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Sato EH, Stevenson KL, Blackburn BE, Peters CL, Archibeck MJ, Pelt CE, Gililland JM, Anderson LA. Impact of Demographic Variables on Recovery After Total Hip Arthroplasty. J Arthroplasty 2024; 39:721-726. [PMID: 37717829 DOI: 10.1016/j.arth.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Several patient factors affect recovery after total hip arthroplasty (THA). However, the impact of these variables on patient-reported outcome measure recovery curves following THA has not been defined. Our goal was to quantify the influence of multiple variables on recovery after primary THA. METHODS There were 1,724 patients in a multicenter study included. Variables included sex, race/ethnicity, anxiety/depression, body mass index, tobacco, and preoperative opioid use. The Hip disability and Osteoarthritis Score for Joint Replacement (HOOS JR) was recorded at multiple time points. Recovery curves were created using longitudinal estimating equations. RESULTS Patients who were women, obese, or smokers demonstrated lower HOOS JR scores at all time points. Preoperative opioid use was also correlated with lower HOOS JR scores, but this difference diminished after 6 months. Black patients demonstrated lower HOOS JR scores compared to Caucasians, and this relative difference increased out to 1-year postoperatively (P = .018). Hispanics also had lower HOOS JR scores, but scores recovered at similar rates compared to non-Hispanics. Patients who had only anxiety or depression had similar HOOS JR scores compared to patients who did not have anxiety or depression. However, patients who had both anxiety and depression had lower HOOS JR scores compared to patients who had neither (P = .049), and this relative difference became greater at 1-year postoperatively (P = .002). CONCLUSIONS Several factors including race/ethnicity, opioid use, and mental health influence recovery trajectory following THA. This information helps provide more individualized counseling about expectations after THA and focus targeted interventions to improve outcomes in at-risk groups.
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Affiliation(s)
- Eleanor H Sato
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | | | - Brenna E Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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2
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Sato EH, Stevenson KL, Blackburn BE, Peters C, Archibeck MJ, Pelt CE, Gililland JM, Anderson LA. Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00358-3. [PMID: 37068568 DOI: 10.1016/j.arth.2023.04.012] [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: 11/22/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Patient reported outcome measures (PROMs) are frequently used for evaluating patient satisfaction and function following total hip arthroplasty (THA). Functional measures along with chronologic modeling may help set expectations perioperatively. Our goal was to define the trajectory of recovery and function in the first year following THA. METHODS Prospective data from 1,898 patients in a multicenter study was analyzed. The PROMs included the Hip disability and Osteoarthritis Score for Joint Replacement (HOOS-JR) and EuroQol-5 dimension (EQ5D). Physical activity was recorded on a wearable technology. Data was collected pre-operatively and at one, three, six, and twelve months post-operatively. Generalized estimating equations were used to evaluate outcomes over time. RESULTS Significant improvement occurred between pre- and post-operative time points for all PROMs. The PROMs showed the greatest proportional recovery within the first month post-operatively, each improving by at least one minimal clinically important difference (MCID). Daily steps and flights of stairs took longer to reach at least one MCID (three months and one year, respectively). Gait speed and walking asymmetry returned to baseline by three months, but did not reach a MCID of improvement by one-year. CONCLUSION Patients can be counseled that the greatest proportional improvement in PROMs is within one month after THA, while function surpasses pre-operative baselines by three-months, and gait quality may not improve until after one-year. This can help set realistic expectations and target interventions toward patients deviating from the norm.
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Affiliation(s)
- Eleanor H Sato
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Brenna E Blackburn
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher Peters
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Michael J Archibeck
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher E Pelt
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy M Gililland
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Lucas A Anderson
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Taylor-Williams O, Inderjeeth CA, Almutairi KB, Keen H, Preen DB, Nossent JC. Total Hip Replacement in Patients with Rheumatoid Arthritis: Trends in Incidence and Complication Rates Over 35 Years. Rheumatol Ther 2022; 9:565-580. [PMID: 34997912 PMCID: PMC8964887 DOI: 10.1007/s40744-021-00414-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/09/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Advances in rheumatoid arthritis (RA) management have made disease remission achievable. We evaluated trends in total hip replacement (THR) and postoperative outcomes in patients with RA in Western Australia (WA) over more than three decades. METHODS This was a retrospective analysis of routinely collected prospective data from a state-wide registry containing longitudinally linked administrative health data based on International Classification of Diseases (ICD) diagnostic and procedural codes. We included patients with two or more diagnostic codes for RA (between 1980 and 2015) and studied THR incidence rates (THR IR) and complication rates (revision, peri-prosthetic fracture, infection, venous thrombosis, and mechanical loosening). Survival rates were estimated by Kaplan-Meier method and predictors analyzed by Cox regression. RESULTS We followed 9201 RA patients over 111,625 person-years, during which 1560 patients (16.9%) underwent THR. From 1985 to 2015, THR IR (per 1000 RA patient-years) decreased from 20.8 (95% CI 20.1-21.5) to 7.3 (95% CI 7.2-7.5), and 5-year THR-free survival increased from 84.3 to 95.3% (1980-2015). Ten-year prosthetic survival was 91.2%. Complication rates in the first 5 years post-THR decreased significantly from 13.1 to 3.7% (p < 0.001). Mechanical complications such as loosening and periprosthetic fracture rates decreased significantly (> 35%, P < 0.05), while infection and revision did not change over the observation period (p > 0.05). CONCLUSIONS Over the last 30 years in RA patients, THR IR and mechanical complication rates decreased significantly, but the medical complication of infection has not changed significantly.
