THE EFFECTS OF A CHALLENGE STATE INTERVENTION ON PATIENTS UNDERGOING ELECTIVE ORTHOPAEDIC SURGERY

Specific aims and objectives Elective orthopaedic surgery is in high demand; increasing pressures and resource constraints within the public health system are limiting the number of elective surgeries performed. Although there are numerous programmes in place to streamline patients for surgery and increase hospital turnover, individual psychological factors are being recognised as having an important role in patient preparedness for and recovery from surgery. One such psychological framework that incorporates these factors is the biopsychosocial model of challenge and threat which examines mechanisms underlying individual differences in performance under stress. Purpose The purpose of this study is to apply this framework to elective orthopaedic patients undergoing total hip/knee arthroplasty and lumbar decompression surgery. This study aims to determine whether a verbal pre-operative challenge state intervention influences the psychology of patients and the effects of the intervention on recovery from surgery. Methods Eligible participants were randomised into intervention and control groups; the intervention was applied pre-operatively. Patient demographics and baseline characteristics were collected. Outcomes, including cognitive appraisal ratio (CAR), length of stay in hospital and patient-reported outcomes measures, were compared between the intervention and control group. Results No significant differences were found in baseline characteristics between the control and intervention group except for frailty. While the intervention affected the psychology of the intervention group into the challenge direction, there were no significant differences in CAR compared to the control group. The intervention group (M = 4.15, SD = 2.48) had a significantly shorter length of stay in hospital compared to the control group (M = 5.85, SD = 2.58, p = .004). Conclusion This study demonstrated that patient psychology can be manipulated towards a challenge state in elective orthopaedic patients and that those who received a challenge state intervention had a significantly shorter stay in the hospital. More experimentation is required to distinguish the mechanism underlying these observations and to control for potential confounding factors such as frailty. However, these results have shown promising results in targeting resource and demand appraisals in elective orthopaedic patients as conceptualised in the biopsychosocial model of challenge and threat.