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Selph TJ, Suleiman LI, Pagadala MS, Bergman R, Franklin PD, Edelstein AI. Agreement of the American Academy of Orthopaedic Surgeons Appropriate Use Criteria With Treatment Recommendations From Arthroplasty Surgeons. Arthroplast Today 2024; 27:101386. [PMID: 38812476 PMCID: PMC11134556 DOI: 10.1016/j.artd.2024.101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/02/2024] [Accepted: 03/24/2024] [Indexed: 05/31/2024] Open
Abstract
Background The American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC) for Surgical Management of Osteoarthritis of the Knee (2016) and Management of Osteoarthritis of the Hip (2017) are intended to provide treatment recommendations for osteoarthritis (OA). This study examined the agreement of AUC appropriateness classifications with arthroplasty surgeon recommendations for total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods The cohort included 558 OA patients (397 knee, 161 hip) referred to a specialty arthroplasty clinic. Surgeons completed the online AAOS AUC patient profiles to generate appropriateness ratings. Surgeons' recommendations for treatment were recorded. We performed univariate and bivariate analyses to evaluate relationships between AUC appropriateness and surgeon recommendations. Results The knee OA AUC classified TKA as "appropriate" for 309 (77.8%) of the 397 knee OA patients. Surgeons recommended TKA for 123 (31.0%), resulting in 46.8% (n = 186) higher rate of "appropriate" classification by AUC than TKA recommendation by surgeons. Weighted Cohen's κ demonstrated slight agreement (κ = 0.06, 95% confidence interval: 0.04, 0.09) between AUC appropriateness and surgeon TKA recommendation. The hip OA AUC classified THA as "appropriate" for 98 (60.9%) of the 161 hip OA patients. Surgeons recommended THA for 76 (47.2%), resulting in 13.7% (n = 22) higher rate of "appropriate" classification by AUC than THA recommendation by surgeons. Weighted Cohen's κ demonstrated moderate agreement (κ = 0.47, 95% confidence interval: 0.37, 0.57) between the AUC appropriateness classification and the surgeon's THA recommendation. Conclusions AAOS AUC guidelines indicated surgical appropriateness significantly more than arthroplasty surgeons. AUC agreed slightly with surgeons for TKA and moderately for THA.
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Affiliation(s)
- T. Jacob Selph
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda I. Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rachel Bergman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patricia D. Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Adam I. Edelstein
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wahl Z, Courbon C, Macindo JRB, Torres GCS, Lecoultre C. Surgical Patient Preoperative Readiness: Translation into French, Cultural Adaptation for Switzerland and Cross-Sectional Exploratory Study in a Tertiary Hospital. J Perianesth Nurs 2024:S1089-9472(24)00051-0. [PMID: 38819361 DOI: 10.1016/j.jopan.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Preoperative evaluation of elective surgery patients traditionally focuses on somatic and organizational aspects of the situation. Patient feelings of readiness, called preoperative readiness (PR), impacts postoperative outcomes, and yet is rarely evaluated. The Preoperative Assessment Tool (PART) is a validated and reliable 15-item questionnaire available in Filipino and English. A reliable tool is essential for evaluating PR within the Swiss health context to offer optimized and comprehensive perioperative care. The aim of this study was to both translate into French and adapt culturally the Preoperative Assessment Tool for Switzerland's francophone population, and to explore patient PR in the preoperative consultation within a Swiss tertiary hospital. DESIGN A mixed design with methodologic phases and descriptive study. METHODS A mixed design in two phases with a methodologic phase with (1) translation and (2) cultural adaptation for Romandie of the PART, following Wild's 10 steps methodology (n = 11) and (3) a cross-sectional exploratory descriptive study with pilot testing of the translated version in a general elective preoperative consultation in a tertiary hospital in Romandie (N = 88). FINDINGS Translation and cultural adaptations are well accepted and understood by the participants (n = 9/11), modifications are accepted by the authors and deemed adequate by the participants (n = 11/11). Time of completion is short (m = 69.06 seconds) and adapted to clinical context. The translated version has a Cronbach (α = 0.85) comparable to the original validated scale (α = 0.86). CONCLUSIONS The translation and cultural adaptation for Switzerland of the PART was achieved, and PR was explored. Further psychometric testing of the PART-FrenCH must be conducted to assess fully the tool before its use in a clinical setting. Including PR in preoperative evaluations could enhance patient-centered approaches and lead to improvement in the quality of care.
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Affiliation(s)
- Zoé Wahl
- Department of Nursing, Haute Ecole de Santé Vaud (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Vaud, Switzerland; College of Nursing, Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Vaud, Switzerland.
| | - Cécile Courbon
- Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland
| | | | - Gian Carlo S Torres
- College of Nursing, University of Santo Tomas, Manila, Philippines; College of Nursing, University of the Philippines, Manila, Philippines
| | - Claudia Lecoultre
- Department of Surgery and Cardio-Vascular, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland
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Steinbeck V, Bischof AY, Schöner L, Langenberger B, Kuklinski D, Geissler A, Pross C, Busse R. Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains. Int J Equity Health 2024; 23:44. [PMID: 38413981 PMCID: PMC10900674 DOI: 10.1186/s12939-024-02131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. METHODS The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). RESULTS Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. CONCLUSIONS Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. TRIAL REGISTRATION German Register for Clinical Trials, DRKS00019916, 26 November 2019.
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Affiliation(s)
- Viktoria Steinbeck
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany.
| | - Anja Yvonne Bischof
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Lukas Schöner
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - Benedikt Langenberger
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - David Kuklinski
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Alexander Geissler
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Christoph Pross
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - Reinhard Busse
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
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Tao H, Li X, Chu M, Wang Q, Li P, Han Q, Chen K, Zhu P, Hao Y, Yang X, Geng D, Gu Y. CB2 regulates oxidative stress and osteoclastogenesis through NOX1-dependent signaling pathway in titanium particle-induced osteolysis. Cell Death Discov 2023; 9:461. [PMID: 38104087 PMCID: PMC10725463 DOI: 10.1038/s41420-023-01761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Periprosthetic osteolysis (PPO) induced by wear particles at the interface between the prosthesis and bone is a crucial issue of periprosthetic bone loss and implant failure. After wear and tear, granular material accumulates around the joint prosthesis, causing a chronic inflammatory response, progressive osteoclast activation and eventual loosening of the prosthesis. Although many studies have been conducted to address bone loss after joint replacement surgeries, they have not fully addressed these issues. Focusing on osteoclast activation induced by particles has important theoretical implications. Cannabinoid type II receptor (CB2) is a seven-transmembrane receptor that is predominantly distributed in the human immune system and has been revealed to be highly expressed in bone-associated cells. Previous studies have shown that modulation of CB2 has a positive effect on bone metabolism. However, the exact mechanism has not yet been elucidated. In our experiments, we found that NOX1-mediated ROS accumulation was involved in titanium particle-stimulated osteoclast differentiation. Furthermore, we confirmed that CB2 blockade alleviated titanium particle-stimulated osteoclast activation by inhibiting the NOX1-mediated oxidative stress pathway. In animal experiments, downregulation of CB2 alleviated the occurrence of titanium particle-induced cranial osteolysis by inhibiting osteoclasts and scavenging intracellular ROS. Collectively, our results suggest that CB2 blockade may be an attractive and promising therapeutic scheme for particle-stimulated osteoclast differentiation and preventing PPO.
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Affiliation(s)
- Huaqiang Tao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, China
| | - Xueyan Li
- Anesthesiology department, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, 242, Guangji Road, Suzhou, Jiangsu, China
| | - Miao Chu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, China
| | - Qiufei Wang
- Department of Orthopedics, Changshu Hospital Affiliated to Soochow University, First People's Hospital of Changshu City, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ping Li
- Department of Central Laboratory, Nanjing Medical University Affiliated Suzhou Hospital, Gusu School, Suzhou, Jiangsu, China
| | - Qibin Han
- Orthopedics and Sports Medicine Center, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, 242, Guangji Road, Suzhou, Jiangsu, China
| | - Kai Chen
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, China
| | - Pengfei Zhu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, China
| | - Yuefeng Hao
- Orthopedics and Sports Medicine Center, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, 242, Guangji Road, Suzhou, Jiangsu, China
| | - Xing Yang
- Orthopedics and Sports Medicine Center, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, 242, Guangji Road, Suzhou, Jiangsu, China.
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu, China.
| | - Ye Gu
- Department of Orthopedics, Changshu Hospital Affiliated to Soochow University, First People's Hospital of Changshu City, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Hawker GA. The Devil Is in the Detail: Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty. Arthritis Rheumatol 2023; 75:1889-1891. [PMID: 37488964 DOI: 10.1002/art.42659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 07/26/2023]
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Hawker GA. The Devil Is in the Detail: Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty. Arthritis Care Res (Hoboken) 2023; 75:2239-2241. [PMID: 37485803 DOI: 10.1002/acr.25202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 07/25/2023]
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Pacheco-Brousseau L, Poitras S, Charette M, Amor SB, Desmeules F, Stacey D. Exploring appropriateness criteria for informing the total knee arthroplasty decision-making process: An interpretive descriptive study. J Eval Clin Pract 2023; 29:942-954. [PMID: 37410789 DOI: 10.1111/jep.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
RATIONAL The Hawker appropriateness criteria for total knee arthroplasty (TKA) are: osteoarthritis symptoms impacting quality of life, evidence of osteoarthritis, trial of conservative treatments, patient's realistic expectations, patient/surgeon agree benefits outweigh risks, and readiness for surgery. Little is known about the barriers and facilitators of using the Hawker et al. appropriateness criteria for TKA in clinical practice. AIMS AND OBJECTIVES Explore the barriers and facilitators to using appropriateness criteria for TKA in making decisions for adults with knee osteoarthritis. METHODS Interpretive descriptive qualitative study at an academic hospital. Purposive sampling aimed to recruit: (1) healthcare team members at all levels influencing care delivery, and (2) adults with TKA assessed at the hospital clinic. Semi-structured interviews asked about the barriers/facilitators to using the Hawker appropriateness criteria. Data analysis consisted of inductive thematic analysis with themes mapped to the Consolidated Framework for Implementation Research domains. RESULTS Nine healthcare professionals and 14 adults with TKA participated and identified common barriers to using the Hawker appropriateness criteria: (a) intervention characteristics domain: difficulty to assess criteria, patients expecting healthcare professionals to decide, limited accessibility to conservative treatments; (b) individuals characteristics domain: no need to change current TKA process, clinical judgement limited to OA severity/age, implicit assessment of subjective criteria; (c) inner setting domain: TKA information received after decision made; and (d) outer setting domain: no timely access to TKA. A facilitator of use was evidence/buy-in fosters programme changes. CONCLUSION Barriers to using the criteria relevant to clinical practice and the healthcare system were identified while only one facilitator was revealed. Interventions tailored to these barriers are needed to support the use of the Hawker appropriateness criteria in TKA decision-making.
