Removing barriers to recovery improves surgical outcomes

When performed prior to orthopaedic surgery, an evaluation from a health behavior psychologist can improve patient outcomes, according to a new study from the University of Missouri School of Medicine. 

Even if the surgery goes well, a successful recovery depends on the patient following the recovery and rehabilitation plan recommended by their doctors. For example, a patient may be prescribed medications, physical therapy and activity restrictions for weeks. Failing to follow the postoperative plan is called nonadherence and has been associated with up to a 15.5 times greater risk for treatment failure after orthopaedic surgery.  

Nonadherence typically results from a combination of factors, often involving barriers that stand in the way of a full recovery. 

“In our study, meeting with a health behavior psychologist helped patients identify potential barriers to recovery and work on ways to address them,” said Kylee Rucinski, study co-author. “The most common barriers that patients reported were ongoing mental health issues and having a high-energy job or hobby that would make it difficult for them to follow the restrictions they were given after surgery.” 

Working with a total of 99 patients, the health behavior psychologist involved with the study, Renee Stucky, would gather information on the patient’s mental health and trauma history, assess patient-specific challenges and identify areas in their life that may need more attention and support.  

In this study, only 7 patients (7%) needed surgery again – and nonadherence was not significantly associated with failure, as seen in previous studies. This suggests that meeting with a health behavior psychologist before orthopaedic surgery can reduce the risk for nonadherence, and in turn, reduce the risk of failure. 

“Surgical outcomes improved when we looked at the patient as a person, rather than just focusing on the medical problem,” senior author James Cook said. “These results are a testament to our focus on patient-centered care and the power of an integrated care team.” 

The research only studied patients undergoing an osteochondral allograft transplantation, which is a surgery that uses donor tissue to restore damaged knee, hip, ankle and shoulder joints; however, other types of surgeries, like bariatric and spinal cord surgery, have also used psychological evaluations for similar purposes.  

This suggests that behavioral health evaluations could be used for different types of surgery and may improve outcomes, but obstacles to more widespread use remain. Rucinski said there aren’t enough people trained as behavioral health psychologists, and that other ways to identify risk factors before surgery, like worksheets or visits with other professionals, should be studied to determine if they can also be effective at identifying and reducing barriers to recovery.  

Kylee Rucinski, PhD is an assistant research professor of orthopaedic surgery at the Mizzou School of Medicine and focuses her research on how to improve patient-centered orthopaedic care. James L. Cook, DVM, PhD, OTSC is the Vice Chair of Orthopaedic Research, Director of Operations & Research at the Joint and Limb Preservation Center and the William C. and Kathryn E. Allen Distinguished Chair in Orthopaedic Surgery at the Mizzou School of Medicine. 

“Presurgical Evaluation by a Health Behavior Psychologist Can Effectively Delineate Patient-Specific Barriers that Impact Treatment Outcomes after Osteochondral Allograft Transplantation” was recently published in the Journal of Knee Surgery. In addition to Rucinski and Cook, Mizzou study authors include Renee Stucky, PhD, behavioral health psychologist at the Missouri Orthopaedic Institute and clinical practice professor at the School of Medicine; James Stannard, MD, orthopaedic surgeon at MU Health Care and Medical Director of the Missouri Orthopaedic Institute; and Clayton Nuelle, MD, orthopaedic surgeon and sports medicine doctor at MU Health Care and an official team doctor for Mizzou Athletics. Felicia Jones, a medical student in Kansas City also contributed.