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 32.7 years) at mean 12.1 months follow-up were included. Independent relationships between patient outcomes and pre-operative measures were determined: short form McGill Pain questionnaire (SF-MPOJ, 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 1KDC-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 Cl 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. (C) 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.