Positive reframing: An important but underutilized coping strategy in youth athletes undergoing sports-related knee surgery.

CONTEXT: It is unknown how specific coping strategies are associated with the short-term outcomes among athletes following knee surgery. OBJECTIVE: 1) To determine whether specific coping strategies are associated with satisfaction, return to sport, self-reported knee function, or kinesiophobia following sports-related knee surgery. 2) To determine whether these associations vary by age, sex, or surgical procedure. STUDY DESIGN: Case series. METHODS: Athletes (n=184 total; n=104 men, n=80 women; n=38 age <20 years, n=35 age 20-25, n=36 age 26-31, n=36 age 32-40, n=39 age >40) who underwent outpatient knee surgery were enrolled from a single center. Utilization of specific coping strategies (self-distraction, use of emotional or instrumental support, venting, positive reframing, and acceptance) was assessed pre-operatively with the Brief-COPE inventory. Relationship between coping strategies and post-operative satisfaction, return to sport, International Knee Documentation Committee-subjective (IKDC-S) and Tampa Scale for Kinesiophobia scores at median 10.7 months follow-up were determined with consideration for age, sex, and surgical procedure. RESULTS: Return to prior level of sport was 72%, and satisfaction was 86%. Most coping strategies had age-specific utilization rates; positive reframing was utilized least frequently in ages <20 years. Satisfaction increased with greater positive reframing among ages <20 years and decreased with greater self-distraction among men. Return to sport was higher with greater positive reframing in ages <32 years. No coping strategies predicted IKDC-S scores. Greater positive reframing correlated with lower kinesiophobia in ages <20 years. Greater instrumental support correlated with lower kinesiophobia in ages >40 years. No other coping strategies were associated with outcomes. Surgical procedure was not related to association between coping strategies and outcomes. CONCLUSION: Coping strategies have age-specific associations with outcomes after knee surgery in athletes. Positive reframing is infrequently utilized in younger athletes. Greater use of positive reframing in this group may improve satisfaction, return to sport, and lower fear of re-injury.

Individual Coping Strategies Are Associated with Patient-Reported Satisfaction upon Completion of Rehabilitation following Sports-Related Knee Surgery.

We sought to determine whether individual coping strategies and optimism are associated with satisfaction after sports-related knee surgery at the time of rehabilitation completion and whether the association between coping strategies/optimism and satisfaction varies by surgical procedure or length of rehabilitation. A total of 104 recreational and competitive athletes who underwent knee surgery completed preoperative assessments for intrinsic optimism using the revised Life Orientation Test and coping strategies using the brief Coping Orientations to the Problem Experience inventory. Postoperative assessments at completion of rehabilitation (mean: 5.5-month follow-up.; maximum: 15 months) included satisfaction with surgery, return to prior level of sport, and International Knee Documentation Committee (IKDC-S) symptom scores. Eighty-one percent were satisfied after completion of rehabilitation with a 68% return to prior level of sport. Irrespective of surgical procedure or length of rehabilitation (p > 0.25, all comparisons), greater reliance on others for emotional support as a coping mechanism increased risk of dissatisfaction after surgery (per point: odds ratio [OR]: 1.75; confidence interval [CI]: 1.13-2.92; p = 0.01), whereas greater use of positive reframing as a coping mechanism was protective (per point: OR: 0.43; CI: 0.21-0.82; p = 0.009). Intrinsic optimism was not predictive of postoperative satisfaction (p = 0.71). Satisfied patients had mean 13.5 points higher IKDC-S scores at follow-up than unsatisfied patients (p = 0.001). Patients who returned to prior level of sport had significantly higher satisfaction scores than patients who had not. Irrespective of surgical procedure or length of rehabilitation, use of positive reframing and reliance on others for emotional support are positive and negative predictors, respectively, of satisfaction after sports-related knee surgery. Preoperative optimism is not predictive of postoperative satisfaction.

Pain perception and coping strategies influence early outcomes following knee surgery in athletes.

