Patient Resilience Is Associated with Greater Post-Surgical Improvement Compared to Global Mental Health and Depression in the Foot and Ankle Population
Authors: Hewitt Michael A. , York Shayne , Buckley Sara E. , Hunt Kenneth 
Published: December 2023

Category: Other Introduction/Purpose: Patient factors such as resilience and mental health play a vital role in perception of pain and surgical outcomes. Increasingly, practices are incorporating psychosocial and mental health patient-reported outcome (PRO) surveys into patient assessment. Individual PROs, such as measures of patient resilience, have been found to correlate with post-surgical outcomes in the orthopaedic population. To date, however, there has been little investigation comparing the efficacy of psychosocial PROs in the foot and ankle population. This study's objective was to evaluate the role of resilience, depression, and global mental health in foot and ankle surgical outcomes and establish the benefits and limitations of each PRO. Methods: Consecutive patients undergoing foot and ankle orthopaedic surgery at a single institution were enrolled in the U- COSMOS platform, an automated outcomes data repository. Patients were included for analysis if they had baseline and minimum 6-month follow-up outcome scores. If more than one follow-up was available, the longest available outcome was used. As measures of physical health, PROMIS Physical Function CAT (PF), PROMIS Pain Interference CAT (PI), Foot and Ankle Single Assessment Numeric Evaluation (FA SANE), and PROMIS Global Physical Health (GPH) were collected. Psychosocial factors were assessed using the Brief Resilience Scale (BRS), PROMIS Depression CAT, and PROMIS Global Mental Health (GMH). Patients lower than, within, and higher than one standard deviation of the average for each psychosocial outcome were divided into three groups. Differences were assessed using ANOVA and corrected for demographics. Results: 725 patients who underwent foot and ankle surgery were included. At longest follow-up, we found that patients reporting higher pre-operative BRS, higher pre-operative GMH, and lower pre-operative Depression report significantly higher follow-up physical health outcomes in all domains (p < 0.05, see Table 1). Importantly, we found stark differences between psychosocial factors when assessing baseline outcomes and post-surgical improvement at longest follow-up. At baseline, GMH and Depression are associated with higher pre-surgical scores in nearly all physical health domains, while BRS is not. Inversely, BRS is associated with higher post-surgical improvement, while GMH and Depression are not. Supporting these findings, baseline Depression and GMH are more strongly correlated with one another (r = 0.67) than with BRS (r = 0.53 and r = 0.46, respectively). Conclusion: We found that patients with higher pre-operative psychosocial PROs reported greater physical health outcomes at follow-up. Patients with high resilience also reported greater improvement in PROs compared to baseline. While global mental health and depression may be associated with physical health scores at a single moment in time, our findings suggest patient resilience plays a larger role in predicting improvement following surgery. Further investigation is warranted to determine the effect resilience scores have on outcomes for specific procedures and conditions. Additionally, interventions to improve patient resilience may be most beneficial for a patient’s long term improvement following surgery.