Preoperative or postoperative self-efficacy: which is a better predictor of outcome after total hip or knee arthroplasty?

OBJECTIVE: Self-efficacy is considered an important determinant of outcome after total hip or knee arthroplasty. Aim of this study is to evaluate the contributions of preoperative and short-term postoperative self-efficacy in predicting long-term outcome.
METHODS: Self-efficacy was determined in 103 total hip and knee arthroplasty patients preoperatively and 6 weeks postoperatively with the Self-Efficacy for Rehabilitation Outcome Scale (SER). The 6-month outcome was assessed with a disease-specific and a generic self-report questionnaire and an objective measure of function (walking speed). Multiple linear regression analyses were used to examine the value of preoperative and short-term postoperative self-efficacy in predicting 6-month outcomes.
RESULTS: Preoperative self-efficacy was only a significant predictor of long-term postoperative walking speed, with higher self-efficacy resulting in faster walking speed at the long-term measurement (R(2)=0.47). Short-term postoperative self-efficacy was a significant predictor of the long-term postoperative generic outcome measure (physical functioning: R(2)=0.30; mental health: R(2)=0.53) and of walking speed (R(2)=0.66), with higher self-efficacy resulting in a better long-term outcome.
CONCLUSION: Short-term postoperative self-efficacy seems a better predictor of long-term outcome after total hip or knee arthroplasty than preoperative self-efficacy. PRACTICE IMPLICATIONS: Interventions should focus on enhancing short-term postoperative rather than preoperative self-efficacy.