The Role of Social Support and Psychological Distress in Predicting Discharge: A Pilot Study for Hip and Knee Arthroplasty Patients

Background: Bundled payment initiatives for joint replacement have prompted re-evaluation of the continuum of care with emphasis on anticipating disposition needs. The purpose of this study is to investigate the role of social support and psychological distress in patient optimization after lower joint replacement.

Methods: Two hundred thirty-one patients undergoing elective joint replacement completed the Risk Assessment and Predictive Tool (RAPT) (social support assessment) and modified STarT Back Tool (mSBT) (assessment of pain-related psychological distress). Outcomes of interest were length of stay (LOS) and discharge location (home vs facility).

Results: No significant differences in mSBT scores were observed across RAPT levels when comparing individuals by discharge location (P > .05). There was significant indirect effect (0.07; P < .001) between mSBT and LOS. Therefore, the mSBT does not predict discharge location as a standalone metric for this sample. Mediation analysis for LOS indicates that higher psychological distress was predictive of longer LOS. Higher psychological distress and lower social support are associated with longer LOS. Despite higher psychological distress scores, higher social support scores are associated with shorter LOS.

Conclusion: Analysis of this cohort suggests that pre-operative assessments of social and psychological constructs may provide preparatory information for patient discharge status. The RAPT is important for predicting LOS and discharge location. The mSBT may be important for predicting LOS for individuals with low to moderate social support.