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Affiliation(s)
- Owen Taylor-Williams
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
| | - Charles A Inderjeeth
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Khalid B Almutairi
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
| | - Helen Keen
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Johannes C Nossent
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia.
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
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4
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Harmelink KEM, Dandis R, der Van der Wees Pj PJ, Zeegers AVCM, der Sanden MWNV, Staal JB. Recovery trajectories over six weeks in patients selected for a high-intensity physiotherapy program after Total knee Arthroplasty: a latent class analysis. BMC Musculoskelet Disord 2021; 22:179. [PMID: 33583403 PMCID: PMC7882075 DOI: 10.1186/s12891-021-04037-7] [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: 11/19/2020] [Accepted: 01/07/2021] [Indexed: 11/11/2022] Open
Abstract
Background Recovery trajectories differ between individual patients and it is hypothesizes that they can be used to predict if an individual patient is likely to recover earlier or later. Primary aim of this study was to determine if it is possible to identify recovery trajectories for physical functioning and pain during the first six weeks in patients after TKA. Secondary aim was to explore the association of these trajectories with one-year outcomes. Methods Prospective cohort study of 218 patients with the following measurement time points: preoperative, and at three days, two weeks, six weeks, and one year post-surgery (no missings). Outcome measures were performance-based physical functioning (Timed Up and Go [TUG]), self-reported physical functioning (Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOS-ADL]), and pain (Visual Analogue Scale [VAS]). Latent Class Analysis was used to distinguish classes based on recovery trajectories over the first six weeks postoperatively. Multivariable regression analyses were used to identify associations between classes and one year outcomes. Results TUG showed three classes: “gain group” (n = 203), “moderate gain group” (n = 8) and “slow gain group” (n = 7), KOOS showed two classes: “gain group” (n = 86) and “moderate gain group” (n = 132), and VAS-pain three classes: “no/very little pain” (n = 151), “normal decrease of pain” (n = 48) and “sustained pain” (n = 19). The” low gain group” scored 3.31 [95% CI 1.52, 5.09] seconds less on the TUG than the “moderate gain group” and the KOOS “gain group” scored 11.97 [95% CI 8.62, 15.33] points better than the “moderate gain group” after one year. Patients who had an early trajectory of “sustained pain” had less chance to become free of pain at one year than those who reported “no or little pain” (odds ratio 0.11 [95% CI 0.03,0.42]. Conclusion The findings of this study indicate that different recovery trajectories can be detected. These recovery trajectories can distinguish outcome after one year.
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Affiliation(s)
- K E M Harmelink
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Geert Grooteplein Zuid 21, 6525, EZ, Nijmegen, the Netherlands. .,FysioHolland Twente, Geessinkbrink 7, 7544, CW, Enschede, the Netherlands.
| | - R Dandis
- Department for Health Evidence, Section Biostatistics, Radboud university medical center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 21, 6525, EZ, Nijmegen, the Netherlands
| | - P J der Van der Wees Pj
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Geert Grooteplein Zuid 21, 6525, EZ, Nijmegen, the Netherlands
| | - A V C M Zeegers
- Medisch Spectrum Twente (MST), Department of Orthopedic surgery, Koningsplein 1, 7512, KZ, Enschede, the Netherlands
| | - M W Nijhuis-van der Sanden
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Geert Grooteplein Zuid 21, 6525, EZ, Nijmegen, the Netherlands
| | - J B Staal
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Geert Grooteplein Zuid 21, 6525, EZ, Nijmegen, the Netherlands.,HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research Group, Kapittelweg 33, 6525, EJ, Nijmegen, the Netherlands
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Sveinsdóttir H, Kristiansen K, Skúladóttir H. Health related quality of life in patients having total knee replacement and associations with symptoms, recovery, and patient education: A six month follow up study. Int J Orthop Trauma Nurs 2020; 42:100830. [PMID: 33518438 DOI: 10.1016/j.ijotn.2020.100830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 01/16/2023]
Abstract
AIM To describe the symptoms, recovery, patient education, and health related quality of life (HRQOL) of patients having total knee replacements at three time points and to detect experiences and situations that predict HRQOL six weeks and six months post-surgery. METHOD A prospective exploratory two-site study assessing 123 patients, while in hospital (T1), at six weeks (T2), and at six months (T3) post-discharge. HRQOL was measured using the SF-36v2 and symptoms were measured with the Hospital and Anxiety Scale. Two questions considered pain and two considered movement and tiredness while two questions addressed recovery and patient education. Linear regression models were used to calculate predictors of mental and physical HRQOL at T2 and T3. RESULTS HRQOL improved from T1 to T3. The main predictors of higher physical scores at T2 were; being older, fewer symptoms of depression and little distress related to movement. At T3 the main predictors were; having resumed work, finding patient education very useful, experiencing no pain in the last 24 h and fewer symptoms of depression. The main predictors of higher mental scores at T2 were fewer symptoms of anxiety and depression and little distress related to movement while at T3 these were fewer symptoms of anxiety and depression and experiencing no pain last 24 h. CONCLUSION Apart from pain, function and resumption of activities, the symptoms of anxiety and depression influence HRQOL. These symptoms should be assessed during the hospital stay.
