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      A comparison of predictors and intensity of acute postsurgical pain in patients undergoing total hip and knee arthroplasty

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          Acute pain is an expected result after surgery. Nevertheless, when not appropriately controlled, acute pain has a very negative impact on individual clinical outcomes, impairing healing and recovery, and has clear consequences on health care system costs. Augmenting knowledge on predictors and potentially modifiable determinants of acute postsurgical pain can facilitate early identification of and intervention in patients at risk. However, only a few studies have examined and compared acute pain after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The aim of this study was to compare THA and TKA in acute postsurgical pain intensity and its predictors.


          A consecutive sample of 124 patients with osteoarthritis (64 undergoing THA and 60 TKA) was assessed 24 hours before (T1) and 48 hours after (T2) surgery. Demographic, clinical, and psychological factors were assessed at T1, and acute postsurgical pain experience was examined at T2. Additionally, the same hierarchical regression analysis was performed separately for each arthroplasty type.


          TKA patients reported higher levels of acute postsurgical pain compared with THA ( t=8.490, p=0.004, d=0.527, 95% confidence interval, 0.196–0.878). In the final THA predictive model, presurgical pain was the only variable approaching significant results ( t[57]=1.746, β=0.254, p=0.086). In the final TKA predictive model, optimism was the only predictor of pain ( t[51]=−2.518, β=−0.339, p=0.015), with emotional representation ( t[51]=1.895, β=0.254, p=0.064) presenting a trend toward significance.


          The current study is the first examining THA and TKA differences on acute postsurgical pain intensity and its predictors using a multivariate approach. Results from this study could prove useful for the design of distinct interventions targeting acute postsurgical pain management depending on whether the site of arthroplasty is the hip or the knee. Finally, the current results also support the argument that these two surgeries, at least with regard to acute pain, should be approached separately.

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          Most cited references 54

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          Coefficient alpha and the internal structure of tests

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            Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test.

            Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.
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              Principles and practices of structural equation modeling


                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                09 May 2017
                : 10
                : 1087-1098
                [1 ]Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
                [2 ]ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
                [3 ]Department of Psychology, Houston Baptist University, Houston, TX, USA
                [4 ]Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
                [5 ]Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
                [6 ]Orthopedics Unit, Alto Ave Hospital Center, Guimarães, Portugal
                Author notes
                Correspondence: Patrícia R Pinto, Life and Health Sciences Research Institute (ICVS), School of Medicine, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal, Tel +351 253 60 4926, Fax +351 253 60 4809, Email patipinto@ 123456med.uminho.pt
                © 2017 Pinto et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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