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Pessimists take longer to return to normal activities after an operation

At a glance:
When encouraged to return to normal activities and to work as soon as possible, patients can recover quickly from hernia
hernia
A protrusion of part of the body outside of its normal space. Common hernias include disc
disc
A 'cushion' between vertebrae in the spine. Each disc helps form a joint to allow movement between the vertebrae.  Disks
disk
A 'cushion' between vertebrae in the spine. Each disc helps form a joint to allow movement between the vertebrae. Disks have a fibrous outer layer surrounding a jelly-like core, which functions to absorb impact in the spine. Alternative spelling: disc.
  have a fibrous outer layer surrounding a jelly-like core, which functions to absorb impact in the spine. Alternative spelling: disk.
 herniations in the spine and inguinal hernia in the groin.
 operations. Patients who had a generally pessimistic
pessimistic
Tends to stress the negative or unfavorable or to take the gloomiest possible view.
 outlook on life were more likely to take longer to return to normal daily activities than those who weren't pessimistic. An optimistic outlook did not affect the time it took to return to normal activities.
Perspectives:
Employee
Being pessimistic means an individual is negative about the issues in hand. This study is on the outcome of one type of operation. However, we know that a person's understanding and beliefs about a situation influences the results of a number of health conditions. When people believe they are able to do things, it is much more likely they will do them.

The important finding arising from this study is that patients should be given a good understanding about their condition, about return to activity, and how they can accelerate their recovery.  

Whether a person returns to everyday activities within two or five days after a Hernia operation is not necessarily a major problem. However being pessimistic about a return to normal activities can have a much more significant effect. 

Return to normal activity and work can be delayed for weeks, or even months, or years if the person does not have a positive outlook and a good understanding of the recovery process.
Employer
A pessimistic attitude and negative expectations lead to a slower return to work and everyday activities.

An optimistic approach, giving the person confidence in their abilities, doing everything you can to make sure they have a good understanding about the recovery process from a medical condition, or surgery, can improve the patient's outlook, level of activity and speed their return to work.
Treater
We can't change a person's personality or demeanour, but we can impact what they believe about the condition. People who are negative about their abilities are slower to return to activity and to work.

This study demonstrates that promoting an optimistic outlook in combination with providing a person with appropriate advice, and a clear understanding of what they are able to do, can improve recovery and return to work outcomes.

The results of this study are consistent with a broad range of other research projects that had indicated a person's beliefs about their situation will have a significant impact on the outcome. The treating practitioner's beliefs and advice can influence the person's beliefs.
Insurer
An individual's personality cannot be changed. However this study shows that when people have less positive expectations their return to normal activity is slower. Similarly their return to work is delayed.

It is important that people have a good understanding of the recovery process from many medical condition and/or operation. Encourage claimants who are having a procedure, or surgery, to gain a good understanding about recovery times and expected return to normal activities and work.
Original Article, Authors & Publication Details:
D. M. G. Bowley, M. Butler, S. Shaw, A. N. Kingsnorth (2003). 

Dispositional pessimism predicts delayed return to normal activities after inguinal hernia operation. Surgery; 133(2):141-146

The Department of General Surgery, Derriford, Hospital, Department of Mathematics and Statistics,
University of Plymouth, and Plymouth Postgraduate Medical School, Plymouth, United Kingdom
Background, Study Objectives, How It Was Done:
Hernia operations are common and many work days are lost during recovery.   The time it takes to recover from a hernia operation varies widely, from 1.5 days to 6 weeks. 

Evidence suggests that a person's outlook on life affects their physical and mental health.  

The aim of this study was to see if outlook on life influenced how quickly people resumed their normal activities after a hernia operation. 

206 patients undergoing a common type of hernia operation (open mesh repair of inguinal hernia) were included in the study. Patients were excluded from the study if they were younger than 18, obese, mentally ill, or had an irreducible hernia. 

Each patient's outlook on life was determined by asking them twelve questions about how they generally tended to expect things to turn out. Their answers were then compared to the time they took to resume work and their normal activities.   Patients were reviewed 3 days, 2 weeks, 6 months and 12 months after the operation to record the time they took to return to normal activities (such as walking, shopping and gardening) and to paid employment. 
Study Findings:
98% of the study participants were male, and 99% had their operations under local anaesthetic. 71% of the operations were performed by the same doctor. The patients' ages ranged between 21 and 92 years. Almost half (45%) of patients were retired, 45% were in full time or part time paid work, 5% were unemployed and 5% were self-employed.

79% of patients had returned to normal everyday activities within 3 days, and 91% within 5 days.

39% of employed patients had returned to work within 10 days.

The average time it took for employed patients to return to work was 21 days.

Patients who returned to normal activity within 3 days had lower “pessimism” scores than those who took longer than 3 days to return to normal activity.

Patients with higher pessimism scores reported a slightly higher amount of pain immediately before their operation, but the severity and duration of pain in the 12 months after the operation was not affected by pessimism score. 

Patients' “optimism” scores did not correlate to level of pain, or how quickly patients returned to normal activity.  
Conclusions:
Patients' expectations, motivations, and level of confidence in their treatment all influence the decision to return to work after surgery. The time taken to return to work depends largely on what the patient is told by their surgeon or physician. 

In this study, patients were encouraged to return to activity and work as soon as possible, and most patients had returned to normal daily activities within 3 days. Patients who were pessimistic were significantly more likely to take longer than 3 days to return to normal activities. As expectations affect time to recovery, explaining to a patient of how long recovery is likely to take after surgery may help reduce their recovery time.  Doctors should emphasise the expected time to recovery and encourage an optimistic outlook to assist patients to return to normal activities as soon as possible.
References:
PubMed Abstract
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