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Affiliation(s)
- Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Quebec, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Healy S, Dorflinger E, Michaleff ZA, Marks D. Patient preferences and decision-making when considering surgery for musculoskeletal disorders: A mixed methods systematic review. Musculoskeletal Care 2023; 21:312-337. [PMID: 37316969 DOI: 10.1002/msc.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The burden of Musculoskeletal disorders (MSD) is large. Surgery is an important management option but the factors that shape patients' surgical decisions are not well understood. As prior reviews have explored only single data types or conditions, a mixed methods appraisal across the musculoskeletal spectrum was undertaken. METHODS A mixed-methods systematic, convergent segregated approach was used, with PubMed, Cumulated Index to Nursing and Allied Health Literature (CINHAL), Embase and PsycINFO searched to identify studies of adult patients' decisions about whether to undergo surgery. A narrative synthesis was conducted, with identified themes integrated across quantitative, qualitative and mixed-methods studies. RESULTS Forty-six studies were included (24 quantitative, 19 qualitative and three mixed methods), with four decision-making themes identified (symptoms, sociodemographic and health factors, information and perceptions). Decision-making involves a complex interaction of individual sociodemographic, health and symptom information, integrated with individual perceptions of candidacy and surgical expectations. While most studies investigated hip and knee surgery, across all included conditions, patients are more likely to favour surgery if symptoms and/or dysfunction are higher, and if perceptions of surgical candidacy and processes (outcomes, inconvenience, and risk) are favourable. Other factors including age, general health, race, financial context, professional and non-professional communication, and information sources also impact decision-making but exert a less consistent impact upon the propensity to prefer surgery. CONCLUSION Patients are more likely to choose surgery for MSD when they have higher levels of symptoms or dysfunction and positive perceptions of surgical suitability and expectations. Other factors important to individuals, have a less consistent impact upon the propensity to prefer surgery. These findings have potential to aid the efficient referral of patients to orthopaedics. More research is needed to validate these findings across the spectrum of MSD.
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Affiliation(s)
- Sarah Healy
- Bond University Faculty of Health Science and Medicine, School of Physiotherapy, Bond Institute of Health and Sport, Robina, Queensland, Australia
| | - Eric Dorflinger
- Bond University Faculty of Health Science and Medicine, School of Physiotherapy, Bond Institute of Health and Sport, Robina, Queensland, Australia
| | - Zoe A Michaleff
- Northern New South Wales Local Health District, Lismore, New South Wales, Australia
| | - Darryn Marks
- Bond University Faculty of Health Science and Medicine, School of Physiotherapy, Bond Institute of Health and Sport, Robina, Queensland, Australia
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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Hawker GA, Bohm E, Dunbar MJ, Faris P, Jones CA, Noseworthy T, Ravi B, Woodhouse LJ, Marshall DA. Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome. RMD Open 2023; 9:rmdopen-2022-002808. [PMID: 37068914 PMCID: PMC10111922 DOI: 10.1136/rmdopen-2022-002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients' preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome. METHODS In patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes-yes/no) and expectations (outcomes deemed 'very important'). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios. RESULTS Of 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66-0.74). The predicted probability of a good outcome ranged from 44.4% (33.9-55.5) to 92.4% (88.4-95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations. CONCLUSIONS Although external validation is required, our findings suggest that incorporation of patients' TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome.
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Affiliation(s)
- Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Eric Bohm
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J Dunbar
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter Faris
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Tom Noseworthy
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Bheeshma Ravi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Department of Public Health and Community Medicine, Tufts University, Phoenix, Arizona, USA
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Pacheco-Brousseau L, Poitras S, Ben Amor S, Desmeules F, Kiss A, Stacey D. Hip and Knee Total Joint Arthroplasty Online Resources for Patients and Health Care Professionals: A Canadian Environmental Scan. Physiother Can 2023. [DOI: 10.3138/ptc-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Purpose: To appraise the quality of publicly available online Canadian resources for patients with hip or knee osteoarthritis considering total joint arthroplasty (TJA) and health care professionals participating in TJA decision-making processes. Method: An environmental scan. Two independent authors appraised: a) patient resources against the International Patient Decision Aids Standards (IPDAS) criteria and the Patient Education Material Evaluation Tool (PEMAT); and b) health care professional resources against six appropriateness criteria for TJA and eight elements of shared decision-making. Analysis was descriptive. Results: Of 84 included resources, 71 were for patients, 11 for health care professionals, and 2 for both. For patient resources, the median number of IPDAS defining criteria met was 2 of 7, median PEMAT understandability score was 83%, and median PEMAT actionability score was 60%. For health care professional resources, the median number of appropriateness criteria was 3 of 6, and the median number of shared decision-making elements was 3 of 8. Conclusions: Only four of 73 patient resources were structured to help patients consider their options and reach a decision based on their preferences. Health care professional resources were limited to traditional criteria for determining TJA appropriateness (evidence of osteoarthritis, use of conservative treatments) and poorly met key elements of shared decision-making.
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Hawker GA. The crux of the issue: assessment of patient appropriateness for joint replacement requires a conversation with the patient. Osteoarthritis Cartilage 2023:S1063-4584(23)00719-7. [PMID: 36907544 DOI: 10.1016/j.joca.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023]
Affiliation(s)
- G A Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Pacheco-Brousseau L, Stacey D, Desmeules F, Ben Amor S, Lambert D, Tanguay E, Hillaby A, Bechiau C, Charette M, Poitras S. Instruments to assess appropriateness of hip and knee arthroplasty: a systematic review. Osteoarthritis Cartilage 2023:S1063-4584(23)00701-X. [PMID: 36898655 DOI: 10.1016/j.joca.2023.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To assess criteria and psychometric properties of instruments for assessing appropriateness of elective joint arthroplasty (JA) for adults with primary hip and knee osteoarthritis (OA). METHODS A systematic review guided by Cochrane methods and PRISMA guidelines. Studies were searched in five databases. Eligible articles include all study designs developing, testing, and/or using an instrument to assess JA appropriateness. Two independent reviewers screened and extracted data. Instruments were compared with Hawker et al. JA consensus criteria. Psychometric properties of instruments were described and appraised guided by Fitzpatrick's and COSMIN approaches. RESULTS Of 55 instruments included, none met all Hawker et al. JA consensus criteria. Criteria the most met were pain (n = 50), function (n = 49), quality of life (n = 33), and radiography (n = 24). Criteria the least met were clinical evidence of OA (n = 18), expectations (n = 15), readiness for surgery (n = 11), conservative treatments (n = 8), and patient/surgeon agree benefits outweigh risks (n = 0). Instrument by Arden et al. met the most criteria (6 of 9). The most tested psychometric properties were appropriateness (n = 55), face/content validity (n = 55), predictive validity (n = 29), construct validity and feasibility (n = 24). The least tested psychometric properties were intra-rater reliability (n = 3), internal consistency (n = 5), and inter-rater reliability (n = 13). Instruments by Gutacker et al. and Osborne et al. met the most psychometric properties (4 of 10). CONCLUSION Most instruments included traditional criteria for assessing JA appropriateness but did not include a trial of conservative treatments or shared decision-making elements. There was limited evidence on psychometric properties.
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Affiliation(s)
- L Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - D Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - F Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Canada.
| | - S Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Canada.
| | - D Lambert
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - E Tanguay
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - A Hillaby
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - C Bechiau
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.
| | - M Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - S Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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A synthesis of qualitative research to understand the complexity behind treatment decision-making for osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100355. [PMID: 37020788 PMCID: PMC10068262 DOI: 10.1016/j.ocarto.2023.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
Objective Osteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement. Methods We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. Results We developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making. Conclusions Osteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.
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Torrente-Jimenez RS, Feijoo-Cid M, Rivero-Santana AJ, Perestelo-Pérez L, Torres-Castaño A, Ramos-García V, Bilbao A, Serrano-Aguilar P. Gender differences in the decision-making process for undergoing total knee replacement. PATIENT EDUCATION AND COUNSELING 2022; 105:3459-3465. [PMID: 36075809 DOI: 10.1016/j.pec.2022.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess gender differences in the decision-making process for treatment of knee osteoarthritis (OA). METHODS A secondary analysis of a randomized trial was conducted (n = 193). Knowledge of OA and total knee replacement (TKR), decisional conflict, satisfaction with the decision-making process, treatment preference and TKR uptake 6 months later were compared by gender. Multivariate regression models were developed to identify gender-specific predictors. RESULTS Women showed less knowledge (MD = -7.68, 95% CI: -13.9, -1.46, p = 0.016), reported less satisfaction (MD = -6.95, 95% CI: -11.7, -2.23, p = 0.004) and gave more importance to avoiding surgery (U = 2.09, p = 0.019). In women, more importance attributed to the time needed to relieve symptoms significantly reduced the odds of surgery (OR = 0.76, p = 0.016). CONCLUSION The provision of information and/or promotion of shared decision-making could be of lower quality in female patients, although other explanations such as differences in information needs or preference for involvement in decision-making cannot be ruled out with the current evidence. Given the study's limitations, especially regarding the sample size, further confirmation is needed. PRACTICE IMPLICATIONS A systematic, shared decision-making approach in consultation is needed to avoid potential gender-based biases.
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Affiliation(s)
| | - Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain.
| | - Amado Javier Rivero-Santana
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - Lilisbeth Perestelo-Pérez
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
| | - Alezandra Torres-Castaño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - Vanesa Ramos-García
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - Amaia Bilbao
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Pedro Serrano-Aguilar
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
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15
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Riddle DL, Dumenci L. Patient Acceptable Symptom State Versus Latent Class Analysis Outcome Classification: A Comparative Longitudinal Study of Knee Arthroplasty. Arthritis Care Res (Hoboken) 2022:10.1002/acr.24962. [PMID: 35638702 PMCID: PMC9708946 DOI: 10.1002/acr.24962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine whether Patient Acceptable Symptom State (PASS), a single-item deterministic binary measure of pain and function outcome satisfaction, leads to better differentiation of outcome classification versus latent class analysis probability-based outcome subgroups 1 year after knee arthroplasty (KA). METHODS We used data from Knee Arthroplasty Skills Training for Pain (KASTPain), a 1-year no-effect multicenter randomized clinical trial of participants with KA, along with prior work that developed and externally validated good and poor outcome trajectories. Confirmatory latent class analyses were conducted on 2 exemplar outcome measures (Euroquol visual analog scale single-item self-rated health and 4-item pain ratings) and compared with PASS scores. Separation of trajectories were used to compare good and poor latent class self-rated health/4-item pain trajectories and PASS score trajectories. RESULTS Prevalence rates for poor outcomes were 10% for self-rated health and 20% for 4-item pain and PASS. Probabilistic latent class-derived classifications of self-rated health and 4-item pain outcomes outperformed PASS in separating growth trajectories. The effect size point estimates for 12-month 4-item pain scale score separation was approximately 3 times larger for latent class analyses as compared with PASS. CONCLUSIONS When used for outcome classification, observed PASS scores consistently underperform relative to probabilistic latent class-derived subgroups of pain and self-rated health outcome. PASS is a weak substitute for probabilistic classification of other patient-reported outcome measures of KA outcome. Clinicians and researchers should rely on latent class analyses over PASS to differentiate between outcome subgroups after KA.