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Affiliation(s)
- Herdís Sveinsdóttir
- University of Iceland, Faculty of Nursing, Eirberg, Eiríksgötu 34, 101, Reykjavík, Iceland; Landspitali University Hospital, Surgical Services, 101, Reykjavík, Iceland.
| | | | - Hafdís Skúladóttir
- University of Iceland, Faculty of Nursing, Eirberg, Eiríksgötu 34, 101, Reykjavík, Iceland; University of Akureyri, School of Health Sciences, Iceland
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6
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Wieczorek M, Rotonda C, Guillemin F, Rat AC. What Have We Learned About the Course of Clinical Outcomes After Total Knee or Hip Arthroplasty? Arthritis Care Res (Hoboken) 2020; 72:1519-1529. [DOI: 10.1002/acr.24045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Francis Guillemin
- Université de Lorraine, EA 4360 Apemac, and Inserm, CHRU Nancy, CIC‐1433 Nancy France
| | - Anne-Christine Rat
- Université de Lorraine, EA 4360 Apemac, Nancy, and CHU Caen Normandy Caen France
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7
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Kittelson AJ, Elings J, Colborn K, Hoogeboom TJ, Christensen JC, van Meeteren NLU, van Buuren S, Stevens-Lapsley JE. Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery. BMC Musculoskelet Disord 2020; 21:482. [PMID: 32698900 PMCID: PMC7376933 DOI: 10.1186/s12891-020-03493-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 07/08/2020] [Indexed: 11/15/2022] Open
Abstract
Background Clinicians and patients lack an evidence-based framework by which to judge individual-level recovery following total knee arthroplasty (TKA) surgery, thus impeding personalized treatment approaches for this elective surgery. Our study aimed to develop and validate a reference chart for monitoring recovery of knee flexion following TKA surgery. Methods Retrospective analysis of data collected in routine rehabilitation practice for patients following TKA surgery. Reference charts were constructed using Generalized Additive Models for Location Scale and Shape. Various models were compared using the Schwarz Bayesian Criterion, Mean Squared Error in 5-fold cross validation, and centile coverage (i.e. the percent of observed data represented below specified centiles). The performance of the reference chart was then validated against a test set of patients with later surgical dates, by examining the centile coverage and average bias (i.e. difference between observed and predicted values) in the test dataset. Results A total of 1173 observations from 327 patients were used to develop a reference chart for knee flexion over the first 120 days following TKA. The best fitting model utilized a non-linear time trend, with smoothing splines for median and variance parameters. Additionally, optimization of the number of knots in smoothing splines and power transformation of time improved model fit. The reference chart performed adequately in a test set of 171 patients (377 observations), with accurate centile coverage and minimal average bias (< 3 degrees). Conclusion A reference chart developed with clinically collected data offers a new approach to monitoring knee flexion following TKA.
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Affiliation(s)
- Andrew J Kittelson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA. .,School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA.
| | - Jordi Elings
- Department of Physiotherapy, University of Maastricht, Maastricht, The Netherlands
| | - Kathryn Colborn
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - Thomas J Hoogeboom
- Radboud university medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jesse C Christensen
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Nico L U van Meeteren
- Department of Physiotherapy, University of Maastricht, Maastricht, The Netherlands.,Health~Holland (Topsector Life Sciences and Health), The Hague, The Netherlands
| | - Stef van Buuren
- Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands.,Department of Methodology and Statistics, University of Utrecht, Utrecht, The Netherlands
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
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8
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Associations between pre-surgical daily opioid use and short-term outcomes following knee or hip arthroplasty: a prospective, exploratory cohort study. BMC Musculoskelet Disord 2020; 21:398. [PMID: 32571280 PMCID: PMC7310486 DOI: 10.1186/s12891-020-03413-z] [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: 03/19/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Retrospective studies have found that daily opioid use pre-arthroplasty predicts worse longer-term service, clinical and patient-reported outcomes. Prospective studies are needed to confirm these observations. This prospective, exploratory study aimed to determine: the proportion of total knee or hip arthroplasty (TKA, THA) patients who use opioids regularly (daily) pre-surgery; if opioid use pre-surgery is associated with acute and sub-acute outcomes to 12-weeks post-surgery. Methods Consecutive patients undergoing primary TKA or THA were prospectively enrolled pre-surgery and followed-up by telephone to 12-weeks post-surgery. Acute-care (oral morphine equivalent dosage (OMED), length of stay, discharge to inpatient rehabilitation, complications) and 12-week outcomes (Oxford Knee or Hip Score, Euroqol ‘today’ health score, current use of opioids, and complications including readmissions) were monitored. Unadjusted and adjusted Odds Ratios (ORs) (95% Confidence Interval, CI), Rate Ratios and β coefficients (standard error) were calculated. Results Five Hundred Twenty-One patients were included (TKA n = 381). 15.7% (95%CI 12.6 to 18.9) used opioids regularly pre-surgery. 86.8% (452/521) were available for follow-up at 12-weeks. In unadjusted analyses, pre-surgical opioid use was significantly associated with higher average acute daily OMED [β 0.40 (0.07), p < 0.001], presence of an acute complication [OR 1.75 (1.02 to 3.00)], and ongoing use of opioids at 12-weeks [OR 5.06 (2.86 to 8.93)]. After adjusting for covariates, opioid use pre-surgery remained significantly associated with average acute daily OMED [β 0.40 (0.07), p < 0.001] and ongoing use at 12-weeks [OR 5.38 (2.89 to 9.99)]. Conclusion People who take daily opioids pre-surgery have significantly greater odds for greater opioid consumption acutely and ongoing use post-surgery. Adequately powered prospective studies are required to confirm whether pre-surgical opioid use is or is not associated with poorer joint and quality of life scores or a complication in the short-term.
