The Effects of a Challenge State Intervention on Patient Recovery when Undergoing Elective Orthopaedic Surgery (WMRF #342)

Joseph Baker,

Grant recipient of the Braemar Charitable Trust grant, in collaboration with Waikato Medical Research Foundation


The biopsychosocial model of challenge and threat provides insight into individual responses to stressful situations. The theory hypothesises that individuals who perceive a situation as a challenge (i.e., in which they believe they have sufficient resources to cope with the situation) have a more adaptive approach than those who perceive the situation as a threat (i.e., in which they believe they do not have sufficient resources to cope with the situation).

Evidence suggests that individuals who appraise a situation as a challenge (i.e., are in a challenge state) have more positive performance outcomes in various contexts, including medical training, pain perception, aviation and sporting environments. Experiments have demonstrated that challenge or threat states can be caused by psychological manipulations and reaffirm that those who have appraised a situation as a challenge (i.e., in a challenge state) have better performance outcomes than those who view the situation as a threat. A recent study shifted the focus to examining the association between surgical outcomes and measured spontaneous challenge and threat states in patients undergoing elective orthopaedic surgery. The outcomes demonstrated that a patient’s self-perceived ability to cope with the surgery was associated with shorter length of stay in hospital and a higher rating on quality of life after surgery.


This study aims to take this one step further by applying a challenge state intervention to one group of patients and to compare their outcomes to patients who did not receive an intervention (controls).


Study will be a randomised controlled trial in the context of elective orthopaedic surgeries in the public system. Participants will be randomly allocated to the control or intervention group performed as block randomization (in blocks of 8) with a 1:1 allocation. Patients and surgeon will be blinded to the allocation. Patients who meet the above inclusion criteria will be invited to participate in the study at least 2 weeks prior to their proposed operation date. Data will be collected on the day of their operation. They will be followed through to 6 weeks post-operatively with questionnaires at the 2-week and 6-week mark.

Intervention of choice for this study is a pre-written verbal script delivered by a trained researcher two days prior to the proposed surgical date. Verbal intervention was chosen as it was easy to implement and easily replicable. Delivery over the phone ensures that the patient has received the intervention. For future studies and implementation, a verbal intervention is also accessible and easily replicable. Participants in both the intervention and comparison group will be receiving a scripted phone call.

Media Summary

The aim of this study is to examine the effects of a pre-operative “challenge state intervention” on the recovery of elective orthopaedic patients from surgery and on their perceptions of the surgery itself. The study stems from a theory in psychology called the Biopsychosocial Model of Challenge and Threat which gives insight into how different individuals respond to stressful situations. We want to know whether there is a relationship between length of hospital stay, short-term post-operative outcomes at 2- and 6- weeks in participants who receive the intervention compared to those who have not received the intervention.

Outcome Statement

This research topic is particularly relevant given the increased demand on the health system and hospital beds in New Zealand as well as increasing waiting times for surgery around the country.

This research will contribute to insight into factors affecting patient recovery from surgery. It can also lead to a cost-effective, easily implemented method of encouraging faster post-operative recovery and decreasing length of stay in hospital. It aims to improve patient perceptions of their own abilities to overcome the challenge of surgery, patient satisfaction, and quality of life, especially in the immediate post-operative period. The outcomes of this study will provide more information to better inform future patient-centred interventions in readying candidates for surgery and a basis of development of further studies.

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