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Affiliation(s)
- Daniel L. Riddle
- Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, 900 East Leigh Street, Room 4:100, Virginia Commonwealth University, Richmond, VA, USA
| | - Levent Dumenci
- Department of Epidemiology and Biostatistics, 1301 Cecil B. Moore, Ave., Ritter Annex, Room 939, Temple University, Philadelphia, PA, USA 19122
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16
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Desai MJ, Bentley A, Keck WA. Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis compared with intra-articular hyaluronan injections based on trial data. BMC Musculoskelet Disord 2022; 23:491. [PMID: 35610642 PMCID: PMC9128114 DOI: 10.1186/s12891-022-05445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Effective symptom control in painful knee osteoarthritis (OA) may improve patient quality of life. In a randomised crossover trial (NCT03381248), COOLIEF* cooled radiofrequency ablation (CRFA) reduced pain and stiffness and improved physical function and quality of life compared with intra-articular hyaluronan (HA) injections. The present study aimed to establish the cost effectiveness of CRFA versus intra-articular HA injections for treating moderate-to-severe OA knee pain from a US Medicare perspective. Methods We conducted a cost-effectiveness analysis using utility data (EQ-5D) from the randomised crossover trial of CRFA versus intra-articular HA injections, which had follow-ups at 1, 3, 6, and 12 months. Patients in the HA group with unsatisfactory outcomes (e.g., continued pain) at 6 months could cross over to CRFA. Economic analysis outcomes included quality-adjusted life-years (QALYs), costs, and cost effectiveness (cost per QALY gained). Base-case analyses were modelled on a 6-month time horizon (to trial crossover). Due to limited trial data in the HA arm beyond 6 months, scenarios explored potential outcomes to 12 months if: 1) Utility with HA persisted for a further 6 months; 2) A second HA injection was received at 6 months and achieved the same utility change for the second 6 months. In both scenarios, the CRFA arm used trial data for patients who received CRFA from baseline to 12 months. Alternative costing scenarios were also explored. Results CRFA resulted in an incremental QALY gain of 0.020 at an incremental cost of US$1707, equating to an incremental cost-effectiveness ratio (ICER) of US$84,392 per QALY over 6 months, versus intra-articular HA injections. Extending the analysis to 12 months and assuming persistence in utility in the HA arm resulted in a larger utility gain for CRFA (0.056 QALYs) and a lower ICER of US$30,275 per QALY. If patients received a second HA injection, the incremental benefit of CRFA out to 12 months was reduced (QALY gain 0.043) but was offset by the costs of the second HA injection (incremental cost US$832). This resulted in an ICER of US$19,316 per QALY. Conclusions CRFA is a cost-effective treatment option for patients with OA-related knee pain considering the typical US threshold of US$100,000/QALY.
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Affiliation(s)
- Mehul J Desai
- International Spine, Pain & Performance Center, Washington DC, USA. .,George Washington University, School of Medicine & Health Sciences, Washington DC, USA.
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17
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A qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain. Pain 2022; 163:e1169-e1183. [PMID: 35504032 DOI: 10.1097/j.pain.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care and qualitative research can have an important part to pay in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis in order to incorporate this knowledge into an educational resource. We comprehensively searched four bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10123 titles, 548 abstracts and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated yet dependent; I accept, but I will not let it define me; (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective healthcare. This finding may be transferable beyond this condition.
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18
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Hawker GA, Bohm E, Dunbar MJ, Jones CA, Noseworthy T, Marshall DA. The Effect of Patient Age and Surgical Appropriateness and Their Influence on Surgeon Recommendations for Primary TKA: A Cross-Sectional Study of 2,037 Patients. J Bone Joint Surg Am 2022; 104:700-708. [PMID: 35226616 DOI: 10.2106/jbjs.21.00597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rising total knee arthroplasty (TKA) rates in younger patients raises concern about appropriateness. We asked: are younger individuals who seek consultation for TKA less likely to be appropriate for and, controlling for appropriateness, more likely to be recommended for surgery? METHODS This cross-sectional study was nested within a prospective cohort study of knee osteoarthritis (OA) patients referred for TKA from 2014 to 2016 to centralized arthroplasty centers in Alberta, Canada. Pre-consultation, questionnaires assessed patients' TKA appropriateness (need, based on knee symptoms and prior treatment; readiness/willingness to undergo TKA; health status; and expectations) and contextual factors (for example, employment). Post-consultation, surgeons confirmed study eligibility and reported their TKA recommendation. Using generalized estimating equations to control for clustering by surgeon, we assessed relationships between patient age (<50, 50 to 59, ≥60 years) and TKA appropriateness and receipt of a surgeon TKA recommendation. RESULTS Of 2,037 participants, 3.3% and 22.7% were <50 and 50 to 59 years of age, respectively, 58.7% were female, and 35.5% were employed. Compared with older participants, younger participants reported significantly worse knee symptoms, higher use of OA therapies, higher TKA readiness, and similar willingness, but had higher body mass index and were more likely to smoke and to consider the ability to participate in vigorous activities, for example, sports, as very important TKA outcomes. TKA was offered to 1,500 individuals (73.6% overall; 52.2%, 71.0%, and 75.4% of those <50, 50 to 59, and ≥60 years, respectively). In multivariate analyses, the odds of receiving a TKA recommendation were higher with greater TKA need and willingness, in nonsmokers, and in those who indicated that improved ability to go upstairs and to straighten the leg were very important TKA outcomes. Controlling for TKA appropriateness, patient age was not associated with surgeons' TKA recommendations. CONCLUSIONS Younger individuals with knee OA referred for TKA had similar or greater TKA need, readiness, and willingness than older individuals. Incorporation of TKA appropriateness criteria into TKA decision-making may facilitate consideration of TKA benefits and risks in a growing population of young, obese individuals with knee OA. CLINICAL RELEVANCE Younger people seeking TKA for knee OA had significant OA pain and disability despite recommended OA therapies, suggesting appropriateness for surgical consideration. However, they were significantly more likely to have morbid obesity, to smoke, and to consider return to vigorous activities, like sport, as important TKA outcomes. Whether the short- and longer-term risks of TKA are outweighed by the benefits is unclear and warrants additional research.
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Affiliation(s)
- Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Bohm
- Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Tom Noseworthy
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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19
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Zhang L, Fu W. A commentary on “The influence of prior arthroscopy on outcomes of primary total lower extremity arthroplasty: A systematic review and meta-analysis” (Int J Surg 2022; 98:106218). Int J Surg 2022; 101:106607. [DOI: 10.1016/j.ijsu.2022.106607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
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20
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Javaid MK, Ward L, Pinedo-Villanueva R, Rylands AJ, Williams A, Insogna K, Imel EA. Musculoskeletal Features in Adults With X-linked Hypophosphatemia: An Analysis of Clinical Trial and Survey Data. J Clin Endocrinol Metab 2022; 107:e1249-e1262. [PMID: 34636401 PMCID: PMC8852215 DOI: 10.1210/clinem/dgab739] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Patients with X-linked hypophosphatemia (XLH) experience multiple musculoskeletal manifestations throughout adulthood. OBJECTIVE To describe the burden of musculoskeletal features and associated surgeries across the lifespan of adults with XLH. METHODS Three groups of adults were analyzed: subjects of a clinical trial, participants in an online survey, and a subgroup of the online survey participants considered comparable to the clinical trial subjects (according to Brief Pain Inventory worst pain scores of ≥ 4). In each group, the adults were categorized by age: 18-29, 30-39, 40-49, 50-59, and ≥ 60 years. Rates of 5 prespecified musculoskeletal features and associated surgeries were investigated across these age bands for the 3 groups. RESULTS Data from 336 adults were analyzed. In all 3 groups, 43% to 47% had a history of fracture, with the proportions increasing with age. The overall prevalence of osteoarthritis was > 50% in all 3 groups, with a rate of 23% to 37% in the 18- to 29-year-old group, and increasing with age. Similar patterns were observed for osteophytes and enthesopathy. Hip and knee arthroplasty was reported even in adults in their 30s. Spinal stenosis was present at a low prevalence, increasing with age. The proportion of adults with ≥ 2 musculoskeletal features was 59.1%, 55.0%, and 61.3% in the clinical trial group, survey group, and survey pain subgroup, respectively. CONCLUSION This analysis confirmed high rates of multiple musculoskeletal features beginning as early as age 20 years among adults with XLH and gradually accumulating with age.
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Affiliation(s)
- Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Correspondence: Dr. Muhammad Kassim Javaid, Associate Professor in Metabolic Bone Disease, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK.
