Resilience Affects Pain and Outcomes After First Carpometacarpal Joint Arthroplasty

Abstract There is increasing focus on the influence of psychological factors in postoperative outcomes for orthopaedic procedures. The purpose of this study was to determine whether psychological resilience, as measured by the Brief Resilience Scale (BRS), affects pain and functional outcomes after thumb carpometacarpal (CMC) arthroplasty. Patients undergoing thumb CMC arthroplasty at a single institution were prospectively enrolled in this study. Patients completed a Visual Analog Scale (VAS) for pain, BRS questionnaire, and Thumb Disability Index (TDX) preoperatively, at 2 weeks, and at 3, 6, and 12 months after surgery. Patient charts were reviewed for demographics and postoperative course. Generalized estimating equations were used to associate baseline and concurrent BRS category (low, medium, high resilience) and psychiatric history with pain and functional outcomes. Of the 81 enrolled subjects (73% female, 62.3 ± 8.7 years old), 13 had low resilience, 51 had normal, and 17 had high resilience. Among them, 74, 41, 21, and 10 have 2-week, 3-month, 6-month, and 12-month follow-up. The presence of psychiatric comorbidities did not correlate with BRS, VAS, or TDX scores or with postoperative course. Those with low baseline resilience had significantly higher pain scores compared with the medium resilience group at 2 weeks and the high resilience group at 6 and 12 months. Additionally, those with low concurrent resilience at 6 months had significantly higher TDX scores than those with high and medium concurrent resilience, and at 12 months had significantly higher VAS and TDX scores compared with the medium concurrent resilience group. Lower baseline resilience is associated with worse pain both early and late postoperatively. Lower concurrent resilience is associated with increased hand disability at 6 and 12 months postoperatively. Current life events or stressors may contribute to worsening outcomes in thumb arthritis surgery.