Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study

Contains fulltext : 175778.pdf (publisher's version ) (Open Access)BACKGROUND: Despite the overall success of total hip replacement (THR) in patients with symptomatic osteoarthritis (OA), up to one-quarter of patients report suboptimal recovery. The aim of this study was to determine whether social support and general self-efficacy predict variability in short-term recovery in a Norwegian cohort. METHODS: We performed secondary analysis of a prospective multicenter study of 223 patients who underwent THR for OA in 2003-2004. The total score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3 months after surgery was used as the recovery variable. We measured self-efficacy using the General Self-Efficacy Scale (GSES) and social support with the Social Provisions Scale (SPS). Preoperative and postoperative scores were compared using Wilcoxon tests. The Mann-Whitney U test compared scores between groups that differed in gender and age. Spearman's rho correlation coefficients were used to evaluate associations between selected predictor variables and the recovery variable. We performed univariate and multiple linear regression analyses to identify independent variables and their ability to predict short-term recovery after THR. RESULTS: The median preoperative WOMAC score was 58.3 before and 23.9 after surgery. The mean absolute change was 31.9 (standard deviation [SD] 17.0) and the mean relative change was 54.8% (SD 26.6). Older age, female gender, higher educational level, number of comorbidities, baseline WOMAC score, self-efficacy, and three of six individual provisions correlated significantly with short-term recovery after THR and predicted the variability in recovery in the univariate regression model. In multiple regression models, baseline WOMAC was the most consistent predictor of short-term recovery: a higher preoperative WOMAC score predicted worse short-term recovery (beta = 0.44 [0.29, 0.59]). Higher self-efficacy predicted better recovery (beta = -0.44 [-0.87, -0.02]). Reliable alliance was a significant predictor of improved recovery (beta = -1.40 [-2.81, 0.01]). CONCLUSIONS: OA patients' general self-efficacy and the expectation of others' tangible assistance predict recovery after THR. Researchers and clinicians should target these psychosocial factors together with the patients and their families to improve the quality of care and surgical outcomes

Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a web-based intervention.

BACKGROUND: This pretrial study aimed to develop and test the usability of a four-week Internet intervention delivered by a Web-enabled mobile phone to support self-management of chronic widespread pain. METHODS: The intervention included daily online entries and individualized written feedback, grounded in a mindfulness-based cognitive behavioral approach. The participants registered activities, emotions and pain cognitions three times daily using the mobile device. The therapist had immediate access to this information through a secure Web site. The situational information was used to formulate and send a personalized text message to the participant with the aim of stimulating effective self-management of the current situation. Six women participated and evaluated the experience. RESULTS: The intervention was rated as supportive, meaningful and user-friendly by the majority of the women. The response rate to the daily registration entries was high and technical problems were few. CONCLUSION: The results indicate a feasible intervention. Web-applications are fast becoming standard features of mobile phones and interventions of this kind can therefore be more available than before. (aut. ref.

Analyzing change processes resulting from a smartphone maintenance intervention based on acceptance and commitment therapy for women with chronic widespread pain.

Purpose: This study investigated change processes resulting from a randomized controlled trial smartphone-delivered maintenance intervention with daily electronic diaries and personalized written feedback based on acceptance and commitment therapy (ACT) following a rehabilitation program for patients with chronic widespread pain. Method: This study included 48 women who during a 5-week period completed electronic diaries three times daily, totaling 3372 entries. In response to the completed diaries, they received daily feedback from a therapist for 4 weeks (excluding weekends), totaling 799 feedback messages. To analyze the change processes, we explored the associations between feedback and daily ratings of participants’ physical activities, positive emotions, pain fear and avoidance, pain acceptance, and self-management. Commitment to physical activities and the participants’ evaluation of feedback were also analyzed. Multilevel models were used in the statistical analyses. Results: Participants’ average pain fear and avoidance decreased over the intervention period (mean −0.019, P = 0.05). Self-management, pain acceptance, and positive feelings increased (mean −0.030, P < 0.01; mean −0.015, P < 0.01; and mean −0.011, P = 0.01, respectively). Participants’ performance of physical activities decreased slightly over time, but the level of commitment was high and they evaluated the feedback as supportive for staying sufficiently active. No correlation between diary contents and feedback messages was found, even though most of the participants evaluated the feedback as supportive. Conclusion: No support was found for an association between diary content and feedback based on ACT. However, diary measures were consistent with the ACT model and may have influenced positively the change processes. (aut. ref.