Keywords

1 Introduction

After total/partial hip arthroplasty, the quality of life is an essential component in postoperative rehabilitation. Each person’s quality of life [1] is strictly related to their ability to influence the environment, to influence daily life. Whatever definition we accept, complication after hip arthroplasty certainly is a factor contributing to the reduction of the quality of life by limiting the mobility of the patient, thus limiting social contact, by pain that often occurs [2].

The main complication from orthopedic and neuropsycological perspective are pain and the adaptative mechanisms of emotive reaction for chronical patients which suffered a hip arthroplasty [3] according to Hip Society [4]. The goals are achieved through the emergence of mechanisms that ensure optimal functionality of the hip joint, in terms of mobility, decreasing pain and functional walking [5,6,7].

On the other hand to analyse in terms of disease response neuropsihologic is a useful method in quantifying the level of health and quality of life after Hip Arthroplasty behavior is adaptive. So emotions are dependent variable with which we describe a series of changes at many levels. Consequences of stress appear as after-effects of long-term chronic reactions [8]. Investigating the physiological mechanisms and consequences of stress, [9] demonstrates that stress involves both adaptation and stimulation and body wear. in this context, distress is generated by limiting the information processing capacity owing to either inadequate cognitive skills, either an excess or deficiency of the informational self esteem as part of cognitive patterns represents an overall assessment of yourself [10] and it’s the combination of the resultant value evaluation and the ability to achieve a goal. Having a tendency to assess negatively, by anticipating actually terminates, this kind of negative affects patients will live, through anger, depression or anxiety. Mental health contains as a feature and the level of self-esteem, this may be interpreted as a good predictor of well being.

Research ethics the study was approved by the Council of Ethics of Recovery Hospital Cluj-Napoca, respecting the integrity, confidentiality and personal data protection of the persons included in the study. Also, all the patients who participated in the study signed the informal consent to use and publication of the results obtained during their assessment for research purposes.

2 Objectives

In our approach we’ve gone from need to interpret the condition of chronic patient, by a plurifactorial model which integrates the analysis of changes of functional and neuropsychological parameters. We have taken into account the effect biomechanical and psychological factors, namely pain and psychosocial parameters as measurement units of psychological response [11], and for the second study we intend to investigate the quality of life of patients after hip arthroplasty at different time intervals, by analyzing variables such as: distress, perceived self-efficacy, self-esteem, dysfunctional attitudes and automatic cognition depending on the time elapsed time from measurements (immediately after the surgery, more than a year after the surgery). The aim was to establish these differences in impairment of quality of life [12]. Settling this frameworks we thing we set out to demonstrate that physical therapy programs (before and after surgery) are effective by decreasing clinical complaint (failure and pain) Active rehabilitation leads to optimize the results and quality of life after hip arthroplasty. The approach from the perspective of medical psychology of the patient with a hip prosthesis is not only useful but also necessary, in the context of primary and tertiary prevention of the complications that may occur.

3 Materials and Methods

Participation in the study was voluntary, based on established inclusion and exclusion criteria. The assessment tools were used before surgery (day hospital patient) and after surgery (one month, respectively on and a half month). The questionnaires were done in pencil-paper format, complying with the standard procedures provided.

  1. A.

    For the first study, a number of 55 patients admitted to the Rehabilitation Hospital Cluj-Napoca, between January 2016 and January 2018. Evaluation was made in different period of time (before surgery, 30 and 90 days after).

    The inclusion criteria were: patients programmed for hip arthroplasty without other major pathology, with the diagnosis of primary coxarthrosis unilateral surgical stage (Sect. 4). Exclusion criteria were: acute phase of the disease, intens pain, lack of cooperation. Assessment tools were: score the balance function assessment Harris Score. Criteria: pain (maximum 44 score), (lamenes, with support, walking distance, max score 33), activity (max 13), biomechanical parameters (changes in flexion, internal rotation, Member: adductive, inequality score 4), mobility (flexion, abduction, adductive, internal rotation, external rotation-6). Points accumulate a maximum total of 100.

    VAS scale: on a scale of 0–10, where 0 represents the absence of pain and the 10 most intense pain is felt, a horizontal line which included painful perception level, with high level of reliability and validity. Scales are variants of Physiotherapeutic predictor programs carried out pre surgical, 30 day and 90 days after, pain, functional impotence, results of measurements. With this instruments functionality was analyzed by determining the control statistics, the predictive value of the independent variables [4].

  2. B.

    The research has been in the form of a controlled clinical trial with two-sample design compared between pairs. In setting the volume of the sample taken into account methodological criteria relating to the power of the test. The criterion for inclusion, (to participate in the study) was represented by the situation of a prosthetic hip with any psychiatric problems.

    Survey participants are 40 subjects who fulfilled the conditions for inclusion, at different intervals of time operator (0–1 year more than 1 year). Customer results in parallel has conducted a study of control, comparison was made with the applied standards of clinical scales. 20 of subjects were patients that were admitted for total hip arthroplasty, the other lot of 20 subjects were admitted on the Balneology section of Rehabilitation Hospital Cluj Napoca. Interval-was March 2016 to April 2017. The tools of the method were PDA (Distress Affective Profile), SS (Self Esteem Scalar), SES (Self Esteem Scale), DAS (Scale of Dysfunctional Attitude) and ATQ (Automatic Thinking Questionaire) from SEC (System of Clinical Evaluation) [4]. Those were the instruments applied to analyzed: the affective distress profile, self-esteem scale [8, 13]. Self esteem coping attitude must be for certain evaluated in order to make a holistic image over the status of an patient with hip arthroplasty.