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9
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Wieczorek M, Rotonda C, Coste J, Pouchot J, Saraux A, Guillemin F, Rat AC. Trajectory analysis combining pain and physical function in individuals with knee and hip osteoarthritis: results from the French KHOALA cohort. Rheumatology (Oxford) 2020; 59:3488-3498. [DOI: 10.1093/rheumatology/keaa148] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The aims of this study were to identify homogeneous subgroups of knee and/or hip OA patients with distinct trajectories of the combination of pain and physical function (PF) over time and to determine the baseline factors associated with these trajectories.
Methods
We used data from the Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) cohort, a French population-based cohort of 878 patients with symptomatic knee and/or hip OA. Pain and PF were measured annually over 5 years with the Medical Outcomes Study Short Form 36 questionnaire. First, trajectory models were estimated with varying numbers of groups for each of the outcomes separately then fitted into a multi-trajectory model. We used multinomial logistic regression to determine the baseline characteristics associated with each trajectory.
Results
Univariate four-class models were identified as most appropriate for pain and PF. Comparison of separate trajectories showed that 41% of patients included in the severe functional limitations trajectory did not belong to the more severe pain trajectory (Cramér’s V statistic = 0.45). Group-based multi-trajectory modelling revealed four distinct trajectories of pain and PF. On multivariate analyses, female sex, older age, high Kellgren grade, low physical activity intensity, low psychosocial distress score (high distress) and low vitality score were associated with the more severe symptoms trajectory.
Conclusion
Over 5 years, we identified four distinct trajectories combining pain and PF. Management of weight, fatigue and psychosocial distress and the practice of physical activity seem important to maintain function and limit pain in patients with lower-limb OA.
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Affiliation(s)
| | | | - Joël Coste
- Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris
| | - Jacques Pouchot
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Paris
| | - Alain Saraux
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Cavale Blanche University Hospital, Brest
- UMR 1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU, Brest, LabEx IGO, Brest
| | - Francis Guillemin
- EA4360 Apemac, Université de Lorraine, Nancy
- ICIC-1433 Epidémiologie Clinique, CHRU Nancy, Université de Lorraine, Inserm, Nancy
| | - Anne-Christine Rat
- EA4360 Apemac, Université de Lorraine, Nancy
- Department of Rheumatology, CHU Caen, Caen, France
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10
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Hesseling B, Mathijssen NMC, van Steenbergen LN, Melles M, Vehmeijer SBW, Porsius JT. Fast Starters, Slow Starters, and Late Dippers: Trajectories of Patient-Reported Outcomes After Total Hip Arthroplasty: Results from a Dutch Nationwide Database. J Bone Joint Surg Am 2019; 101:2175-2186. [PMID: 31609887 DOI: 10.2106/jbjs.19.00234] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to explore whether subgroups of patients with different functional recovery trajectories after total hip arthroplasty can be discerned, as well as their predictors, using data from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten [LROI]). METHODS We retrospectively reviewed prospectively collected Oxford Hip Scores (OHS) up to 1 year postoperatively for patients who had undergone a primary total hip arthroplasty. Latent class growth modeling was used to classify subgroups of patients according to the trajectory of functional recovery represented by the patients' OHS. We used multivariable multinomial logistic regression analysis to explore factors associated with class membership. RESULTS A total of 6,030 patients were analyzed. Latent class growth modeling identified fast starters (fast initial improvement, high 12-month scores; 87.7%), slow starters (no initial change and subsequent improvement; 4.6%), and late dippers (initial improvement and subsequent deterioration; 7.7%). Factors associated with slow starters were female sex (odds ratio [OR], 1.63 [95% confidence interval (CI), 1.14 to 2.33]) and smoking (OR, 1.95 [95% CI, 1.26 to 3.03]); an anterior approach (OR, 0.47 [95% CI, 0.29 to 0.78]) had a protective effect against a less favorable response. Factors associated with late dippers were age of >75 years (OR, 1.62 [95% CI, 1.22 to 2.15]), smoking (OR, 1.68 [95% CI, 1.17 to 2.42]), American Society of Anesthesiologists (ASA) grade of III or IV (OR, 1.41 [95% CI, 1.05 to 1.91]), obesity (OR, 1.96 [95% CI, 1.43 to 2.69]), poorer EuroQol-5 Dimensions (EQ-5D) Self-Care (OR, 1.41 [95% CI, 1.09 to 1.82] for "some problems" and OR, 2.90 [95% CI, 1.39 to 6.03] for "unable"), poorer EQ-5D Anxiety/Depression (OR, 1.31 [95% CI, 1.00 to 1.71] for "moderately" and OR, 1.86 [95% CI, 1.06 to 3.24] for "extremely"), poorer EQ-5D visual analog scale (OR, 0.91 [95% CI, 0.86 to 0.97] per 10 points), direct lateral approach (OR, 2.18 [95% CI, 1.58 to 3.02]), and hybrid fixation with a cemented acetabular implant (OR, 1.79 [95% CI, 1.00 to 3.21]). CONCLUSIONS We discerned fast starters, slow starters, and late dippers after total hip arthroplasty. Female sex, older age, obesity, higher ASA grades, and worse EQ-5D scores were associated with a less favorable response to total hip arthroplasty, as well as hybrid fixation (cemented acetabular implant) and direct lateral approach. Anterior approach had a protective effect against a less favorable response. However, all subgroups experienced functional improvement following total hip arthroplasty. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- B Hesseling
- Department of Orthopedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - N M C Mathijssen
- Department of Orthopedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - L N van Steenbergen
- Dutch Arthroplasty Register, Landelijke Registratie Orthopedische Implantaten (LROI), Hertogenbosch, the Netherlands
| | - M Melles
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - S B W Vehmeijer
