Depression folowing surgery for an achilles tendon rupture

NewsBot · Jun 21, 2021

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Depression Following Operative Treatments for Achilles Ruptures and Ankle Fractures
Reid Davison, MSE, Jean-Philippe A. Daniel, BS, Alexander J. Idarraga, BA, ...
Foot & Ankle International June 10, 2021

Background:
The sudden and debilitating nature of lower extremity injuries can trigger mood disturbances, including major depressive disorder.

Methods:
This prospective study enrolled patients undergoing operative repair of ankle fractures and Achilles ruptures and followed them for 1 year postoperatively. The validated Patient Health Questionnaire (PHQ-9) for depressive symptoms was administered at the preoperative visit and at postoperative weeks 1, 2, 4, 8, 16, 24, 32, 40, and 52. PHQ-9 is scored 0 to 27, with higher values indicating greater depression symptoms.

Results:
Fifty-eight patients completed 1 year of follow-up. The mean PHQ-9 score was 2.7 (range, 0-20) at the preoperative visit, peaked at postoperative week 1 (4.9; range, 0-16), and reached its low at postoperative week 52 (0.8; range, 0-7). Cumulative incidences of depressive symptoms during the first year following surgery were 51.7% for at least mild depression, 22.4% for at least moderate depression, and 6.9% for severe depression. A history of mental health disorder and the inability to work during the period of postoperative immobilization were independently associated with greater depressive symptoms.

Conclusion:
The majority of patients undergoing operative treatment of Achilles ruptures and ankle fractures develop postoperative symptoms of mild to moderate depression that normalize after several months. Patients with a history of mental health disorder or who cannot work while immobilized postoperatively are at greatest risk.
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NewsBot · Jun 21, 2021

Related Thread:
Achilles tendon rupture

NewsBot · Oct 19, 2021

Psychological Factors Change during the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study
Anton J Slagers, PT, MSc, Olivier C Dams, MD, Sara D van Zalinge, BSc, Jan H B Geertzen, MD, PhD, Johannes Zwerver, MD, PhD, Inge H F Reininga, PhD, Inge van den Akker-Scheek, PhD
Physical Therapy, 04 October 2021

Objective
To gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR.

Methods
Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire), kinesiophobia (Tampa Scale for Kinesiophobia), expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score), and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR.

Results
Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation and performance.

Conclusion
Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified.

Impact
According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population.

Lay Summary
If you have Achilles tendon rupture, your level of motivation, psychological readiness for return to sport, and fear of movement can affect your rehabilitation outcome. Your physical therapist can help you recognize these factors.
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NewsBot · Oct 19, 2021

Beyond the tendon: psychological factors during rehabilitation of lower limb tendon injuries
Anton Jeroen Slagers
Thesis

In recent years the amount of literature on patients’ psychological responses to injury during rehabilitation and the influence on return to sports has increased− in particular regarding anterior cruciate ligament injuries. However, there is a lack of studies on this topic regarding other sports injuries, specifically regarding the contribution of psychological factors to pain, dysfunction and rehabilitation outcome in lower limb tendon injuries, and there is a clear gap in the literature regarding the role of psychological factors in the recovery from Achilles tendon rupture.
The general aim of this thesis is to increase the knowledge of the role of psychological factors during rehabilitation of Achilles tendinopathy, patellar tendinopathy and Achilles tendon rupture, and to assess the validity, reliability and responsiveness of patient-reported outcome measures that assess psychological readiness and confidence to Return to sports participation.
The ACL-Return to Sport after Injury (ACL-RSI) scale and the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale were translated from English to Dutch and showed sufficient validity and reliability to assess psychological readiness to resume sports among Dutch-speaking patients after ACL reconstruction. Both questionnaires are able to detect clinically important changes over time at group level.
In patients with lower limb tendinopathy, the majority of the investigated psychological factors were associated with tendinopathy severity, tendon function, participation and satisfaction. Physiotherapists and other practitioners should aim to recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain. In patients with Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement may affect rehabilitation outcome.
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NewsBot · Apr 14, 2022

Disappointment and frustration, but long-term satisfaction: patient experiences undergoing treatment for a chronic Achilles tendon rupture—a qualitative study
Anna Nordenholm, Niklas Nilsson, Ferid Krupic, Eric Hamrin Senorski, Katarina Nilsson Helander, Olof Westin & Jón Karlsson
Journal of Orthopaedic Surgery and Research volume 17, Article number: 217 (2022)

Background
Delayed treatment of Achilles tendon ruptures is generally due to either misdiagnosis or patient delay. When the treatment is delayed more than 4 weeks, the rupture is defined as “chronic”, and almost always requires more invasive surgery and longer rehabilitation time compared with acute Achilles tendon ruptures. There is insufficient knowledge of patient experiences of sustaining and recovering from a chronic Achilles tendon rupture.

Methods
To evaluate patients’ experiences of suffering a chronic Achilles tendon rupture, semi-structured group interviews were conducted 4–6 years after surgical treatment using a semi-structured interview guide. The data were analyzed using qualitative content analysis described by Graneheim and Lundman.

Results
The experiences of ten patients (65 ± 14 years, 7 males and 3 females) were summarized into four main categories: (1) “The injury”, where the patients described immediate functional impairments, following either traumatic or non-traumatic injury mechanisms that were misinterpreted by themselves or the health-care system; (2) “The diagnosis”, where the patients expressed relief in receiving the diagnosis, but also disappointment and/or frustration related to the prior misdiagnosis and delay; (3) “The treatment”, where the patients expressed high expectations, consistent satisfaction with the surgical treatment, and addressed the importance of the physical therapist having the right expertise; and (4) “The outcomes”, where the patients expressed an overall satisfaction with the long-term outcome and no obvious limitations in physical activity, although some fear of re-injury emerged.

Conclusions
An Achilles tendon rupture can occur during both major and minor trauma and be misinterpreted by both the assessing health-care professional as well as the patient themselves. Surgical treatment and postoperative rehabilitation for chronic Achilles tendon rupture results in overall patient satisfaction in terms of the long-term outcomes. We emphasize the need for increased awareness of the occurrence of Achilles tendon rupture in patients with an atypical patient history.
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