4 Results

4.1 Results for the First Study

Descriptive statistical results obtained for evaluation before surgery VAS scales, 30 days after and 90 days after the surgery, between batches of patients who performed kinetic programs and those programs haven’t. The results reveal that physical therapy programs explain 33.5% of the variation of VAS Score Harris, 29.6% variation. F values were obtained (2.49) = 12.46 (p = 0.001) and F (2.49) = 9.00 (p = 0.001). Application of individualized programmes leading with an average of 7.22 points to Score Harris, decreasing by an average of 17.87 estimated pain within the VAS Scale Table 1.

Table 1 Regression coefficients for Medical variables (Score Harris Scale VAS)
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Table 2 shows the results obtained for the variable mobility and gait. To score Harris, mobility variable predicts 15.8% of variation F (2.49) = 4.56 (p = 0.016). For VAS, 7.6% predict the mobility variable from variation, F (2.49) = 2.05 (p = 0.14).

Table 2 Regression coefficients for walking (Score Harris)
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Table 3 shows the regression analysis in which the variables are physical therapy programs. Both scores are predicted if the patients continue standardized programs of physical therapy. Describe F (3.48) = 16.38 (p = 0.001). For variable pain we have obtain (t = 3.18, p = 0.003).

Table 3 Regression coefficients for medical variables 90 days after surgery (Score Harris Scale VAS)
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The only significant variable remains kinetic programs, according to this statistical model. Preoperative physical kinetic programs, added to a postoperative rapid mobilization of the patient, will provide a better hip functionality recovery.

4.2 Results for the Second Study

Regression testing was performed by introducing the SPSS for Windows software (version 16): initial testing of the most common predictors, and then by statistical testing of all predictors. We obtained a predictive model in which the variables were significantly altered, a statistically significant difference, p < 0.03 for functional emotions. At the threshold p < 0.01 a statistically significant difference for self-esteem, perceived self-efficacy, dysfunctional attitudes.

The two averages obtained were compared by t Test.

There is also a statistically significant difference between the level of functional negative emotions recorded by subjects and the general population.

There are differences between the two groups of patients (immediately after surgery and after a period of time—more than 1 year) in terms of quality of life. The t test was calculated to compare the average of the patients who were admitted for total/partial hip arthroplasty and those who were more than one year ago. Table 4 shows the mean values and the standard deviations for dependent variables in the study.

Table 4 Descriptive statistics for life quality variables
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Although the differences between the dysfunctional emotions recorded immediately after surgery and those at least one year apart are not statistically significant, there is a tendency to decrease them after one year, while the functional emotions tend to increase (Table 5).

Table 5 Variable of life quality
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In other words, the meaning is the regaining of the quality of life, to distinct the level of self-confession only as a tendency to reduce the distress.

This study has indicated that from the point of view of self-esteem, distress, and dysfunctional attitudes, endo-prosthetic patients that suffered also complications, have a lower quality of life than the general population. Even more than a year after surgery, there are differences in perceived self-efficacy, but fortunately negative emotions are decreasing. Also after one year, self-esteem and dysfunctional attitudes again show some stability [4].

5 Discussions

The rate of success in this type of surgery is demonstrated in all analyses of literature. However about 15% of cases are reported with complications, pain and functionality are on top [14]. The aim of this study was to develop a predictive model of the functional parameters. In this sense, we have achieved an exploratory regression analysis. The following variables were selected: pain, kinetic programs, mobility, testing of measurements obtained. Regression analyses were also carried out for the different time periods (before surgery, at 30, 90 days after surgery), and was achieved through statistical control. The results of the study are similar to the literature data, and physical therapy programs shows effective rehabilitation after hip arthroplasty. Increased physical activity has a good therapeutic efficacy, facilitate recovery. Predictive model takes in consideration as criterion of Scale VAS-pain-34.6% this explains the variable. In this model, though programs have significant benefits and increased recovery. Patients have to cope not only with the physiological and psychological stresses that precede surgery [15], but also with the requirements of the recovery process [16]. The degree of pain and joint mobility after surgery, they both influence independent functioning and are influenced by patient expectations [11]. Chronic pain is the most common complication of any major surgery. It is the major cause of dysfunction and maladaptative reactions..

6 Conclusions

All this predictive factors must be evaluated in the moment of taking the decision of hip arthroplasty. The type of surgery and the preparation of the joint by kinetic programs are very important.

A limit of the studies is related to their application to independent, not longitudinal samples, the inter-individual differences may influence the results.

Another limit of the study is related to the control group. These subjects were not selected by randomization, but only after meeting inclusion criteria.

In the post-surgery phases, quality of life was positively influenced by changes in VAS parameters, inducing an increase of physical functioning. Walking patients after Hip Arthroplasty can be corrected by means of the application of the programs, though kinetic.

The implication of the second study can aim to improve the relationship between those patients taking into account dysfunctional attitudes.

The first study was a follow up between results with those obtained in the same clinic, regarding quality of life after hip arthroplasty [17]. The particularity in our case refers to a model of prediction for avoiding, as much as is possible complications such as pain and functional.

The conclusion of those studies are similar and lead us to the necessity of treating our patients from a holistic and interdisciplinary perspective, in the benefit of our patient, his life expectancy and quality of life.