- Department of Orthopedic Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - J T Porsius
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, and Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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11
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Harmelink K, Nijhuis-van der Sanden R, Zeegers E, Hullegie W, Van der Wees P, Staal B. Reasons for continuing physiotherapy treatment after a high-intensity physyiotherapy program in patients after total knee arthroplasty: a mixed-methods study. Physiother Theory Pract 2019; 37:1321-1336. [PMID: 31760847 DOI: 10.1080/09593985.2019.1693675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Patients after total knee arthroplasty treated with a 10-day high-intensity physiotherapy program in a resort were expected to recover fast without need for a longer physiotherapy treatment period.Objective: To explore the expectations and experiences of patients with total knee arthroplasty following the high-intensity physiotherapy program, including the perceived recovery level at discharge, and reasons for (not) adhering to the given advice at discharge (being either continuing with or refraining from further physiotherapy treatment).Design: A mixed-methods approach: semi-structured interviews were held and were then used to develop items and answer categories for a survey.Methods: Fifteen patients participated in semi-structured interviews, which focused on expectations and experiences related to the total knee arthroplasty and physiotherapy program, the perceived recovery level at the moment of discharge, and the reasons for the advice at discharge (continuing with or refraining from physiotherapy treatment) being followed. A deductive thematic analysis of those interviews was used to develop a survey, which was sent to the total cohort of 60 patients. Logistic regression models were estimated to determine which factors were associated with the continuation of physiotherapy treatment and (not) following the advice. Results: Four themes were identified: (1) confidence of independent recovery; (2) experiencing residual complaints; (3) expecting further improvement of physical fitness; and (4) preferring to be supervised by a healthcare professional. These themes were covered by 14 items in the survey. In total, 55 out of 60 patients completed the survey. Out of 36 patients, 23 continued with physiotherapy treatment despite an adequate level of recovery. Five out of 19 patients, who were advised to continue with physiotherapy treatment, decided to refrain. Advice to continue with physiotherapy treatment was followed more often than advice to refrain from physiotherapy treatment (OR 0.09; 95%CI 0.01-0.85). Reasons for continuing with physiotherapy treatment were residual complaints, the expectation that their physical fitness could be improved and preferring to be supervised by a healthcare professional. In contrast, patients who refrained from physiotherapy, despite being advised to continue, were self-confident that they could do exercises by themselves.Conclusions: A substantial proportion of patients continued with physiotherapy treatment because they expected that a higher level of recovery could be reached. The level of self-confidence to recover on their own seemed to be an important factor in deciding to continue with or refrain from physiotherapy treatment. It would be helpful to focus on self-management skills during the high-intensity physiotherapy program following total knee arthroplasty.
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Affiliation(s)
- Karen Harmelink
- FysioHolland Twente, Enschede, Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ria Nijhuis-van der Sanden
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elgun Zeegers
- Department of Orthopedic Surgery, Medisch Spectrum Twente (MST), Enschede, Netherlands
| | - Wim Hullegie
- Fysiotherapie Hullegie and Richter, Enschede, Netherlands
| | - Philip Van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart Staal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands.,HAN University of Applied Sciences, Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, Nijmegen, Netherlands
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Wylde V, Penfold C, Rose A, Blom AW. Variability in long-term pain and function trajectories after total knee replacement: A cohort study. Orthop Traumatol Surg Res 2019; 105:1345-1350. [PMID: 31594730 DOI: 10.1016/j.otsr.2019.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/25/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Previous research suggests that patient-reported outcomes plateau by one year after total knee replacement (TKR). Analysis of trajectories to date has predominately been based on changes in median/mean scores over the first post-operative year, rather than variability in trajectory patterns over the longer-term. The aim was to evaluate variability in long-term pain and function trajectories after TKR. HYPOTHESIS There will be variability in long-term pain and function trajectories after TKR. PATIENTS AND METHODS In all, 266 patients undergoing a Triathlon® TKR because of osteoarthritis were recruited from one orthopaedic centre. Participants completed the WOMAC Pain and Function scales preoperatively and then at 3 months, 1 year, 2 years, 3 years, 5 years and 7 years post-operative. Longitudinal analyses evaluated patterns of clinically meaningful change. RESULTS Most patients had an improvement in pain and function during the first year post-operative; improvement was greatest in the first 3 months. By 1-year post-operative, 8% of patients had no change or a worsening of pain and 21% for function. Thereafter, approximately 15% of patients improved and 15% worsened between each assessment time. For those patients who had no change in symptoms from pre-operative to 1-year post-operative, one third had further improvement between 1 and 2 years post-operative. DISCUSSION This study identified clinically meaningful variability in long-term outcomes after TKR, which could be discussed with patients to ensure they have realistic expectations of their outcome. Further research is needed to evaluate determinants of this variability and whether patients who will do poorly can be identified early in their recovery pathway. LEVEL OF EVIDENCE IV, prospective cohort study.
