The influence of illness perceptions and self-efficacy on emotional outcomes after joint replacement

Abstract

Background: Whilst substantial evidence of the influence of illness perceptions and self-efficacy on illness outcomes exists, few studies have addressed the dynamic of change in such beliefs nor addressed these questions amongst surgical populations. The current prospective study examines such questions in terms of the short and longer-term emotional outcomes of osteoarthritis hip and knee replacement patients. We also examine whether adherence to exercise rehabilitation mediates the relationships between beliefs and emotional outcomes. Methods: This prospective longitudinal study included three assessments (before surgery, and six weeks and nine months after surgery). 40 hip and knee replacement patients (M= 68.90yrs, SD= 7.60) were recruited in a general hospital and completed a questionnaire-booklet including the Revised Illness Perceptions Questionnaire, the General Self-Efficacy Scale, the Self-Efficacy for Rehabilitation Outcome Scale, the Falls-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Short Form of Psychological Well-Being Index, the Medication Adherence Report Scale and the Morisky Medication Adherence Scale (adapted for exercise adherence). Findings: A series of multiple hierarchical regression analyses were performed, using residual change scores as independent variables. Mediation was tested using bootstrapping. Early increases (T1-T2) in general self-efficacy and perceived illness consequences predicted 6-week anxiety and depression outcomes; while late changes (T2-T3) in general self-efficacy and emotional representations predicted 9-month depression and emotional well-being. Exercise adherence did not mediate these relationships. Conclusion: Change in illness cognitions variably explains emotional outcomes. Such findings hold implications regarding both the content and the implementation timing of future interventions.