Background:

Recovery from orthopaedic surgery requires a degree of physical and mental resilience. To date, there is limited evidence evaluating the use of resilience as a preoperative benchmark in foot and ankle orthopaedic procedures. This study aims to determine whether resilience, measured using the Brief Resilience Scale (BRS), is associated with improved patient-reported outcomes following foot and ankle surgery.

Methods:

Patients undergoing foot and ankle surgery at a single institution completed the BRS scale preoperatively and were categorized into low- (LR), average- (AR), and high-resilience (HR) groups based on standard deviation (SD). Patients also completed the PROMIS physical function (PF), PROMIS pain interference (PI), PROMIS depression, PROMIS global physical health (GPH) and global mental health (GMH), and a Single Assessment Numeric Evaluation (SANE) preoperatively and 24 months postoperatively. A total of 1180 patients had at least one 24-month outcome available and were included for analysis

Results:

The mean preoperative BRS was 3.87 ± 0.69 SD, defining HR as a score of 4.57 to 5.00, AR as 3.18 to 4.56, and LR as 0.00 to 3.17. At 24-month follow-up, HR and AR patients reported significantly greater mean scores than LR patients for all collected patient-reported outcomes (P < .001). All resilience groups reported significant improvement from baseline in PF, PI, SANE, and GPH (P < .001), at an average score exceeding the published minimal clinically important difference range for each outcome. However, HR and AR patients reported significantly greater improvement compared with the LR group for PI (P = .004), and AR patients furthermore reported greater improvement in GPH (P = .033) and SANE (P = .005) compared with LR patients.

Conclusion:

Patients with higher preoperative resilience scores demonstrated greater 24-month improvements in PI, GPH, and SANE compared to patients with low resilience scores. While all groups reported clinically meaningful improvement from baseline, our results support that higher preoperative resilience, measured using BRS, is associated with improved patient-reported outcomes. Additional resources or support may be beneficial to improve postoperative outcomes for patients with lower resilience.

Graphical Abstract

This is a visual representation of the abstract.