoperative scores for evaluating functional knee recovery and quality of life after total knee replacement. Brazilian Journal of Medical and Biological Research, 49, e4616.
Papakostidou, I., Dailiana, Z. H., Papapolychroniou, T., Liaropoulos, L., Zintzaras, E., Karachalios, T. S., & Malizos, K. N. (2012). Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskeletal Disorders, 13, 116.
Pinto, P. R., McIntyre, T., Ferrero, R., Almeida, A., & Araújo-Soares, V. (2013). Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. Journal of Pain, 14, 502–515.
Piscitelli, P., Iolascon, G., Di Tanna, G., Bizzi, E., Chitano, G., Argentiero, A., Neglia, C., Giolli, L., Distante, A., Gimigliano, R., Brandi, M. L., & Migliore, A. (2012). Socioeconomic burden of total joint arthroplasty for symptomatic hip and knee osteoarthritis in the Italian population: a 5-year analysis based on hospitalization records. Arthritis Care and Research, 64, 1320–1327. https://doi.org/10.1002/acr.21....
Prieto, L., Alonso, J., Viladrich, M. C., & Antó, J. M. (1996). Scaling the Spanish version of the Not-tingham Health Profile: evidence of limited value of item weights. Journal of Clinical Epidemiology, 49, 31–38.
Rasouli, M., Menendez, M. E., Sayadipour, A., Purtill, J. J., & Parvizi, J. (2016). Direct cost and com-plications associated with total joint arthroplasty in patients with preoperative anxiety and depres-sion. Journal of Arthroplasty, 31, 533–536.
Rat, A. C., Guillemin, F., Osnowycz, G., Delagoutte, J. P., Cuny, C., Mainard, D., & Baumann, C. (2010). Total hip or knee replacement for osteoarthritis: mid- and long-term quality of life. Arthritis Care and Research 62, 54–62.
Resnick, B., Orwig, D., Wehren, L., Hawkes, W., Hebel, R., Zimmerman, S., & Magaziner, J. (2005). Health-related quality of life: is it a good indicator of function post THR? Rehabilitation Nursing, 30, 46–54.
Şendir, M., Büyükyılmaz, F., & Muşovi, D. (2013). Patients’ discharge information needs after total hip and knee arthroplasty: a quasi-qualitative pilot study. Rehabilitation Nursing, 38, 264–271.
Singh, J. A., & Lewallen, D. G. (2013). Medical and psychological comorbidity predicts poor pain outcomes after total knee arthroplasty. Rheumatology, 52, 916–923.
Stubbs, B., Aluko, Y., Myint, P. K., & Smith, T. O. (2016). Prevalence of depressive symptoms and anxiety in osteoarthritis: a systematic review and meta-analysis. Age and Ageing, 45, 228–235.
Tang, J., & Gibson, S. J. (2005). A psychophysical evaluation of the relationship between trait anxie-ty, pain perception, and induced state anxiety. Journal of Pain, 6, 612–619.
Uutela, T., Hakala, M., & Kautiainen, H. (2003). Validity of the Nottingham Health Profile in a Finnish out-patient population with rheumatoid arthritis. Rheumatology, 42, 841–845.
Vissers, M. M., Bussmann, J. B., Verhaar, J. A., Busschbach, J. J., Bierma-Zeinstra, S. M., & Reijman, M. (2012). Psychological factors affecting the outcome of total hip and knee arthro-plasty: a systematic review. Seminars in Arthritis and Rheumatism, 41, 576–588.
Wilson, C. J., Mitchelson, A. J., Tzeng, T. H., El-Othmani, M. M., Saleh, J., Vasdev, S., LaMonta-gne, H. J., & Saleh, K. (2016). Caring for the surgically anxious patient: a review of the interven-tions and a guide to optimizing surgical outcomes. American Journal of Surgery, 212, 151–159.
Woolf, A. D., & Pfleger, B. (2003). Burden of major musculoskeletal conditions. Bulletin of the World Health Organization, 81, 646–656.
Wrześniewski, K. (1997). Badanie subiektywnego stanu zdrowia za pomocą polskiej adaptacji the Not-tingham Health Profile [Evaluating subjective health status with Polish adaptation of Nottingham Health Profile]. In J. B. Karski, H. Kirschner, & J. Leowski (Eds.), Współczesne potrzeby i możliwo-ści pomiaru zdrowia [Current needs and possibilities in health assessment] (pp. 37–41). Warsaw: Ig-nis.
Wrześniewski, K., Sosnowski, T., & Matusik, D. (2002). Inwentarz Stanu i Cechy Lęku STAI – polska adaptacja STAI. Podręcznik [Polish adaptation of State and Trait Anxiety Index]. Warsaw: PTP.
Wylde, V., Dixon, S., & Blom, A. W. (2012). The role of preoperative self-efficacy in predicting out-come after total knee replacement. Musculoskeletal Care, 10, 110–118.
Yildiz, N., Topuz, O., Gungen, G. O., Deniz, S., Alkan, H., & Ardic, F. (2010). Health-related quality of life (Nottingham Health Profile) in knee osteoarthritis: correlation with clinical variables and self-reported disability. Rheumatology International, 30, 1595–1600.
Copyright: © Institute of Psychology, University of Gdansk This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Journals System - logo
Scroll to top