Psychological Predictors f Rehabilitation Success: The Role of Anxiety, Depression, And Self-Efficacy in Physiotherapy Outcomes After Orthopedic Injury

Abstract

Orthopedic injury and rehabilitation following orthopedic surgery are generally assessed through physical benchmarks; however, individuals with comparable tissue injuries who undergo comparable physical therapy regimes experience varying recovery times. The current paper assesses whether anxiety, depression, and self-efficacy account for such variations. A critical analysis of relevant research with quantitative data extraction was carried out using 24 peer-reviewed articles written between 2022 and 2026, including research focused on arthroplasty of the knee and hip, anterior cruciate ligament reconstruction (ACLR), and fractures of the lower limb. Effect estimates presented in the reviewed articles were recorded verbatim and, where possible, converted into equivalent derived measures (shared variance, per 10-point odds ratios, risk ratios). Psychological morbidity was common: the prevalence varied from 17% to 43% in case of depressive symptoms/diagnoses and from 21% to 36% in case of anxiety. The state anxiety, depressive symptoms, and low self-efficacy were consistently linked to poorer outcomes in terms of self-reported pain, function, and acceptable symptom state, showing bivariate correlations in primary studies in small-to-moderate sample sizes (|r| ≈ 0.31-0.57; 10-32% shared variance). Scores taken shortly after surgery predicted chronic pain a year later following fracture fixation more strongly than baseline scores. Correlations were less strong, and frequently not significant after adjustments, for objectively measured performance variables and clinical diagnoses of mental disorders, in meta-analyses. Cognitive-behavioural and theory-based physiotherapy interventions led to improvements in psychological preparedness, self-efficacy and function, in randomised and quasi-experimental trials. There is support for systematic psychological screening and physiotherapy interventions that account for psychological issues, but the research base is limited to single-site observational cohorts with different measures.