| | - Leanne Ward
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Angela J Rylands
- Health Economics and Outcomes Research, Kyowa Kirin International, Marlow, UK
| | - Angela Williams
- Health Economics and Outcomes Research, Kyowa Kirin International, Marlow, UK
| | - Karl Insogna
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Erik A Imel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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21
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Dodd A, Pinsker E, Younger ASE, Penner MJ, Wing KJ, Dryden PJ, Glazebrook M, Daniels TR. Sex Differences in End-Stage Ankle Arthritis and Following Total Ankle Replacement or Ankle Arthrodesis. J Bone Joint Surg Am 2022; 104:221-228. [PMID: 35007215 DOI: 10.2106/jbjs.21.00287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the influence of sex on patient-reported outcomes preoperatively and following total ankle replacement and ankle arthrodesis. METHODS Patients who had undergone total ankle replacement or ankle arthrodesis for the treatment of end-stage ankle arthritis and who had ≥2 years of follow-up were identified from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database. Standard surgical techniques and implantation methods were followed, and STAR, Hintegra, Mobility, and Agility prostheses were used. Data were collected on patient demographics, revisions, secondary procedures, complications, Ankle Osteoarthritis Scale (AOS) scores, Short Form-36 (SF-36) scores, and expectations and satisfaction. Statistical analyses included 3-way repeated-measures analysis of variance (ANOVA) and multiple linear regression models controlling for inflammatory arthritis, age, preoperative scores, and surgery type. RESULTS The study included 872 patients: 629 who had undergone total ankle replacement (316 men, 313 women) and 243 who had undergone ankle arthrodesis (154 men, 89 women). The mean duration of follow-up (and standard deviation) was 4.9 ± 2.4 and 4.0 ± 1.9 years for the total ankle replacement and ankle arthrodesis groups, respectively. Men were older than women (p ≤ 0.001). In both the total ankle replacement and ankle arthrodesis groups, women had higher AOS pain scores (i.e., more pain) than men preoperatively (p < 0.05). Pain was reduced significantly in both sexes postoperatively (p < 0.05), with no significant difference between sexes. In both the total ankle replacement and ankle arthrodesis groups, women had higher AOS disability scores (i.e., more disability) and lower SF-36 Physical Component Summary (PCS) scores (i.e., worse function) than men both preoperatively and postoperatively (p < 0.001). Postoperatively, AOS disability and SF-36 PCS scores improved significantly from baseline in both sexes (p < 0.001). After controlling for covariates, sex was not a significant predictor of postoperative SF-36 MCS (Mental Component Summary), AOS pain, or AOS disability scores (p > 0.05) but explained 0.5% of variance in SF-36 PCS scores (p = 0.03). Sex did not significantly influence preoperative expectations or postoperative satisfaction. When patients with inflammatory arthritis were excluded, preoperative and postoperative outcome measures, expectations, and satisfaction were similar. CONCLUSIONS Men and women with end-stage ankle arthritis benefited from total ankle replacement and ankle arthrodesis with similar magnitudes of improvement. Small differences in pain and function between men and women undergoing total ankle replacement and ankle arthrodesis mostly disappeared when controlling for potential confounding variables. Both total ankle replacement and ankle arthrodesis remain good options for men and women with end-stage ankle arthritis. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew Dodd
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Ellie Pinsker
- Division of Orthopaedic Surgery, Unity Health Network-St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alastair S E Younger
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Clinic for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada
| | - Murray J Penner
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Clinic for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada
| | - Kevin J Wing
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Clinic for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada
| | - Peter J Dryden
- Rebalance MD, Island Health Authority, Victoria, British Columbia, Canada
| | - Mark Glazebrook
- Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, Unity Health Network-St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Effectiveness of patient decision aids for total hip and knee arthroplasty decision-making: a systematic review. Osteoarthritis Cartilage 2021; 29:1399-1411. [PMID: 34302958 DOI: 10.1016/j.joca.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the effectiveness of patient decision aids (PtDAs) compared to alternative interventions (including usual care) on decision quality and quality of the decision-making process for adults with hip and knee osteoarthritis considering primary elective total joint arthroplasty. METHODS A systematic review guided by Cochrane methods and PRISMA reporting guidelines. Studies were searched in five databases. Included studies were RCTs evaluating the effect of PtDAs on total joint arthroplasty decision-making. Study quality was appraised with Cochrane's risk of bias tool. Quality and strength of recommendations were appraised with GRADE. RESULTS Ten included studies were conducted in North American using the same PtDA. Compared to usual care, PtDA groups demonstrated increased decision quality (e.g., higher knowledge, more informed values-based choices) and quality of the decision making process (e.g., decreased decisional conflict) (6 trials). Secondary outcomes showed increased surgeon satisfaction within the consultation and no difference in patient satisfaction or uptake of the chosen option (surgery: RR 1.03, 95% CI = 0.84 to 1.25; I2 = 66%; 4 trials). When PtDAs formtats were compared, there were similar effects but no difference between PtDAs (4 trials). CONCLUSIONS There was low to very low GRADE certainty of evidence for the effect of PtDAs on decision quality and quality of the decision-making process compared to usual care. No differences were found when different formats of PtDAs were compared (moderate to very low GRADE certainty of evidence).
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23
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Robarts S, Denis S, Kennedy D, Dickson P, Juma S, Palinkas V, Rachevitz M, Boljanovic-Susic D, Stratford P. Patient gender does not influence referral to an orthopaedic surgeon by advanced practice orthopaedic providers: a prospective observational study in Canada. BMC Health Serv Res 2021; 21:952. [PMID: 34511124 PMCID: PMC8435171 DOI: 10.1186/s12913-021-06965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background The role of an advanced practice physiotherapist has been introduced in many countries to improve access to care for patients with hip and knee arthritis. Traditional models of care have shown a gender bias, with women less often referred and recommended for surgery than men. This study sought to understand if patient gender affects access to care in the clinical encounter with the advanced practice provider. Our objectives were: (1) To determine if a gender difference exists in the clinical decision to offer a consultation with a surgeon; (2) To determine if a gender difference exists in patients’ decisions to accept a consultation with a surgeon among those patients to whom it is offered; and, (3) To describe patients’ reasons for not accepting a consultation with a surgeon. Methods This was a prospective study of 815 patients presenting to a tertiary care centre for assessment of hip and knee arthritis, with referral onward to an orthopaedic surgeon when indicated. We performed a multiple logistic regression analysis adjusting for severity to address the first objective and a simple logistic regression analysis to answer the second objective. Reasons for not accepting a surgical consultation were obtained by questionnaire. Results Eight hundred and fifteen patients (511 women, 304 men) fulfilled study eligibility criteria. There was no difference in the probability of being referred to a surgeon for men and women (difference adjusted for severity = − 0.02, 95% CI: − 0.07, 0.02). Neither was there a difference in the acceptance of a referral for men and women (difference = − 0.05, 95% CI: − 0.09, 0.00). Of the 14 reasons for declining a surgical consultation, 5 showed a difference with more women than men indicating a preference for non-surgical treatment along with fears/concerns about surgery. Conclusions There is no strong evidence to suggest there is a difference in proportion of males and females proceeding to surgical consultation in the model of care that utilizes advanced practice orthopaedic providers in triage. This study adds to the evidence that supports the use of suitably trained alternate providers in roles that reduce wait times to care and add value in contexts where health human resources are limited. The care model is a viable strategy to assist in managing the growing backlog in orthopaedic care, recently exacerbated by the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06965-5.
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Affiliation(s)
- Susan Robarts
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada. .,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Suzanne Denis
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Deborah Kennedy
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Patricia Dickson
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada.,Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shahiroz Juma
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Veronica Palinkas
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada
| | - Maria Rachevitz
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada
| | - Dragana Boljanovic-Susic
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Stratford
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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The role of pain and walking difficulties in shaping willingness to undergo joint surgery for osteoarthritis: Data from the Swedish BOA register. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100157. [DOI: 10.1016/j.ocarto.2021.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 11/20/2022] Open
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Dell’Isola A, Jönsson T, Rolfson O, Cronström A, Englund M, Dahlberg L. Willingness to Undergo Joint Surgery Following a First-Line Intervention for Osteoarthritis: Data From the Better Management of People With Osteoarthritis Register. Arthritis Care Res (Hoboken) 2021; 73:818-827. [PMID: 33053273 PMCID: PMC8251860 DOI: 10.1002/acr.24486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/08/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the proportion of participants reconsidering their willingness to undergo surgery after 3 and 12 months. Secondary aims were to analyze and compare the characteristics of individuals willing and unwilling to undergo joint surgery for osteoarthritis (OA) before a first-line intervention, and to study the association between pain intensity, walking difficulties, self-efficacy, and fear of movement with the willingness to undergo surgery. METHODS This was an observational study based on Swedish register data. We included 30,578 individuals with knee or hip OA who participated in a first-line intervention including education and exercise. RESULTS Individuals willing to undergo surgery at baseline showed a higher proportion of men (40% versus 27%) and more severe symptoms and disability. Respectively, 45% and 30% of the individuals with knee and hip OA who were willing to undergo surgery at baseline became unwilling after the intervention. At the end of the study period (12 months), 35% and 19% of those with knee and hip OA, respectively, who were willing to undergo surgery at baseline became unwilling. High pain intensity, walking difficulties, and fear of movement were associated with higher odds of being willing to undergo surgery at both follow-ups, while increased self-efficacy showed the opposite association. CONCLUSION A first-line intervention for OA is associated with reduced willingness to undergo surgery, with a greater proportion among patients with knee OA than hip OA. Due to its temporal variability, willingness to undergo surgery should be used with care to deem surgery eligibility.
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Affiliation(s)
| | | | - Ola Rolfson
- The Swedish Hip Arthroplasty RegisterCentre of Registers Västra Götaland, and Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Karunaratne S, Harris IA, Trevena L, Horsley M, Fajardo M, Solomon M. Online Decision Aids for Knee Arthroplasty: An Environmental Scan. JBJS Rev 2021; 9:01874474-202104000-00006. [PMID: 33830958 DOI: 10.2106/jbjs.rvw.20.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Knee arthroplasty is a high-risk, resource-intensive procedure that should be reserved for patients in whom the benefit will outweigh the risks. The provision of high-quality, publicly available decision aids can help patients to balance the benefits against the harms of treatments and to assist informed decision-making. The aim of this study was to identify and evaluate the content and readability of freely available knee arthroplasty decision aids. METHODS A systematic search using an environmental scan methodology of publicly available online materials was performed in December 2018. Included materials were assessed for quality using the International Patient Decision Aid Standards instrument (IPDASi), understandability and actionability from a patient's perspective using the Patient Education Materials Assessment Tool (PEMAT), and readability grade level using the Flesch-Kincaid Grade Level and the Gunning Fog Index. RESULTS Of 761 online materials screened, 26 decision aids were identified. Only 18 (69%) may be considered to meet criteria to be defined as a decision aid and 4 (15%) met criteria suggesting that the material did not introduce potential harmful bias according to the IPDASi. The mean score (and standard deviation) for all decision aids was 74% ± 12% for understandability and 44% ± 19% for actionability using the PEMAT. Readability indices indicated a mean minimum reading level of Grade 10 (10.8 ± 2.5). No decision aid included a wait-and-see option. CONCLUSIONS Few high-quality decision aids exist for patients considering knee arthroplasty and none include a wait-and-see option. Many do not provide actionable options and are pitched at above-average reading levels. Developers need to address these issues to encourage high-quality decision-making, especially for those with low health literacy.
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Affiliation(s)
- Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ian A Harris
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Fajardo
- Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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[Decision for total hip arthroplasty-the surgeons' view]. DER ORTHOPADE 2021; 50:278-286. [PMID: 33666675 DOI: 10.1007/s00132-021-04078-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The decision for total hip arthroplasty (THA) is based on pain, loss of function, radiological changes and failed conservative therapy. These criteria are rarely based on systematic research and have not been integrated in generally accepted treatment guidelines. Aim of our study was, therefore, to analyse which decision criteria German orthopaedic and trauma surgeons use in order to recommend THA for patients with hip osteoarthritis. MATERIALS AND METHODS From 10/2019 to 07/2020 we conducted a nation-wide survey among 218 orthopaedic and trauma surgeons about their criteria for and against THA surgery, as well as their treatment objectives. RESULTS 147 fully completed questionnaires were analysed. Pain (99%), limitation of movement (99%), as well as impairment of walking distance (97%), and the subjective burden (97%) were the most frequent criteria. 97% and 96% of surgeons consider prescription of analgesics and physical therapy, as well as a lack of their effectiveness, as criteria for THA. 87% see radiological changes grade Kellgren & Lawrence III as threshold. A recommendation against surgery is triggered by obesity (BMI ≥ 40 kg/m2) in 48% and by the presence of an active infection in 96%. CONCLUSIONS Current surgeons' practice criteria of recommendations for THA in Germany seem to reflect widely nationally and internationally discussed recommendations. Particular attention is given to patient factors like pain, loss of function and subjective burden, as well as previous conservative treatment and contraindications, like poorly controlled diabetes or an active infection, whereas morbid obesity is not seen as contraindication by all surgeons.