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Affiliation(s)
- Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
| | - Chris Penfold
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Alice Rose
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS10 5NB, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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13
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Dias Correia F, Nogueira A, Magalhães I, Guimarães J, Moreira M, Barradas I, Molinos M, Teixeira L, Pires J, Seabra R, Lains J, Bento V. Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study. JMIR Rehabil Assist Technol 2019; 6:e14523. [PMID: 31228176 PMCID: PMC6611148 DOI: 10.2196/14523] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background The demand for total hip arthroplasty (THA) is rising. In the face of rapidly increasing health care costs, ensuring widespread, cost-effective rehabilitation is a priority. Technologies allowing independent home-based rehabilitation may be the key to facilitate access, improve effectiveness, and lower costs of care. Objective The aim of this study was to assess the feasibility of a novel artificial intelligence–powered digital biofeedback system following THA and compare the clinical outcomes against supervised conventional rehabilitation. Methods This was a single-center, parallel-group pilot study, with an 8-week intervention program. Patients were assessed at baseline, during the program (at 4 and 8 weeks), and 3 and 6 months after surgery. The primary outcome was the Timed Up and Go (TUG) score and secondary outcomes were the Hip dysfunction and Osteoarthritis Outcome Scale (HOOS; a patient-reported outcome) and hip range of motion (ROM). Results A total of 66 patients were included: 35 digital physiotherapy (PT) versus 31 conventional. There were no differences at baseline between groups except for lower HOOS quality of life (QoL) subscale scores in the digital PT group. Clinically relevant improvements were noted in both groups at all time points. The digital PT group showed a retention rate of 86% (30/35). Per-protocol analysis revealed a superiority of the digital PT group for all outcome measures. Intention-to-treat analysis revealed the superiority of the digital PT group at all time points for TUG (change between baseline and 4 and 8 weeks: P<.001; change between baseline and 3 and 6 months: P=.001 and P=.005, respectively), with a difference between median changes of −4.79 seconds (95% CI −7.24 to −1.71) at 6 months post-THA. Between baseline and month 6, results were also superior in the digital PT group for the HOOS sports and QoL subscales and all ROM except for standing flexion. Conclusions This study demonstrates this novel solution holds promise in rehabilitation after THA, ensuring better clinical outcomes than conventional rehabilitation while reducing dependence on human resources. Trial Registration ClinicalTrials.gov NCT03045549; https://clinicaltrials.gov/ct2/show/NCT03045549
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Affiliation(s)
- Fernando Dias Correia
- Neurology Department, Hospital de Santo António-Centro Hospitalar do Porto, Porto, Portugal
| | | | | | | | | | | | | | - Laetitia Teixeira
- Department of Population Studies, Abel Salazar Institute of Biomedical Sciences, Porto, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Joaquim Pires
- Orthopaedics Department, Hospital da Prelada-Domingos Braga da Cruz, Porto, Portugal
| | - Rosmaninho Seabra
- Orthopaedics Department, Hospital da Prelada-Domingos Braga da Cruz, Porto, Portugal
| | - Jorge Lains
- Physical Rehabilitation Medicine Department, Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
| | - Virgílio Bento
- Engineering Department, Instituto Universitário da Maia, Maia, Porto, Portugal
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Mills K, Falchi B, Duckett C, Naylor J. Minimal change in physical activity after lower limb joint arthroplasty, but the outcome measure may be contributing to the problem: a systematic review and meta-analysis. Physiotherapy 2019; 105:35-45. [DOI: 10.1016/j.physio.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/17/2018] [Indexed: 12/27/2022]
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Greimel F, Dittrich G, Schwarz T, Kaiser M, Krieg B, Zeman F, Grifka J, Benditz A. Course of pain after total hip arthroplasty within a standardized pain management concept: a prospective study examining influence, correlation, and outcome of postoperative pain on 103 consecutive patients. Arch Orthop Trauma Surg 2018; 138:1639-1645. [PMID: 30066029 DOI: 10.1007/s00402-018-3014-x] [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: 04/26/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Postoperative pain management options are of great importance for patients undergoing total hip arthroplasty, as joint replacement surgery is reported to be one of the most painful surgical procedures. This study demonstrates pain outcome until 4 weeks postoperatively and evaluates factors influencing pain in the postoperative course after total hip arthroplasty. MATERIALS AND METHODS A total of 103 patients were included in this prospective cohort trial and underwent total hip arthroplasty. Postoperative pain was described using a numerical rating scale (NRS); demographic data and perioperative parameters were correlated with postoperative pain. RESULTS Evaluation of pain scores in the postoperative course showed a constant decrease in the first postoperative week (mean NRS 3.1 on day 1 to mean NRS 2.3 on day 8) and, then, a perpetual increase for 3 days (mean NRS 2.6 on day 9 to mean NRS 2.3 on day 12). Afterwards, a continuous pain-level decrease was stated (continuous to a mean NRS 0.9 on day 29). No correlation was found between the potential influencing factors sex, age, body mass index, duration of surgery, ASA score, and postoperative pain levels, but a high significant correlation could be stated for preoperative pain levels and postoperative pain intensity (pain while moving p < 0.02 to p < 0.05 depending on the time period "week 1 postoperatively", "week 2-4", or "week 1-4"; pain while resting p < 0.001, in all the measured time intervals, respectively). CONCLUSION Increasing pain levels after the first week postoperatively, for 3 days, are most likely to be caused by the change to more extensive mobilization and physiotherapy in the rehabilitation unit. No significant influence or correlation on the intensity of postoperative pain could be found while evaluating potential predictors except preoperative pain levels. Pain management has to take these findings into account in the future to further increase patients' satisfaction in the postoperative course after total hip arthroplasty and to adapt pain management programs.
