Derivation of a clinical prediction rule for chronic post-surgical pain after total knee arthroplasty considering biopsychosocial factors: A prospective cohort study

Junji Nishimoto; Taketo Shiraoka; Yoshihiro Takiguchi; Ryota Imamura; Kenta Hirohama; Shigeharu Tanaka; Yu Inoue; Shigeru Obayashi; Ryo Tanaka

doi:10.1016/j.knee.2023.04.015

Derivation of a clinical prediction rule for chronic post-surgical pain after total knee arthroplasty considering biopsychosocial factors: A prospective cohort study

Knee. 2023 Jun:42:364-372. doi: 10.1016/j.knee.2023.04.015. Epub 2023 May 5.

Authors

Junji Nishimoto¹, Taketo Shiraoka², Yoshihiro Takiguchi³, Ryota Imamura³, Kenta Hirohama⁴, Shigeharu Tanaka⁵, Yu Inoue⁶, Shigeru Obayashi⁷, Ryo Tanaka⁸

Affiliations

¹ Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation, Saitama Medical Center, Saitama Medical University, Saitama, Japan. Electronic address: d212512@hiroshima-u.ac.jp.
² Department of Rehabilitation, Kawagoe Clinic, Saitama Medical University, Saitama, Japan.
³ Department of Rehabilitation, Hiroshima Clinic, Hiroshima, Japan.
⁴ Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan.
⁵ Faculty of Health and Social Services, Kanagawa University of Human Services, Kanagawa, Japan.
⁶ Research Institute of Health and Welfare, Kibi International University, Okayama, Japan; Department of Rehabilitation, Kurashiki Heisei Hospital, Okayama, Japan.
⁷ Department of Rehabilitation, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
⁸ Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan.

PMID: 37150024
DOI: 10.1016/j.knee.2023.04.015

Abstract

Background: Biopsychosocial factors are involved in the occurrence of chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA). The purpose of this study was to develop a clinical prediction rule (CPR) that considers biopsychosocial factors to predict which patients are more likely to develop CPSP after TKA.

Methods: CPSP after TKA was dichotomized into CPSP and non-CPSP groups using the Likert scale and Minimal clinically important difference, and binomial logistic regression analysis was performed. Cut-off values were then calculated using the extracted factors and dichotomized variables. The cut-off values and dichotomized variables were then used to derive a CPR that discriminates between groups with and without CPSP.

Results: Seventy-one TKA patients were included in the study. Binomial logistic regression analysis revealed that Central Sensitization Inventory (CSI) and Pittsburgh Sleep Quality Index (PSQI) were associated with CPSP. The cut-off values for CSI and PSQI were 26 and 7, respectively. The CPSP scale was created using the cut-off values of CSI and PSQI, with a score of 0 for being below the cut-off values of both CSI and PSQI, 1 for being above the cut-off values of either CSI or PSQI, and 2 for being above the cut-off values of both CSI and PSQI. Furthermore, the area under the curve (AUC) for CPR created by the presence of CPSP and using the CPSP scale was significant (AUC = 0.766; P = 0.001).

Conclusion: The combination of the two tests, CSI and PSQI, suggested the possibility of predicting CPSP after TKA.

Keywords: Biopsychosocial factors; Chronic post-surgical pain; Clinical prediction rule; Total knee arthroplasty.

MeSH terms

Arthroplasty, Replacement, Knee* / adverse effects
Chronic Pain* / diagnosis
Chronic Pain* / epidemiology
Chronic Pain* / etiology
Clinical Decision Rules
Humans
Pain, Postoperative / diagnosis
Pain, Postoperative / epidemiology
Pain, Postoperative / etiology
Prospective Studies