Summary

The goal of this study is to assess how resilience scores vary between subpopulations of patients surgically treated for a lower extremity condition, and whether preoperative resileince scores are predictive of outcomes in physical and mental health domains.

Abstract

Introduction

The Brief Resilience Scale (BRS) has been proposed as a preoperative metric that may offer predictive power for surgical outcomes. In hip and knee-related orthopedic procedures, high preoperative BRS has been shown to be associated with higher baseline and follow-up physical health outcomes. However, there are currently few studies investigating BRS among patients treated for lower-extremity conditions such as ankle fractures or total ankle arthroplasty (TAA).

Purpose

The goal of this study is to assess how BRS scores vary between subpopulations of patients surgically treated for a lower extremity condition, and whether preoperative BRS scores are predictive of outcomes in physical and mental health domains.

Methods

We retrospectively reviewed all patients surgically treated for a lower-extremity condition who were enrolled in our U-COSMOS outcomes pathway. We assessed pre-operative BRS, as well as PROMIS Physical Function (PF) Computer Adaptive Test (CAT), PROMISE Pain Interference (PI) CAT, PROMISE Depression (D) CAT, and Global Mental Health (GMH) Short Form, which are collected pre-operatively and at 3-, 6-, 12-, and 24-months post-operatively. The longest follow-up outcome available was used for each patient. We used a BRS cutoff of <3 (lower resilience, LR), 3-3.9 (intermediate resilience, IR), and >=4 (high resilience, HR) to create three cohorts. Differences in outcomes between the three BRS groups were determined non-parametrically using a Kruskal–Wallis one-way analysis of variance.

Results

Patients with at least one paired baseline and follow-up outcome were included for analysis (n = 1492, average follow-up 219 days). 113 were categorized as LR (7.5%), 536 as IR (35.9%), and 843 as HR (56.5%). Assessing the general patient population, LR patients had significantly lower pre- and post-operative physical function (p < 0.001) and higher pain interference (p < 0.001) than IR and HR groups. Mental health outcomes, such as PROMIS D and GMH, were also lower among LR patients. Comparing cohorts based on condition, only 2% of patients treated for an Achilles rupture report LR, compared to 6% and 8.9% of patients treated for an ankle fracture or reconstruction/arthritis-related condition such as TAA, respectively. In all three groups, LR patients report lower physical function than IR and HR patients in the same cohort.

Conclusion

Assessing patients surgically treated for lower-extremity conditions, we found that there are significant differences in pre- and post-operative mental and physical health domains based on BRS score. We also found that the proportion of patients with a lower pre-operative BRS score changes among different surgical procedures. Patients treated for an Achilles rupture, which most commonly occurs in sports-related injury, report high BRS values. Patients treated for reconstruction or arthritis-related conditions report lower BRS values on average. Our data suggests an interdependent relationship between BRS scores and orthopedic outcomes – while BRS may be predictive of physical function outcomes, it may also be reflective of pre-operative diagnosis severity and patient demographics.