Article

Control cognitions have been directly related to positive engagement
with rehabilitation regimes.
The impact of such cognitions on recovery following
surgery is not well understood. PURPOSE: To assess whether perceived control
cognitions predict function 9-12 months following total hip replacement (THR).
METHODS: Prospective cohort study performed as part of a randomised controlled
trial. Behavioural cognitions (BC) (recovery locus of control (RLOC); perceived
external behavioural control (PEBC))) and subjective functional outcome measures
(Oxford hip score (OHS) and a reduced version of the Western Ontario and
McMasters University Osteoarthritis Function scale (rWOMAC PF)) were administered
pre-operatively and up to 12 months post-operatively to 50 patients randomised to
home-based progressive resistance training (N = 26) or standard rehabilitation (N
= 24), post-THR. Regression analysis investigated variance in functional scores.
RESULTS: Group randomisation had no effect on BC. RLOC and OHS (6 months)
correlated significantly with 12-month OHS, with 6-month OHS predicting 62.3% of
the variance in 12-month OHS. 12-month rWOMAC PF was determined by each of its
three previous assessments (pre-operative 8.8%, 6 weeks 17.8% and 6 months
67.3%). Variance in functional gain at 12 months (OHS and rWOMAC PF) was
explained by pre-operative OHS and rWOMAC PF (63.7% and 63.8%, respectively).
CONCLUSIONS: BC had no impact on functional outcome in this population.
Subjectively assessed function at 12 months, as well as the levels of functional
gain over time, was best explained by the patients' earlier functional status.
Implications for Rehabilitation It is important to assess psychological factors
such as poor pre-operative mental health and pain catastrophising in patients
undergoing joint replacement surgery as these factors have an adverse effect on
subjective patient outcomes. Pre-operative behavioural cognitions appear to have
no impact on subjective functional outcome at 12 months post-THR. The
pre-existing functional status of the patient appears to be most predictive of
subjective function at 12 months post-THR, implying that perhaps earlier surgery
may be optimal before the onset of a decline in function.

Langue : ANGLAIS