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Hawker GA, Conner-Spady BL, Bohm E, Dunbar MJ, Jones CA, Ravi B, Noseworthy T, Woodhouse LJ, Peter F, Dick D, Powell J, Paul P, Marshall DA. The Relationship between Patient-Reported Readiness for Total Knee Arthroplasty and Likelihood of a Good Outcome at One Year. Arthritis Care Res (Hoboken) 2021; 74:1374-1383. [PMID: 33460528 DOI: 10.1002/acr.24562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 01/12/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the relationship between patients' pre-operative readiness for total knee arthroplasty (TKA) and surgical outcome at one-year. METHODS This prospective cohort study recruited knee osteoarthritis (OA) patients aged 30+ years referred for TKA at two hip/knee surgery centers in Alberta, Canada. Those who received primary, unilateral TKA completed questionnaires pre-TKA to assess WOMAC-pain, KOOS-physical function, Perceived Arthritis Coping Efficacy, General Self-Efficacy, PHQ-8, BMI, comorbidities and TKA readiness (Patient Acceptable Symptom State; willingness to undergo TKA), and one-year post-TKA to assess outcomes. A good TKA outcome was defined as improved knee symptoms (OARSI-OMERACT responder criteria) AND overall satisfaction with results. Poisson regression with robust error estimation was used to estimate relative risk of a good outcome for exposures, before and after controlling for covariates. RESULTS Of 1,272 TKA recipients assessed at one year, 1,053 with data for our outcome were included (mean age 66.9 years (SD 8.8); 58.6% female). Most (87.8%) were definitely willing to undergo TKA and had 'unacceptable' knee symptoms (79.7%). 78.1% achieved a good TKA outcome. Controlling for pre-TKA OA-related disability, arthritis coping efficacy, comorbid hip symptoms and depressed mood, definite willingness to undergo TKA and unacceptable knee symptoms were associated with greater likelihood of a good TKA outcome (adjusted RRs 1.18, 95% CI 1.04-1.35, and 1.14, 95% CI 1.02-1.27, respectively). CONCLUSION Among TKA recipients for knee OA, patients' psychological readiness and willingness for TKA were associated greater likelihood of a good outcome. Incorporation of these factors in TKA decision-making may enhance patient outcomes and appropriate use of TKA.
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Affiliation(s)
- Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Eric Bohm
- Concordia Hip & Knee Institute, University of Manitoba, Winnipeg, MB, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tom Noseworthy
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.,School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia
| | - Faris Peter
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Donald Dick
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - James Powell
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paulose Paul
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Pacheco-Brousseau L, Charette M, Stacey D, Poitras S. Protocol for systematic review: patient decision aids for total hip and knee arthroplasty decision-making. Syst Rev 2021; 10:8. [PMID: 33397488 PMCID: PMC7784361 DOI: 10.1186/s13643-020-01549-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Total hip and knee arthroplasty are a highly performed surgery; however, patient satisfaction with surgery results and patient involvement in the decision-making process remains low. Patient decision aids (PtDAs) are tools used in clinical practices to facilitate active patient involvement in healthcare decision-making. Nonetheless, PtDA effects have not been systematically evaluated for hip and knee total joint arthroplasty (TJA) decision-making. The aim of this systematic review is to determine the effect of patient decision aids compared to alternative of care on quality and process of decision-making when provided to adults with hip and knee osteoarthritis considering primary elective TJA. METHODS This systematic review will follow the Cochrane Handbook for Systematic Reviews. This protocol was reported based on the PRISMA-P checklist guidelines. Studies will be searched in CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science. Eligible studies will be randomized control trial (RCT) evaluating the effect of PtDA on TJA decision-making. Descriptive and meta-analysis of outcomes will include decision quality (knowledge and values-based choice), decisional conflict, patient involvement, decision-making process satisfaction, actual decision made, health outcomes, and harm(s). Risk of bias will be evaluated with Cochrane's risk of bias tool for RCTs. Quality and strength of recommendations will be appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). DISCUSSION This review will provide a summary of RCT findings on PtDA effect on decision-making quality and process of adults with knee and hip osteoarthritis considering primary elective TJA. Further, it will provide evidence comparing different types of PtDA used for TJA decision-making. This review is expected to inform further research on joint replacement decision-making quality and processes and on ways PtDAs facilitate shared decision-making for orthopedic surgery. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020171334.
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Affiliation(s)
- Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada
| | - Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada.
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Schwartz AM, Chan FJ, Levy BJ, Tarpada SP, Schwechter EM. Telerounding Offers High Patient Satisfaction After Total Joint Arthroplasty. HSS J 2020; 16:461-467. [PMID: 33173447 PMCID: PMC7646716 DOI: 10.1007/s11420-020-09813-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Research in surgical fields other than orthopedics has demonstrated high patient satisfaction with non-traditional telerounding modalities. QUESTIONS/PURPOSES We sought to determine patient satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores of patients who experienced telerounding in the post-operative period after undergoing total joint arthroplasty (TJA). METHODS Fifty consecutive TJA patients were prospectively enrolled to receive telerounding. The patients were divided into two groups based on their satisfaction with telerounding. The HCAHPS scores of the patients who received telerounding were compared with 50 control patients. RESULTS Overall, the telerounding cohort had a positive reaction to telerounding. Comparing patients who were highly satisfied to those who were dissatisfied with telerounding, younger patients were found to be more frequently satisfied with telerounding. Compared with patients who did not receive telerounding, patients who experienced telerounding rated the hospital higher on a 10-point scale were more likely to recommend the hospital to others, more frequently believed their physicians treated them with courtesy and respect, and more often believed their physicians always listened to them carefully. CONCLUSION An overwhelming majority of our patients found telerounding using FaceTime enhanced their care while recovering post-operatively from TJA. Those patients were typically younger and had significantly higher HCAHPS scores, which potentially can enhance the physician-patient relationship.
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Affiliation(s)
- Andrew M. Schwartz
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA 30322 USA ,Emory University Orthopaedics & Spine Hospital, 1455 Montreal Rd. E., Tucker, GA 30084 USA
| | - Ferdinand J. Chan
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461 USA ,Department of Orthopaedics, Montefiore Medical Center, 1250 Waters Pl, Bronx, NY 10461 USA
| | - Benjamin J. Levy
- UBMD Orthopaedics & Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York, 4225 Genesee Street, Suite 400, Cheektowaga, NY 14225 USA
| | - Sandip P. Tarpada
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461 USA ,Department of Orthopaedics, Montefiore Medical Center, 1250 Waters Pl, Bronx, NY 10461 USA
| | - Evan M. Schwechter
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461 USA ,Department of Orthopaedics, Montefiore Medical Center, 1250 Waters Pl, Bronx, NY 10461 USA
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Matthies N, Keshen S, Lewis S, Webster F, Perruccio AV, Rampersaud YR. An Exploratory Analysis of Spine Patients' Preoperative Concerns and Decision-making Process: Does What Surgeons Say Matter? Spine (Phila Pa 1976) 2020; 45:1067-1072. [PMID: 32675614 DOI: 10.1097/brs.0000000000003456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional, pre-post patient survey. OBJECTIVE The aim of this study was to determine what factors affect a patient's decision to undergo elective surgery following a surgical consultation. SUMMARY OF BACKGROUND DATA The surgical consultation is an important step in selecting and preparing patients for elective surgery. Despite the proven effectiveness and low risk of complications, many spine procedure candidates may still choose to forgo surgery after an appropriate discussion and clear surgical indications. METHODS Survey and open-response questions regarding pre- and post-consultation surgical concerns and overall willingness to undergo surgery were collected and analyzed from 124 patients deemed surgical candidates. Demographics, surgical willingness, and patient concerns were analyzed. Open-ended response data were tallied for surgical concerns and responses were analyzed line-by-line to assess for main themes. Sub-analysis was included on patients who reconsidered their willingness post-consultation. RESULTS Qualitative thematic analysis of patient's concerns regarding surgery uncovered six major themes: Interference on quality of life (QOL), fear, physical concerns, success, risk, and concerns regarding the surgeon (CS). Success and risk were most commonly mentioned pre-consultation (27%, 26%); risk and QOL were most commonly mentioned post-consultation (22%, 21%). Of 124 patients, 103 were willing to have surgery before consultation and remained willing post-consultation; six patients became unwilling. Twenty-one patients were unwilling to consider surgery before consultation; only five remained unwilling. No differences were found between degenerative and deformity patients regarding initial willingness or changes thereafter. CONCLUSION The decision to undergo surgery is a multifactorial and complex process with a variety of patient concerns. We grouped these concerns into six categories to aid in future discussion with patients. 87% of patients have made up their mind before attending their surgical consultation. Appropriate understanding of patient-specific willingness and concerns should help facilitate necessary discussion and aid in a more efficient and useful shared decision-making process. LEVEL OF EVIDENCE 4.
