Mental Toughness and Osteoarthritis: Postsurgery Improvement in Knee Pain/Functionality in Older Adults

• Published in: Rehabilitation psychology Vol. 68; no. 2; pp. 212 - 219
• Main Authors: Stamatis, Andreas, Morgan, Grant B., Spinou, Alexandra, Tsigaridis, Konstantinos G.
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-05-2023
• Subjects: Aged; Arthritis; Arthroplasty, Replacement, Knee - methods; Cognitive Ability; Female; Human; Humans; Knee; Knee Joint - surgery; Male; Older Adulthood; Osteoarthritis, Knee - diagnosis; Osteoarthritis, Knee - surgery; Pain; Psychologists; Rehabilitation; Surgery; Treatment Outcome; rehabilitation psychology; clinic-based rehabilitation; sports medicine; mentally tough; knee rehabilitation
• ISSN: 0090-5550; 1939-1544
• DOI: 10.1037/rep0000499

Purpose: To investigate longitudinally the role of mental toughness (MT) in knee rehabilitation in terms of perceived pain and functionality in a sample of older adults with arthritis who adhered to their postsurgery clinic-based rehabilitation protocols and provide suggestions to rehabilitation psychologists. Design: To strengthen the internal validity of this study, we designed our methods and implementation in a way to minimize bias by utilizing the National Institute of Health Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. The data were collected from 92 older-adult patients, who had a diagnosis of osteoarthritis and underwent knee surgery. All patients were diagnosed, underwent surgery, and were evaluated by the same physician. We administered the Oxford Knee Score (OKS) to measure rehabilitation outcomes in terms of pain and functionality and the MT Index (MTI) to measure MT levels three times: 1 day before and 1 and 6 months after the surgery. We used a multilevel growth model to examine the change in the OKS across administrations using MTI scores as a time-varying covariate and sex, age at surgery, and knee as time-invariant covariates. Results: About 62% of the variability in OKS was due to between-patient differences. Of the variability that was attributable to differences within-patient across time, MT accounted for about 38% of the variability. Conclusions: MT could be another, positive psychology-based tool rehabilitation psychologists use to contribute to health promotion efforts to reduce the incidence of disability of older adults with osteoarthritis who undergo knee replacement surgery.
Impact and Implications
Following control for in-clinic rehabilitation adherence of patients after total knee replacement surgery, this is the first study to investigate the proportion of variance in knee rehabilitation-related pain and function accounted for by mental toughness (MT) across time and the potential interaction of MT and time on the growth trajectory in knee rehabilitation-related pain and function. The study highlights the importance of considering individual levels of MT in knee rehabilitation outcomes and suggests that nearly 40% of the change across time is accounted for by an individual's MT levels. The findings indicate that healthcare providers, including surgeons and physical therapists, should focus on a multidisciplinary approach to managing the rehabilitation of total knee replacement and consider collaborating with rehabilitation psychologists to develop ways to increase MT levels before surgery.