The Effectiveness of the Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-score versus the Brief Resiliency Scale at Identifying the Potential for Poor Outcomes Following Elective Total Knee and Hip Arthroplasty.

Abstract

Psychosocial factors, including mental health and resilience, influence recovery after total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, it remains unclear which screening tool offers greater predictive value. This study aimed to compare the effectiveness of the Patient-Reported Outcomes Measurement Information System Global Health Instrument (PROMIS-10) Mental Health T-score (MHT) and the Brief Resiliency Scale (BRS) in identifying patients at risk for poor outcomes from the inpatient stay through 12 months following elective THA and TKA. A retrospective analysis was performed on 3,475 patients undergoing primary THA or TKA at a single academic institution. Preoperative MHT and BRS scores were collected and assessed for associations with key perioperative outcomes, including length of stay, opioid use, ambulation distance, pain, and patient-reported outcomes (PROs) at discharge and six months postoperatively. Multivariate regression models were constructed, adjusting for demographic and clinical variables, to compare the predictive strength of MHT and BRS. Both MHT and BRS were significantly associated with multiple postoperative outcomes. However, MHT consistently demonstrated stronger beta coefficients and higher R² values across nearly all models. In multivariate models including both measures, the MHT remained an independent predictor of key outcomes, such as opioid consumption, early functional mobility, pain, and patient satisfaction, whereas the BRS often lost significance. The PROMIS-10 Mental Health T-score more effectively identifies patients who are between the ages of 60 and 80 years old and who are at risk for poor outcomes following elective TKA and THA. Its superior performance and integration within standard outcome frameworks make it a valuable tool for preoperative psychosocial screening.