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Postler A, Goronzy J, Günther KP, Lange T, Redeker I, Schmitt J, Zink A, Callhoff J. Which disease-related factors influence patients' and physicians' willingness to consider joint replacement in hip and knee OA? Results of a questionnaire survey linked to claims data. BMC Musculoskelet Disord 2020; 21:352. [PMID: 32503503 PMCID: PMC7275466 DOI: 10.1186/s12891-020-03368-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/25/2020] [Indexed: 02/04/2023] Open
Abstract
Background A great heterogeneity in total joint replacement (TJR) rates has been reported for osteoarthritis (OA), most likely arising from a gap between patients’ and physicians’ views on the need for TJR. The purpose of this study therefore was to analyze potential cofactors which might influence the desire of patients to undergo TJR and physicians’ willingness to discuss surgery with their patients. Methods A total of 8995 patients in Germany with a claims data diagnosis of hip or knee OA or polyarthrosis were asked to complete a questionnaire for this cross-sectional study of sociodemographic factors, indicators of current joint function (WOMAC score), willingness to undergo TJR and whether they had already discussed TJR with a physician. The overall response rate was 40%. Responders with polyarthrosis and individuals without current or chronic symptoms in the corresponding joints, pain in already replaced joints or simultaneous symptomatic hip and knee OA were excluded. We linked the survey results to claims data. Separate logistic regression models were used to assess which parameters were associated with patients’ willingness to undergo TJR and physicians’ discussion of surgery. Results We analyzed 478 hip OA and 932 knee OA patients. Just 17% with hip OA and 14% with knee OA were willing to undergo TJR, although 44 and 45% had already discussed surgery with their physicians. Patients’ willingness was associated with higher WOMAC scores, a deterioration of symptoms over the last 2 years, and previous TJR for another joint. The discussion with a physician was influenced by the impact on personal life and previous arthroplasty. Older age (odds Ratio (OR) 1.2 per 10 years), male sex (OR 0.69 vs female), longer symptom duration (OR 1.08 per 5 years), deterioration of symptoms (OR 2.0 vs no change/improvement), a higher WOMAC score (OR 1.3 per 10% deterioration) and reduced well-being (OR 1.1 per 10% deterioration) were associated with physician discussion in knee OA patients. Conclusions The proportion of patients willing to undergo TJR is lower than the proportion in whom physicians discuss surgery. While previous TJR seems to enhance patients’ and surgeons’ willingness, the influence of other cofactors is heterogeneous.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedics and Traumatology, University Medicine Carl, Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Jens Goronzy
- University Center of Orthopaedics and Traumatology, University Medicine Carl, Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Klaus-Peter Günther
- University Center of Orthopaedics and Traumatology, University Medicine Carl, Gustav Carus Dresden, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Toni Lange
- Center for Evidence-Based Healthcare, Medical Faculty, Technical University, Dresden, Dresden, Germany
| | - Imke Redeker
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty, Technical University, Dresden, Dresden, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Johanna Callhoff
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Claassen AAOM, Schers HJ, Busch VJJF, Heesterbeek PJC, van den Hoogen FHJ, Vliet Vlieland TPM, van den Ende CHM. Preparing for an orthopedic consultation using an eHealth tool: a randomized controlled trial in patients with hip and knee osteoarthritis. BMC Med Inform Decis Mak 2020; 20:92. [PMID: 32414368 PMCID: PMC7229631 DOI: 10.1186/s12911-020-01130-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To evaluate the effect of a stand-alone mobile and web-based educational intervention (eHealth tool) compared to usual preparation of a first orthopedic consultation of patients with hip or knee osteoarthritis (OA) on patients' satisfaction. METHODS A two-armed randomized controlled trial involving 286 patients with (suspicion of) hip or knee OA, randomly allocated to either receiving an educational eHealth tool to prepare their upcoming consultation (n = 144) or usual care (n = 142). Satisfaction with the consultation on three subscales (range 1-4) of the Consumer Quality Index (CQI - primary outcome) and knowledge (assessed using 22 statements on OA, range 0-22), treatment beliefs (assessed by the Treatment beliefs in OsteoArthritis questionnaire, range 1-5), assessment of patient's involvement in consultation by the surgeon (assessed on a 5-point Likert scale) and patient satisfaction with the outcome of the consultation (numeric rating scale), were assessed. RESULTS No differences between groups were observed on the 3 subscales of the CQI (group difference (95% CI): communication 0.009 (- 0.10, 0.12), conduct - 0.02 (- 0.12, 0.07) and information provision 0.02 (- 0.18, 0.21)). Between group differences (95% CI) were in favor of the intervention group for knowledge (1.4 (0.6, 2.2)), negative beliefs regarding physical activities (- 0.19 (- 0.37, - 0.002) and pain medication (- 0.30 (- 0.49, - 0.01)). We found no differences on other secondary outcomes. CONCLUSIONS An educational eHealth tool to prepare a first orthopedic consultation for hip or knee OA does not result in higher patient satisfaction with the consultation, but it does influence cognitions about osteoarthritis. TRIAL REGISTRATION Dutch Trial Register (trial number NTR6262). Registered 30 January 2017.
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Affiliation(s)
- Aniek A O M Claassen
- Department of Rheumatology, Sint Maartenskliniek, PO Box 9011, Nijmegen, GM, 6500, The Netherlands.
| | - Henk J Schers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent J J F Busch
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, PO Box 9011, Nijmegen, GM, 6500, The Netherlands.,Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, PO Box 9011, Nijmegen, GM, 6500, The Netherlands.,Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Kurkis G, Erwood A, Maidman SD, Manz WJ, Nazzal E, Bradbury TL, Bariteau JT. Mobility Limitation After Surgery for Degenerative Pathology of the Ankle, Hindfoot, and Midfoot vs Total Hip Arthroplasty. Foot Ankle Int 2020; 41:501-507. [PMID: 32129086 DOI: 10.1177/1071100720907034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgery for degenerative foot and ankle conditions often results in a lengthy recovery. Current outcome measures do not accurately assess postoperative mobility, especially in older patients. The Life-Space Assessment (LSA), a questionnaire quantifying patients' mobility after a medical event, was used in this study to assess perioperative mobility in total hip arthroplasty (THA) and foot and ankle surgery patients. We hypothesized that patients undergoing elective foot and ankle surgery would have greater postoperative mobility limitation than THA patients. METHODS Preoperative, 3-month, and 6-month postoperative LSA data were collected from THA and foot and ankle cohorts. Twelve-month postoperative data were obtained for the foot and ankle group as well. Patient demographics were recorded, and data were analyzed using a Mann-Whitney U test. RESULTS Twenty-eight degenerative foot and ankle operative patients and 38 THA patients met inclusion criteria. Only patients aged ≥60 years were included in this study. The mean preoperative LSA score was lower in the foot and ankle group (68.8) compared with THA (74.0), although the difference was not statistically significant (P = .602). THA patients showed a significant increase in LSA score from preoperative (74) to 6 months postoperation (95.9) (P = .003); however, foot and ankle patients showed no significant difference between preoperative (68.8) and 6-month (61.2) scores (P = .468). Twelve months postoperatively, foot and ankle patients showed improvement in LSA score (88.3) compared with preoperation (P = .065). CONCLUSION Compared with THA, recovery of mobility after foot and ankle surgery was slower. THA patients exhibited improved mobility as early as 3 months after surgery, whereas foot and ankle patients did not show full improvement until 12 months. This work will assist the foot and ankle specialist in educating patients about challenges in mobility during their recovery from surgery. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Gregory Kurkis
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University Orthopaedics and Spine Center, Atlanta, GA, USA
| | - Amalie Erwood
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University Orthopaedics and Spine Center, Atlanta, GA, USA
| | | | - Wesley J Manz
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Thomas Lane Bradbury
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University Orthopaedics and Spine Center, Atlanta, GA, USA
| | - Jason Tyler Bariteau
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University Orthopaedics and Spine Center, Atlanta, GA, USA
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Trask D, Etzioni D, Schwartz AJ. Aversion to Total Joint Arthroplasty: Functional Scores Predict Patient Preferences. Orthopedics 2020; 43:147-153. [PMID: 32191946 DOI: 10.3928/01477447-20200314-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/28/2020] [Indexed: 02/03/2023]
Abstract
Many patients who may benefit from total hip arthroplasty and total knee arthroplasty prefer to avoid surgery. Reasons for avoidance may include, but are not limited to, experience or dissatisfaction with prior treatment, living status, and symptom severity. Taking these variables into account, the authors sought to determine whether preoperatively collected functional scores would predict an aversion to total joint arthroplasty. A prospective cross-sectional survey was administered to consecutive patients during a 5-month period at the initial consultation for osteoarthritis of the hip or knee. Patient demographics, Hip disability and Osteoarthritis Outcome Score (HOOS), Knee injury and Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR-12) score, radiographic findings, and preference for or against surgical treatment for osteoarthritis were collected. Logistic regression was performed to determine factors associated with aversion to total joint arthroplasty, and receiver operating characteristic curves were used to determine an appropriate functional score cutoff associated with aversion to surgery. Twenty-two of 103 total patients (21.4%) were averse to surgery. The proportion of patients who underwent surgery was significantly smaller for those averse compared with those not averse to surgery (4.6% vs 23.5%, P<.05). Baseline characteristics, including age, radiographic scores, satisfaction with prior treatment, work status, education, living status, and VR-12 scores were similar between the groups. Functional scores were significantly higher for averse patients (KOOS, 66.6 vs 50.6, P<.001; HOOS, 73.2 vs 62.2, P<.05). Univariate logistic regression revealed a significant association between functional scores and aversion. Optimal cutoff values for all patients overall were 57.1 and 58.9, with an area under the curve of 0.73 and 0.68, for KOOS and HOOS, respectively. Initial aversion was a strong predictor of the ultimate method of treatment chosen. When controlling for other clinically important baseline characteristics, prospectively collected functional scores may be useful in predicting surgical aversion. [Orthopedics. 2020;43(3):147-153.].
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O’Brien DW, Bassett S, Clair VWS, Siegert RJ. Can the Pain Attitudes and Beliefs Scales be adapted for use in the context of osteoarthritis with general practitioners and physiotherapists? BMC Rheumatol 2020; 4:15. [PMID: 32309777 PMCID: PMC7147025 DOI: 10.1186/s41927-020-0116-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/17/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Conservative, first-line treatments (exercise, education and weight-loss if appropriate) for hip and knee joint osteoarthritis are underused despite the known benefits. Clinicians' beliefs can affect the advice and education given to patients, in turn, this can influence the uptake of treatment. In New Zealand, most conservative OA management is prescribed by general practitioners (GPs; primary care physicians) and physiotherapists. Few questionnaires have been designed to measure GPs' and physiotherapists' osteoarthritis-related health, illness and treatment beliefs. This study aimed to identify if a questionnaire about low back pain beliefs, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), can be adapted to assess GP and physiotherapists' beliefs about osteoarthritis. METHODS This study used a cross-sectional observational design. Data were collected anonymously from GPs and physiotherapists using an online survey. The survey included a study-specific demographic and occupational characteristics questionnaire and the PABS-PT questionnaire adapted for osteoarthritis. All data were analysed using descriptive statistics, and the PABS-PT data underwent principal factor analysis. RESULTS In total, 295 clinicians (87 GPs, 208 physiotherapists) participated in this study. The principal factor analysis identified two factors or subscales (categorised as biomedical and behavioural), with a Cronbach's alpha of 0.84 and 0.44, respectively. CONCLUSIONS The biomedical subscale of the PABS-PT appears appropriate for adaptation for use in the context of osteoarthritis, but the low internal consistency of the behavioural subscale suggests this subscale is not currently suitable. Future research should consider the inclusion of additional items to the behavioural subscale to improve internal consistency or look to develop a new, osteoarthritis-specific questionnaire. TRIAL REGISTRATION This trial was part of the primary author's PhD, which began in 2012 and therefore this study was not registered.
