ABSTRACT
INTRODUCTION: To help combat the SARS-CoV-2 (COVID-19) pandemic, elective inpatient procedures have been reduced. The authors hypothesized that a nationwide lockdown would negatively affect the postoperative outcome after total knee arthroplasty (TKA) due to reduced physiotherapy as well as restrictions in external facilities of physiotherapy and rehabilitation. MATERIALS AND METHODS: We conducted a retrospective, comparative study including 41 patients who had undergone primary TKA during the first lockdown of the COVID-19 pandemic from March 2020 to April 2020 and a comparable control group consisting of 47 patients with a minimum follow-up of 6 months before the COVID-19 pandemic from 2019. Relevant end points were the visual analogue scale (VAS) for pain, Knee Society Function Score (KSS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM). RESULTS: The lockdown group had a significantly worse outcome compared to the control group 6 months after TKA regarding WOMAC (p = 0.001), KSS (p < 0.001), OKS (p < 0.001), and length of hospital stay (p < 0.001). We found no statistically significant difference between the groups in ROM (p = 0.132), KSFS (p = 0.933), VAS at rest (p = 0.9.22), and exercise (p = 0.304). CONCLUSION: The COVID-19 pandemic negatively affected early clinical outcome parameters of elective primary TKA at 6 months of follow-up due to restrictions in postoperative care. We believe that standardized protocols for physiotherapy will improve clinical outcomes for TKA in the event of future lockdowns and underline the importance of appropriate postoperative care during this pandemic.
ABSTRACT
INTRODUCTION: COVID-19 is a respiratory infection that causes not only somatic health issues, but also frequently psychosocial burdens. The aims of this study were to investigate biopsychosocial factors that might further aggravate fear of COVID-19, and to establish a biopsychosocial model of severe fear of COVID-19. METHODS: 368 participants were included in this study. Biopsychosocial factors observed comprised biological factors (somatic risk), psychological factors (state/trait anxiety, physical symptoms of anxiety, severe health anxiety, specific phobias, depression), and psychosocial factors (social support, financial losses, social media consumption, social contacts with COVID-19 infected people). Psychometric questionnaires included State-Trait Anxiety Inventory, Beck's Anxiety Inventory, Whiteley-Index / Illness Attitude Scales, Specific Phobia Questionnaire, WHO-5 and Social Support Survey. RESULTS: 162/368 (44.0%) participants had almost no fear, 170/368 (46.2%) participants had moderate fear, and 45/368 (12.2%) participants had severe fear of COVID-19. Female participants showed higher levels of fear of COVID-19 than male participants (gender: χ2 = 18.47, p<0.001). However, the level of fear of COVID-19 increased in male participants when they had contact with people who were infected with COVID-19, while in contrast the level of fear of COVID-19 decreased in female participants when they had such contacts [ANCOVA: fear of COVID-19 (contact x gender): F(1,363) = 5.596, p = .019]. Moreover, participants without relationships showed higher levels of fear of COVID-19 (marital status: χ2 = 14.582, p = 0.024). Furthermore, financial losses due to the COVID-19 were associated with higher levels of fear of COVID-19 [ANCOVA: fear of COVID-19(financial loss x gender): F(1, 363) = 22.853, p< .001]. Multiple regression analysis revealed female gender, severe health anxiety (WI-IAS) and state /trait anxiety (STAI) as significant predictors of severe fear of COVID-19. CONCLUSION: In this study significant predictors of severe fear of COVID-19 were female gender, pre-existing state and trait anxiety, as well as severe health anxiety. The finding of significant predictors of fear of COVID-19 might contribute to detect people who might suffer most from severe, overwhelming fear of COVID-19 at an early stage.