Research on the functional results after surgery as it relates to a patient's emotional health shows a definitive link. Multiple studies over the last few years in the literature show the connection between a patient's emotional well being and how it influences the postoperative functional recovery.
This link has been highlighted in areas such as joint reconstruction, spine surgery, trauma, and sports medicine. Patients who have a lower emotional health have a higher risk of not improving functionally as much as they should after surgery. This risk stands across multiple demographics including gender, socioeconomic background, and age.
So what exactly does emotional health include? Emotional well being refers to whether the patient tends to be anxious, has less coping skills and social support, and potentially lives with a low-grade depression. This low-grade depression is not one where the patient physically is undergoing treatment for it, but it's a part of who they are.
In addition patients overload their emotional coping skills and have a tendency toward poor social support. So how are surgeons supposed to identify patients who are either living with a reduced emotional well being or on the brink of an emotional health breakdown post-operatively? One of the best ways is for the surgeon to spend time discussing these areas with their patients that could put them at high risk.
This may include discussing such issues as anxiety, depression, and discussing potential poor coping skills which may definitely come into existence when someone has to cope with just having had a major musculoskeletal surgery. There are some patient questionnaires that can help identify patients at increased risk for lower emotional well being, and may include the SF 36 or the SF 12.
It is unclear then, if a patient tends to be at high risk for a reduced emotional well being, whether to intervene preoperatively to try and help with this issue or to change the postoperative course to try and get a better chance of recovery functionally. Currently, there are studies being funded by in NIH that are ongoing and looking at the aspects of emotional health as it relates to surgical outcomes.
It may be that if the patient is deemed to be at risk for an emotional well being issue, then there can be more post operative resources devoted to that patient's emotional health which can help improve their functional outcomes. Here's an example. This patient has some low grade depression that is picked up and activated by the surgery, then maybe that patient is unable to perform the full amount of physical therapy multiple days for week due to being depressed.
Noticing that before surgery and increasing resources to help increase that patients emotional health postoperatively can allow a patient to do the necessary rehab. Unfortunately most patients consider orthopedic surgeons to be high technology and low on the emotional scale. So it may be that additional ancillary support is necessary to help in these situations.
Patients want to be seen as people, and not diseases, and unfortunately in medicine all too often that is what occurs. Physicians, in order to cope with the magnitude of disease that they see on a daily basis, tend to place patients into categories and ignore a lot of the emotion associated with the patient's underlying mindset. One of the things that has been proposed to help with the emotional health of patients is to utilize a multidisciplinary approach for postoperative care that includes counselors, psychologists, social workers and other additional ancillary support.
And it stands right now, a patient's emotional health is an extremely subjective matter. Hopefully as more research is performed it will be possible to identify those who are in need of additional support and with new research potentially identify how exactly to help the patient to increase their functional outcomes along with reducing pain.
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