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Affiliation(s)
- Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Gregor Dittrich
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Timo Schwarz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Moritz Kaiser
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Bernd Krieg
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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16
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Naylor JM, Hart A, Mittal R, Harris IA, Xuan W. The effectiveness of inpatient rehabilitation after uncomplicated total hip arthroplasty: a propensity score matched cohort. BMC Musculoskelet Disord 2018; 19:236. [PMID: 30021552 PMCID: PMC6052669 DOI: 10.1186/s12891-018-2134-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/14/2018] [Indexed: 02/08/2023] Open
Abstract
Background Inpatient rehabilitation is an expensive option following total hip arthroplasty (THA). We aimed to determine if THA patients who receive inpatient rehabilitation report better hip and quality of life scores post-surgery compared to those discharged directly home. Methods Prospective, propensity score matched cohort involving 12 private hospitals across five Australian States. Patients undergoing THA secondary to osteoarthritis were included. Those receiving inpatient rehabilitation for reasons other than choice or who experienced significant health events within 90-days post-surgery were excluded. Comparisons were made between those who did and did not receive inpatient rehabilitation for patient-reported hip pain and function (Oxford Hip Score, OHS) and ‘today’ health rating (EuroQol 0–100 scale). Rehabilitation provider charges were also estimated and compared. Results Two hundred forty-six patients (123 pairs, mean age 67 (10) yr., 66% female) were matched on 19 covariates for their propensity to receive inpatient rehabilitation. No statistically nor clinically significant between-group differences were observed [OHS median difference (IQR): 0 (− 3, 3), P = 0.60; 0 (− 1 to 1), P = 0.91, at 90 and 365-days, respectively; EuroQol scale median difference 0 (− 10, 12), P = 0.24; 0 (− 10, 10), P = 0.49; 5 (− 10, 15), P = 0.09, at 35-, 90- and 365-days, respectively]. Median rehabilitation provider charges were 10-fold higher for those who received inpatient rehabilitation [median difference $7582 (5649, 10,249), P < 0.001]. Sensitivity analyses corroborated the results of the primary analyses. Conclusion Utilization of inpatient rehabilitation pathways following THA appears to be low value healthcare. Sustainability of inpatient rehabilitation models may be enhanced if inpatient rehabilitation is reserved for those most impaired or who have limited social supports. Trial registration ClinicalTrials.gov Identifier: NCT01899443. Electronic supplementary material The online version of this article (10.1186/s12891-018-2134-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Justine M Naylor
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW, 2170, Australia. .,South West Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, 2170, Australia. .,Ingham Institute of Applied Medical Research, Westfields Liverpool, PO Box 3151, Liverpool, NSW, 2170, Australia.
| | - Andrew Hart
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW, 2170, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW, 2170, Australia
| | - Ian A Harris
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW, 2170, Australia.,South West Sydney Local Health District, Locked Bag 7103, Liverpool, NSW, 2170, Australia.,Ingham Institute of Applied Medical Research, Westfields Liverpool, PO Box 3151, Liverpool, NSW, 2170, Australia
| | - Wei Xuan
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Elizabeth Drive, Liverpool, NSW, 2170, Australia.,Ingham Institute of Applied Medical Research, Westfields Liverpool, PO Box 3151, Liverpool, NSW, 2170, Australia
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Naylor JM, Pocovi N, Descallar J, Mills KA. Participation in Regular Physical Activity After Total Knee or Hip Arthroplasty for Osteoarthritis: Prevalence, Associated Factors, and Type. Arthritis Care Res (Hoboken) 2018; 71:207-217. [PMID: 29799669 DOI: 10.1002/acr.23604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/22/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe the rates of participation in regular physical activity presurgery and at 3 years follow-up after knee or hip arthroplasty, and to describe factors associated with participation postsurgery and types of activity undertaken. METHODS A previously acquired multicenter, prospective cohort of knee or hip arthroplasty recipients was followed up for 3 years postsurgery. Regular participation in physical activity was defined as participation in physical activity ≥1 time/week, excluding incidental activities. Participants were interviewed about current participation as well as participation in the year presurgery. Joint-specific and health-related quality-of-life scores and information on experience of major complications were obtained. Information about comorbidity and body weight were updated. Factors associated with 3-year physical activity participation were determined using multivariable logistic regression modeling. RESULTS In total, 73.4% of the eligible cohort (1,289 of 1,757) were followed up (718 patients with total knee arthroplasty, and 571 patients with total hip arthroplasty). Participation profiles were similar regardless of the joint replaced. Participation in physical activity increased postsurgery in the combined cohort (from 45.2% to 63.5%; P < 0.001). Participation at 3 years was associated with participation presurgery (P < 0.0001), better 3-year quality of life (P < 0.001), younger age (P = 0.002), better 3-year joint scores (P = 0.01), >1 lifetime arthroplasty (P = 0.02), and higher education level (P = 0.04). Low-impact and nonambulatory activities significantly increased postsurgery with no change in high-impact activities. CONCLUSION Participation rates increased postsurgery when recovery was stable, but approximately one-third of arthroplasty recipients did not engage in physical activity at least once per week. Because participation is associated with habitual activity presurgery, a potential role for behavior change interventions is suggested. The increase in nonambulatory activities indicates that current devices measuring ambulatory activity alone are inadequate for capturing physical activity.