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Affiliation(s)
- Daniel W. O’Brien
- Physiotherapy Department, School of Clinical Sciences, Auckland University of Technology, North Shore Campus, Akoranga Drive, Northcote, Auckland, 0627 New Zealand
| | - Sandra Bassett
- Physiotherapy Department, School of Clinical Sciences, Auckland University of Technology, North Shore Campus, Akoranga Drive, Northcote, Auckland, 0627 New Zealand
| | | | - Richard J. Siegert
- Psychology Department, Auckland University of Technology, Auckland, New Zealand
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King LK, Marshall DA, Faris P, Woodhouse LJ, Jones CA, Noseworthy T, Bohm E, Dunbar MJ, Hawker GA. Use of Recommended Non-surgical Knee Osteoarthritis Management in Patients prior to Total Knee Arthroplasty: A Cross-sectional Study. J Rheumatol 2019; 47:1253-1260. [PMID: 31732554 DOI: 10.3899/jrheum.190467] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aim was to assess prior use of core recommended non-surgical treatment among patients with knee osteoarthritis (OA) scheduled for total knee arthroplasty (TKA), and to assess potential patient-level correlates of underuse, if found. METHODS This was a cross-sectional study of patients undergoing TKA for primary knee OA at 2 provincial central intake hip and knee clinics in Alberta, Canada. Standardized questionnaires assessed sociodemographic characteristics, social support, coexisting medical conditions, OA symptoms and coping, and previous non-surgical management. Multivariable logistic regression was used to assess the patient-level variables independently associated with receipt of recommended non-surgical knee OA treatment, defined as prior use of pharmacotherapy for pain, rehabilitation strategies (exercise or physiotherapy), and weight loss if overweight or obese (body mass index ≥ 25 kg/m2). RESULTS There were 1273 patients included: mean age 66.9 years (SD 8.7), 39.9% male, and 44.1% had less than post-secondary education. Recommended non-surgical knee OA treatment had been used by 59.7% of patients. In multivariable modeling, the odds of having received recommended non-surgical knee OA treatment were significantly and independently lower among individuals who were older (OR 0.97, 95% CI 0.95-0.99), male (OR 0.33, 0.25-0.45), and who lacked post-secondary education (OR 0.70, 0.53-0.93). CONCLUSION In a large cross-sectional analysis of knee OA patients scheduled for TKA, 40% of individuals reported having not received core recommended non-surgical treatments. Older individuals, men, and those with less education had lower odds of having used recommended non-surgical OA treatments.
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Neuprez A, Neuprez AH, Kaux JF, Kurth W, Daniel C, Thirion T, Huskin JP, Gillet P, Bruyère O, Reginster JY. Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years. Clin Rheumatol 2019; 39:861-871. [DOI: 10.1007/s10067-019-04811-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022]
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Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill-Cornell Medical School, Department of Medicine, New York, New York, USA.
| | - Peter K Sculco
- Hospital for Special Surgery, Weill-Cornell Medical School, Department of Medicine, New York, New York, USA
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40
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Desai M, Bentley A, Keck WA, Haag T, Taylor RS, Dakin H. Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis based on trial data. BMC Musculoskelet Disord 2019; 20:302. [PMID: 31238925 PMCID: PMC6593544 DOI: 10.1186/s12891-019-2681-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/13/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND For patients with painful knee osteoarthritis, long-term symptomatic relief may improve quality of life. Cooled radiofrequency ablation (CRFA) has demonstrated significant improvements in pain, physical function and health-related quality of life compared with conservative therapy with intra-articular steroid (IAS) injections. This study aimed to establish the cost-effectiveness of CRFA compared with IAS for managing moderate to severe osteoarthritis-related knee pain, from the US Medicare system perspective. METHODS We conducted a cost-effectiveness analysis utilizing efficacy data (Oxford Knee Scores) from a randomized, crossover trial on CRFA (NCT02343003), which compared CRFA with IAS out to 6 and 12 months, and with IAS patients who subsequently crossed over to receive CRFA after 6 months. Outcomes included health benefits (quality-adjusted life-years [QALYs]), costs and cost-effectiveness (expressed as cost per QALY gained). QALYs were estimated by mapping Oxford Knee Scores to the EQ-5D generic utility measure using a validated algorithm. Secondary analyses explored differences in the settings of care and procedures used in-trial versus real-world clinical practice. RESULTS CRFA resulted in an incremental QALY gain of 0.091 at an incremental cost of $1711, equating to a cost of US$18,773 per QALY gained over a 6-month time horizon versus IAS. Over a 12-month time horizon, the incremental QALY gain was 0.229 at the same incremental cost, equating to a cost of US$7462 per QALY gained versus IAS. Real-world cost assumptions resulted in modest increases in the cost per QALY gained to a maximum of US$21,166 and US$8296 at 6 and 12 months, respectively. Sensitivity analyses demonstrated that findings were robust to variations in efficacy and cost parameters. CONCLUSIONS CRFA is a highly cost-effective treatment option for patients with osteoarthritis-related knee pain, compared with the US$100,000/QALY threshold typically used in the US.
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Affiliation(s)
- Mehul Desai
- International Spine Pain and Performance Center, Washington, DC, USA.
| | | | | | | | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Helen Dakin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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41
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Davis T, Loudermilk E, DePalma M, Hunter C, Lindley DA, Patel N, Choi D, Soloman M, Gupta A, Desai M, Cook E, Kapural L. Twelve-month analgesia and rescue, by cooled radiofrequency ablation treatment of osteoarthritic knee pain: results from a prospective, multicenter, randomized, cross-over trial. Reg Anesth Pain Med 2019; 44:rapm-2018-100051. [PMID: 30772821 DOI: 10.1136/rapm-2018-100051] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/15/2018] [Accepted: 01/21/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES As a follow-up to the 6-month report,12 this study investigated the analgesic effect of cooled radiofrequency ablation (CRFA) in patients with knee osteoarthritis (OA) 12 months postintervention and its ability to provide pain relief in patients who experienced unsatisfactory effects of intra-articular steroid injection (IAS). METHODS Seventy-eight per cent (52/67) of patients originally treated with CRFA were evaluated at 12 months, while at 6 months post-IAS, 82% (58/71) of those patients crossed over to CRFA and assessed 6 months later. RESULTS At 12 months, 65% of the original CRFA group had pain reduction ≥50%, and the mean overall drop was 4.3 points (p<0.0001) on the numeric rating scale. Seventy-five per cent reported 'improved' effects. The cross-over group demonstrated improvements in pain and functional capacity (p<0.0001). No unanticipated adverse events occurred. CONCLUSIONS This study demonstrates that analgesia following CRFA for OA knee pain could last for at least 12 months and could rescue patients who continue to experience intolerable discomfort following IAS. CLINICAL TRIAL REGISTRATION The ClinicalTrials.gov registration number for this study is NCT02343003.
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Affiliation(s)
- Tim Davis
- Orthopedic Pain Specialists, Santa Monica, California, USA
| | - Eric Loudermilk
- Piedmont Comprehensive Pain Management Group, Greenville, South Carolina, USA
| | | | - Corey Hunter
- Ainsworth Institute of Pain, New York City, New York, USA
| | - David A Lindley
- Interventional Pain Management of Texas, Mineral Wells, Texas, USA
| | | | - Daniel Choi
- Valley Pain Consultants, Scottsdale, Arizona, USA
| | - Marc Soloman
- Valley Anesthesia Consultants, Phoenix, Arizona, USA
| | - Anita Gupta
- Drexel University, Philadelphia, Pennsylvania, USA
| | - Mehul Desai
- International Spine, Pain & Performance Center, Washington, Washington DC, USA
| | | | - Leonardo Kapural
- Center for Clinical Research, Winston Salem, North Carolina, USA
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Huynh C, Puyraimond-Zemmour D, Maillefert JF, Conaghan PG, Davis AM, Gunther KP, Hawker G, Hochberg MC, Kloppenburg M, Lim K, Lohmander LS, Mahomed NN, March L, Pavelka K, Punzi L, Roos EM, Sanchez-Riera L, Singh JA, Suarez-Almazor ME, Dougados M, Gossec L. Factors associated with the orthopaedic surgeon's decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1905 patients. Osteoarthritis Cartilage 2018; 26:1311-1318. [PMID: 30017727 DOI: 10.1016/j.joca.2018.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/30/2018] [Accepted: 06/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine factors associated with orthopaedic surgeons' decision to recommend total joint replacement (TJR) in people with knee and hip osteoarthritis (OA). DESIGN Cross-sectional study in eleven countries. For consecutive outpatients with definite hip or knee OA consulting an orthopaedic surgeon, the surgeon's indication of TJR was collected, as well as patients' characteristics including comorbidities and social situation, OA symptom duration, pain, stiffness and function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), joint-specific quality of life, Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) radiographic grade (0-4), and surgeons' characteristics. Univariable and multivariable logistic regressions were performed to identify factors associated with the indication of TJR, adjusted by country. RESULTS In total, 1905 patients were included: mean age was 66.5 (standard deviation [SD], 10.8) years, 1082 (58.0%) were women, mean OA symptom duration was 5.0 (SD 7.0) years. TJR was recommended in 561/1127 (49.8%) knee OA and 542/778 (69.7%) hip OA patients. In multivariable analysis on 516 patients with complete data, the variables associated with TJR indication were radiographic grade (Odds Ratio, OR for one grade increase, for knee and hip OA, respectively: 2.90, 95% confidence interval [1.69-4.97] and 3.30 [2.17-5.03]) and WOMAC total score (OR for 10 points increase: 1.65 [1.32-2.06] and 1.38 [1.15-1.66], respectively). After excluding radiographic grade from the analyses, on 1265 patients, greater WOMAC total score was the main predictor for knee and hip OA; older age was also significant for knee OA. CONCLUSION Radiographic severity and patient-reported pain and function play a major role in surgeons' recommendation for TJR.
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Affiliation(s)
- C Huynh
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France; Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, PARIS, France
| | - D Puyraimond-Zemmour
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France; Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, PARIS, France
| | - J F Maillefert
- Department of Rheumatology, Dijon University Hospital, Dijon F 21078, France; INSERM U1093, University of Burgundy, Dijon F 21079, France
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - A M Davis
- Division of Health Care and Outcomes Research, Krembil Research Institute, Toronto, Ontario, Canada; Department of Rehabilitation Science and Health Policy, University of Toronto, Canada; Department of Management and Evaluation, University of Toronto, Canada
| | - K-P Gunther
- University Center of Orthopaedics and Traumatology, Technische Universität, Dresden, Germany
| | - G Hawker
- Division of Rheumatology, Department of Medicine, Women's College Hospital, Women's College Research Institute, Canada; Faculty of Medicine, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - M C Hochberg
- Division of Rheumatology & Clinical Immunology, Department of Medicine and Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Lim
- University of Melbourne, Department of Medicine (Western), Dept of Rheumatology, Western Health, Australian Institute of Musculoskeletal Science, Melbourne, Australia
| | - L S Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - N N Mahomed
- Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Arthritis Program, University Health Network, Toronto, Canada
| | - L March
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital, St Leonards, Australia
| | - K Pavelka
- Institute of Rheumatology, Charles University Prague, Czech Republic
| | - L Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - E M Roos
- Institute of Sports and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - L Sanchez-Riera
- University Hospital Bristol NHS Foundation Trust, Bristol, UK; Birmingham VA Medical Center, University of Alabama, Birmingham, AL, USA
| | - J A Singh
- Section of Rheumatology and Clinical Immunology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - M E Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA
| | - M Dougados
- Paris Descartes University, Department of Rheumatology, Hôpital Cochin, APHP, INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris 14, France
| | - L Gossec
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France; Rheumatology Department, Hôpital Pitié Salpêtrière, AP-HP, PARIS, France.
