Importance of self-rated health and mental well-being in predicting health outcomes following total joint replacement surgery for osteoarthritis
Article first published online: 29 JUN 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 7, pages 973–981, July 2011
How to Cite
Perruccio, A. V., Davis, A. M., Hogg-Johnson, S. and Badley, E. M. (2011), Importance of self-rated health and mental well-being in predicting health outcomes following total joint replacement surgery for osteoarthritis. Arthritis Care Res, 63: 973–981. doi: 10.1002/acr.20467
- Issue published online: 29 JUN 2011
- Article first published online: 29 JUN 2011
- Accepted manuscript online: 18 MAR 2011 12:15PM EST
- Manuscript Accepted: 1 MAR 2011
- Manuscript Received: 18 AUG 2010
- Canadian Institutes of Health Research Operating Grant. Grant Number: 77518
- Canadian Institutes of Health Research Canada Graduate Scholarship Doctoral Award
The determinants of outcomes and the scope of outcomes examined in total joint replacement (TJR) typically have been limited to aspects of physical health. We investigated mental well-being, physical and social health, and self-rated health (SRH) as predictors of future health status within a cohort undergoing a TJR for hip or knee osteoarthritis. We also investigated the interrelationships among these health dimensions as they relate to SRH.
Participants (n = 215 hip, n = 234 knee) completed measures presurgery and 3 and 6 months postsurgery, including pain, physical function, fatigue, anxiety, depression, social participation limitations, passive/active recreation, community mobility, and SRH. Structural equation modeling was used to investigate the interrelationship between 3 latent health dimensions (physical, mental, social) and the predictive significance of SRH for future health status.
The mean age was 63.5 years (range 31–88 years) and 60% were women. Prior dimension status strongly predicted future status. Adjusted for prior dimension scores, comorbidity, and sociodemographic characteristics, SRH predicted future scores for all 3 health dimensions. Worse prior SRH predicted less improvement at all time points. The effects of physical and social health on SRH were fully mediated through mental well-being. Only mental well-being significantly predicted SRH, within and across time.
Mental well-being is critical for understanding the relationship between physical health and SRH. In addition, SRH significantly predicts TJR outcomes, above and beyond prior physical health. The exclusive focus on any one health dimension may lead to missed opportunities for predicting and improving outcomes following surgery, and likely improving overall health generally.