Patients With Higher Resilience Report Greater Improvement in Global Physical Health and Pain Interference Following Foot and Ankle Surgery

Abstract

Background:

Recovery from orthopaedic surgery requires a degree of physical and mental resilience. To date, there is limited evidence evaluating the use of resilience as a preoperative benchmark in foot and ankle orthopaedic procedures. This study aims to determine whether resilience, measured using the Brief Resilience Scale (BRS), is associated with improved patient-reported outcomes following foot and ankle surgery.

Methods:

Patients undergoing foot and ankle surgery at a single institution completed the BRS scale preoperatively and were categorized into low- (LR), average- (AR), and high-resilience (HR) groups based on standard deviation (SD). Patients also completed the PROMIS physical function (PF), PROMIS pain interference (PI), PROMIS depression, PROMIS global physical health (GPH) and global mental health (GMH), and a Single Assessment Numeric Evaluation (SANE) preoperatively and 24 months postoperatively. A total of 1180 patients had at least one 24-month outcome available and were included for analysis

Results:

The mean preoperative BRS was 3.87 ± 0.69 SD, defining HR as a score of 4.57 to 5.00, AR as 3.18 to 4.56, and LR as 0.00 to 3.17. At 24-month follow-up, HR and AR patients reported significantly greater mean scores than LR patients for all collected patient-reported outcomes (P < .001). All resilience groups reported significant improvement from baseline in PF, PI, SANE, and GPH (P < .001), at an average score exceeding the published minimal clinically important difference range for each outcome. However, HR and AR patients reported significantly greater improvement compared with the LR group for PI (P = .004), and AR patients furthermore reported greater improvement in GPH (P = .033) and SANE (P = .005) compared with LR patients.

Conclusion:

Patients with higher preoperative resilience scores demonstrated greater 24-month improvements in PI, GPH, and SANE compared to patients with low resilience scores. While all groups reported clinically meaningful improvement from baseline, our results support that higher preoperative resilience, measured using BRS, is associated with improved patient-reported outcomes. Additional resources or support may be beneficial to improve postoperative outcomes for patients with lower resilience.

Graphical Abstract

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Keywords

resilience Brief Resilience Scale physical function pain interference patient-reported outcomes U-COSMOS

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References

Andrews

Tran

Young

, et al. Impact of resilience on patient reported outcome of first metatarsophalangeal arthrodesis. Osteology. 2022;2(2):87-98.

Andrews

Dib

Torrez

, et al. Impact of patient resilience on outcomes of open Brostrom-Gould lateral ligament repair. J Am Acad Orthop Surg Glob Res Rev. 2021;5(11):e21.00103. doi:10.5435/JAAOSGlobal-D-21-00103

Bongers

MER

Groot

Thio

, et al. Prospective study for establishing minimal clinically important differences in patients with surgery for lower extremity metastases. Acta Oncol. 2021;60(6):714-720. doi:10.1080/0284186x.2021.1890333

Cella

Riley

Stone

, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010;63(11):1179-1194. doi:10.1016/j.jclinepi.2010.04.011

Coronado

Robinette

Henry

, et al. Bouncing back after lumbar spine surgery: early postoperative resilience is associated with 12-month physical function, pain interference, social participation, and disability. Spine J. 2021;21(1):55-63. doi:10.1016/j.spinee.2020.07.013

DeFoor

Cognetti

Bedi

, et al. Patient resilience does not conclusively affect clinical outcomes associated with arthroscopic surgery but substantial limitations of the literature exist. Arthrosc Sports Med Rehabil. 2024;6(2):100812. doi:10.1016/j.asmr.2023.100812

DiSilvestro

Bond

Alsoof

, et al. Preoperative resilience and early postoperative outcomes following lumbar spinal fusion. World Neurosurg. 2022;163:e573-e578.

Drayer

Wallace

, et al. High resiliency linked to short-term patient reported outcomes and return to duty following arthroscopic knee surgery. Mil Med. 2020;185(1-2):112-116. doi:10.1093/milmed/usz180

Franovic

Kuhlmann

Pietroski

, et al. Preoperative patient-centric predictors of postoperative outcomes in patients undergoing arthroscopic meniscectomy. Arthroscopy. 2021;37(3):964-971. doi:10.1016/j.arthro.2020.10.042

10.

Hoch

Pire

Scott

Gross

CE.

The influence of pain and resiliency on foot and ankle surgery outcomes. Foot Ankle Orthop. 2022;7(2):24730114221108137. doi:10.1177/24730114221108137

11.

Hung

Baumhauer

Licari

Voss

Bounsanga

Saltzman

CL.

PROMIS and FAAM minimal clinically important differences in foot and ankle orthopaedics. Foot Ankle Int. 2019;40(1):65-73. doi:10.1177/1071100718800304

12.

Jildeh

Lizzio

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