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The "tipping point" for 931 elective shoulder arthroplasties. J Shoulder Elbow Surg 2018; 27:1614-1621. [PMID: 29748122 DOI: 10.1016/j.jse.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/01/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND A patient with arthritis usually experiences the progression of symptoms over time. At some stage, the patient may decide that the symptoms have reached a level of severity that leads him or her to elect to proceed with joint replacement; we refer to this degree of symptom severity as the "tipping point." Our goal was to study the factors that influenced the tipping point for patients undergoing elective shoulder arthroplasty. METHODS We analyzed the characteristics of 931 patients undergoing shoulder arthroplasty to determine the factors affecting the tipping point as characterized by the patients' comfort and function at the time they determined their symptoms had progressed to the point when this elective surgery was merited. RESULTS The preoperative Simple Shoulder Test (SST) score for all patients averaged 3.6 ± 2.7. The average tipping points were different for the ream-and-run procedure (mean SST score, 5.0 ± 2.5), hemiarthroplasty (mean SST score, 3.1 ± 3.3), total shoulder arthroplasty (mean SST score, 3.0 ± 2.4), cuff tear arthropathy arthroplasty (mean SST score, 2.8 ± 2.5), and reverse total shoulder arthroplasty (mean SST score, 1.5 ± 1.8). A number of other factors were significantly associated with a higher tipping point: younger age, better health, male sex, commercial insurance, married, nonuse of narcotics, use of alcohol, and shoulder problem not related to work. CONCLUSIONS Analysis of the tipping point-the patients' self-assessed comfort and function at the point they decide to undergo shoulder joint replacement-provides a means by which surgeons can understand the factors influencing the indications for these procedures.
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Bostick GP, Dick BD, Wood M, Luckhurst B, Tschofen J, Wideman TW. Pain Assessment Recommendations for Women, Made by Women: A Mixed Methods Study. PAIN MEDICINE 2018; 19:1147-1155. [PMID: 28549183 DOI: 10.1093/pm/pnx137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective To quantitatively describe women's priorities for pain assessment and qualitatively explain unique features of women's pain experiences. Design Mixed-methods study that included a three-round Delphi study followed by in-depth interviews. Setting Clinical research study. Participants Twenty-three women with chronic pain recruited from three women's pain treatment facilities and one interdisciplinary chronic pain clinic. Methods Phase 1 (Delphi) involved completion of a questionnaire that rated agreement with the importance of 32 commonly used pain assessment measures. Answers were compiled, and controlled feedback was provided after each round. This iterative process continued until acceptable stability was reached. Stability was defined as proportion agreement for each response that reached the a priori cutoff score of 75%. Phase 2 (qualitative) involved one-to-one telephone interviews that followed a semistructured interview guide partially informed from phase 1 findings. A descriptive approach summarized and described participants' perspectives while avoiding abstractions. Textual data were analyzed using content analysis. Results Phase 1 identified 15 pain assessments as important. Some commonly used pain assessment measures such as the numeric pain intensity rating scale did not reach agreement as important. However, no pain assessments reached agreement as unimportant. Ten additional women completed face-to-face interviews, and an overall theme of stigmatization emerged that highlighted the importance of soliciting the pain narrative and why some aspects of psychosocial pain assessment did not reach agreement. Conclusions Priorities identified by women for the assessment of pain were largely consistent with expert recommendations; however, important differences were raised that merit consideration for clinicians to reduce stigma.
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Affiliation(s)
| | - Bruce D Dick
- Anesthesiology and Pain Medicine, Psychiatry and Pediatrics, University of Alberta, Edmonton, Canada
| | - Mary Wood
- Cura Physical Therapies, Edmonton, Canada
| | | | | | - Timothy W Wideman
- School of Occupational and Physical Therapy, McGill University, Montreal, Canada
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Traumer L, Sørensen EE, Kusk KH, Skou ST. Investigating the motives of patients with knee OA undergoing a TKR: A qualitative interview study. Musculoskeletal Care 2018; 16:380-387. [PMID: 29656439 DOI: 10.1002/msc.1244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Line Traumer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Søren Thorgaard Skou
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Smith TO, Dainty JR, MacGregor A. Trajectory of physical activity following total hip and knee arthroplasty: data from the English Longitudinal Study of Ageing (ELSA) cohort. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1332683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Toby O. Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jack R. Dainty
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alex MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK
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The Effect of Interprofessional Rounds on Length of Stay and Discharge Destination for Patients Who Have Had Lower Extremity Total Joint Replacements. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2017. [DOI: 10.1097/jat.0000000000000062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smith TO, Dainty JR, MacGregor AJ. Changes in social isolation and loneliness following total hip and knee arthroplasty: longitudinal analysis of the English Longitudinal Study of Ageing (ELSA) cohort. Osteoarthritis Cartilage 2017; 25:1414-1419. [PMID: 28445775 DOI: 10.1016/j.joca.2017.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/12/2017] [Accepted: 04/18/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence and change in social isolation and loneliness in people before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in England. DESIGN The English Longitudinal Study of Ageing (ELSA) dataset, a prospective study of community-dwelling older adults, was used to identify people who had undergone primary THA or TKA because of osteoarthritis. Social isolation was assessed using the ELSA Social Isolation Index. Loneliness was evaluated using the Revised University of California, Los Angeles (UCLA) Loneliness Scale. The prevalence of social isolation and loneliness were calculated and multilevel modelling was performed to assess the potential change of these measures before arthroplasty, within a two-year operative-recovery phase and a following two-year follow-up. RESULTS The sample consisted of 393 people following THA and TKA. The prevalence of social isolation and loneliness changed from 16.9% to 18.8% pre-operative to 21.8% and 18.9% at the final post-operative follow-up respectively. This was not a statistically significant change for either measure (P = 0.15; P = 0.74). There was a significant difference in social isolation at the recovery phase compared to the pre-operative phase (P = 0.01), where people following arthroplasty reported an increase in social isolation (16.9-21.4%). There was no significant difference between the assessment phases in respect to UCLA Loneliness Scale score (P ≥ 0.74). CONCLUSIONS Given the negative physical and psychological consequences which social isolation and loneliness can have on individuals following THA or TKA, clinicians should be mindful of this health challenge for this population. The reported prevalence of social isolation and loneliness suggests this is an important issue.
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Affiliation(s)
- T O Smith
- School of Health Sciences, University of East Anglia, Norwich, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - J R Dainty
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A J MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK
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Schaal T, Schoenfelder T, Klewer J, Kugler J. Effects of perceptions of care, medical advice, and hospital quality on patient satisfaction after primary total knee replacement: A cross-sectional study. PLoS One 2017; 12:e0178591. [PMID: 28609474 PMCID: PMC5469462 DOI: 10.1371/journal.pone.0178591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 05/16/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction The increase in the number of patients presenting with osteoarthritis in the past decade has led to a 32% increase in knee replacement surgeries designed to reduce restrictions on patient movement and improve their quality of life. Patient satisfaction is becoming an increasingly important indicator of quality of care. This study was designed to identify predictors of various service components in the treatment process and hospital key performance indicators significantly associated with patient satisfaction. Materials and methods A multicenter cross-sectional study was conducted with 856 patients having their primary total knee replacements at 41 hospitals. Patient satisfaction was queried via a validated, multidimensional questionnaire mainly using a six-point scale. In addition to bivariate calculations, patient satisfaction was the dependent variable in a binary logistic regression model. Results The bivariate analysis showed a strong association between satisfaction and sex (male or female), the patients’ health before admission, and the length of stay. The number of cases treated at each hospital did not reveal any impact on satisfaction. The multivariate analysis identified three predictors associated with overall satisfaction. The strongest factor was the treatment outcome and the weakest was the quality of food. It became apparent that the statutory procedure minimums were not being met. Conclusions The relevant factors influencing patient satisfaction were partially the same as previous study results and allowed more detailed conclusions. The results provide suggestions across hospitals that could help health care providers better meet needs of patients after knee arthroplasties.
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Affiliation(s)
- Tom Schaal
- Department of Public Health, Dresden Medical School, University of Dresden, Loescherstrasse 18, Dresden, Saxony, Germany
- * E-mail:
| | - Tonio Schoenfelder
- Department of Public Health, Dresden Medical School, University of Dresden, Loescherstrasse 18, Dresden, Saxony, Germany
| | - Joerg Klewer
- Department of Public Health and Health Care Management, University of Applied Sciences Zwickau, Dr.-Friedrichs-Ring 2A, Zwickau, Saxony, Germany
| | - Joachim Kugler
- Department of Public Health, Dresden Medical School, University of Dresden, Loescherstrasse 18, Dresden, Saxony, Germany
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Riddle DL, Golladay GJ, Hayes A, Ghomrawi HM. Poor expectations of knee replacement benefit are associated with modifiable psychological factors and influence the decision to have surgery: A cross-sectional and longitudinal study of a community-based sample. Knee 2017; 24:354-361. [PMID: 27914722 PMCID: PMC5359031 DOI: 10.1016/j.knee.2016.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/12/2016] [Accepted: 11/12/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA. METHODS A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization. RESULTS Approximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR)=2.11, 95% CI=1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR=3.17, 95% CI=2.26, 4.44 when both were coded 'yes'). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR=4.9, 95% CI=2.2, 11.1). CONCLUSION A variety of modifiable psychological factors impact people's expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure.
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Affiliation(s)
- Daniel L. Riddle
- Department of Physical Therapy, School of Allied Health Professions,Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University,Corresponding author: Department of Physical Therapy, West Hospital, Room B-100, Virginia Commonwealth University, Richmond, Virginia 23298-0224, USA. Tel.: 804-828-0234; fax: 804-828-8111. (Daniel L. Riddle)
| | - Gregory J. Golladay
- Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University
| | - Amanda Hayes
- Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Medical College, Cornell University,Healthcare Research Institute, Hospital for Special Surgery
| | - Hassan M.K. Ghomrawi
- Division of Comparative Effectiveness and Outcomes Research, Department of Healthcare Policy and Research, Weill Medical College, Cornell University,Healthcare Research Institute, Hospital for Special Surgery
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