OBJECTIVES: To determine whether pain perceptions and coping strategies are predictive of the following outcomes after knee surgery in athletes: (1) return to similar level of sport, (2) improvement in symptoms, and (3) improvement in kinesiophobia. DESIGN: Prospective cohort study. METHODS: 101 athletes (52 men, 49 women; mean age 32.7years) at mean 12.1months follow-up were included. Independent relationships between patient outcomes and pre-operative measures were determined: short form McGill Pain questionnaire (SF-MPQ), Pain Catastrophizing Scale (PCS), Pain Coping Measure (PCM), and the brief COPE subscales of acceptance, denial, positive reframing, and use of instrumental support. Adjustment was performed for length of follow-up, symptom duration, surgical history, age, activity level, and surgical procedure. RESULTS: Rate of return to similar level of sport was 73%; severe pain catastrophizers (PCS >36 points) had increased odds of not returning to similar level of sport (OR 11.3 CI 1.51, 236; p=0.02) whereas COPE-use of instrumental support was protective (per point increase: 0.72 CI 0.54, 0.94; p=0.02). Problem-focused coping positively correlated with improvement in IKDC-S scores (beta 0.032 SE 0.010; p=0.001). Improvement in kinesiophobia after surgery was less likely with higher pre-operative perceived pain frequency (OR 0.23 CI 0.06, 0.71; p=0.009) and higher COPE-denial scores (OR 0.43 CI 0.21, 0.88; p=0.02). CONCLUSIONS: Among athletes undergoing knee surgery, severe pain catastrophizing is negatively associated with return to similar level of sport. Instrumental support and problem-focused coping strategies are associated with improved outcomes. High preoperative pain scores are negatively associated with improvement in kinesiophobia after rehabilitation.

The role of illness uncertainty in the relationship between disease knowledge and patient-reported outcomes among adolescents and adults with congenital heart disease.

BACKGROUND: Greater general disease knowledge predicts better patient-reported outcomes (PROs) among congenital heart disease (CHD) survivors, but higher illness uncertainty is associated with elevated emotional distress and poorer well-being among patients with chronic disease. OBJECTIVES: This study explored the relationship of illness uncertainty and disease knowledge with emotional distress and health-related quality of life (HRQoL) among patients with CHD. METHODS: Individuals with CHD (N = 169, ages 15-39) completed self-report measures of disease knowledge (general and risk-related), illness uncertainty, depressive and anxiety symptoms, and HRQoL. Pearson correlations and regressions analyses were utilized. RESULTS: Greater risk-related knowledge was associated with greater anxiety (b = .41, p = .03, 95% CI = [.04, .77]) and poorer emotional HRQoL (b = -.53, p = .03, 95% CI = [-1.02, -.05]) when illness uncertainty was higher. CONCLUSION: When individuals with CHD feel uncertain about their disease course and outcomes, knowledge about future cardiovascular risks may result in higher levels of distress.

Pilot randomized trial of brief behavioral treatment for insomnia in patients with heart failure.

BACKGROUND: Insomnia is prevalent among patients with heart failure (HF) and is associated with reduced physical and mental functioning, including possible exacerbation of cognitive deficits. OBJECTIVES: This study evaluated the effects of Brief Behavioral Treatment for Insomnia (BBTI) on insomnia and related factors among HF patients. METHODS: Twenty-three HF patients with insomnia (70% women; 65% white; Mage = 55.7 ±â€¯11.3 years; NYHA Class II = 70%) were randomized to a behavioral intervention (BI; n = 12) or sleep monitoring (SM; n = 11) group. Sleep, cognitive functioning, quality of life, distress, self-care, and functional status were assessed pre- and post-intervention. RESULTS: BI participants experienced reduced insomnia and increased sleep quality and efficiency, with 58% demonstrating clinically meaningful improvements in insomnia and 25% achieving remission of insomnia symptoms. Depression and anxiety also improved in BI participants. CONCLUSIONS: BBTI was tolerated well within this symptom-limited patient population and was associated with reduced symptoms of insomnia and distress.