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Affiliation(s)
- Justine M Naylor
- Ingham Institute Applied Medical Research, Sydney, New South Wales, Australia
| | - Natasha Pocovi
- Macquarie University, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Ingham Institute Applied Medical Research, Sydney, New South Wales, Australia
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18
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Schilling C, Petrie D, Dowsey MM, Choong PF, Clarke P. The Impact of Regression to the Mean on Economic Evaluation in Quasi-Experimental Pre-Post Studies: The Example of Total Knee Replacement Using Data from the Osteoarthritis Initiative. HEALTH ECONOMICS 2017; 26:e35-e51. [PMID: 28127856 DOI: 10.1002/hec.3475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/23/2016] [Accepted: 12/02/2016] [Indexed: 06/06/2023]
Abstract
Many treatments are evaluated using quasi-experimental pre-post studies susceptible to regression to the mean (RTM). Ignoring RTM could bias the economic evaluation. We investigated this issue using the contemporary example of total knee replacement (TKR), a common treatment for end-stage osteoarthritis of the knee. Data (n = 4796) were obtained from the Osteoarthritis Initiative database, a longitudinal observational study of osteoarthritis. TKR patients (n = 184) were matched to non-TKR patients, using propensity score matching on the predicted hazard of TKR and exact matching on osteoarthritis severity and health-related quality of life (HrQoL). The economic evaluation using the matched control group was compared to the standard method of using the pre-surgery score as the control. Matched controls were identified for 56% of the primary TKRs. The matched control HrQoL trajectory showed evidence of RTM accounting for a third of the estimated QALY gains from surgery using the pre-surgery HrQoL as the control. Incorporating RTM into the economic evaluation significantly reduced the estimated cost effectiveness of TKR and increased the uncertainty. A generalized ICER bias correction factor was derived to account for RTM in cost-effectiveness analysis. RTM should be considered in economic evaluations based on quasi-experimental pre-post studies. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Chris Schilling
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Michelle M Dowsey
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Peter F Choong
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Philip Clarke
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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Mayer M, Naylor J, Harris I, Badge H, Adie S, Mills K, Descallar J. Evidence base and practice variation in acute care processes for knee and hip arthroplasty surgeries. PLoS One 2017; 12:e0180090. [PMID: 28723917 PMCID: PMC5516983 DOI: 10.1371/journal.pone.0180090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Lack of evidence contributes to unnecessary variation in treatment costs and outcomes. This study aimed to identify from interventions historically used for total knee or hip arthroplasty (TKA, THA): i) if routine use is supported by high-level evidence; ii) whether surgeon use aligns with the evidence. METHODS Part 1: Systematic search of electronic library databases for systematic reviews and practice guidelines concerning seven acute-care interventions. Intervention-specific recommendations concerning routine use were extracted by assessors. Part 2: Prospective medical record audit of the acute-care received by 1900 patients involving 120 orthopaedic surgeons. Surgeon use per intervention was summarized using caterpillar plots. Surgeon-specific routine and non-routine use was defined as use in ≥ 90% and ≤ 10% of patients, respectively. Primary analysis included only surgeons contributing ≥ 10 patients. RESULTS Continuous passive motion (TKA): Routine use not recommended; 85.7% of surgeons did not use it routinely. Tranexamic Acid: Routine use recommended; 26.9% of surgeons used it routinely. Cryotherapy: Routine use not recommended; 45.7% of surgeons used it routinely for TKA; 31.8% used it routinely for THA. Intra-articular drainage: Routine use not recommended for TKA, but possible benefits for THA; 5.7% of surgeons used it routinely for TKA, 0.0% used it routinely for THA. Antibiotic loaded bone cement: Routine use for TKA not supported, recommendations for use for THA are inconsistent; 90.0% of surgeons used it routinely for TKA, 100.0% used it routinely for THA. Patella resurfacing (TKA): No recommendation could be made; 57.1% of surgeons routinely resurfaced the patella. Indwelling urinary catheterisation: Routine use recommended; 59.6% of surgeons used it routinely. CONCLUSION Recommendations for routine use or not exist for some of the acute-care interventions examined. Surgeon practices vary widely even in the presence of high-level recommendations. It is unclear whether further evidence alone would lessen unwarranted practice variation.
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Affiliation(s)
- Marcel Mayer
- Whitlam Orthopaedic Research Centre, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, UNSW, Randwick, Australia
- Technical University Munich, Munich, Bavaria, Germany
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, UNSW, Randwick, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, UNSW, Randwick, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Helen Badge
- Whitlam Orthopaedic Research Centre, Liverpool Hospital, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, UNSW, Randwick, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Sam Adie
- South Western Sydney Clinical School, UNSW, Randwick, Australia
| | | | - Joseph Descallar
- South Western Sydney Clinical School, UNSW, Randwick, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
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20
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Schilling CG, Dowsey MM, Petrie DJ, Clarke PM, Choong PF. Predicting the Long-Term Gains in Health-Related Quality of Life After Total Knee Arthroplasty. J Arthroplasty 2017; 32:395-401.e2. [PMID: 27612604 DOI: 10.1016/j.arth.2016.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/27/2016] [Accepted: 07/19/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We investigated the predictors of long-term gains in quality-adjusted life years (QALYs) from total knee arthroplasty (TKA) and the patient attributes that predicted cost-effective TKA. METHODS Data on TKA patients (n = 570) from 2006 to 2007 were extracted from a single-institution registry. QALY gains over 7 years post surgery were calculated from health-related quality of life (HrQoL) scores measured preoperatively and annually postoperatively using the short-form health survey (SF-12) instrument. Multivariate linear regression analysis investigated the predictors of QALY gain from TKA from a broad range of preoperative patient characteristics and was used to predict QALY gains for each individual. Patients were grouped into deciles according to their predicted QALY gain, and the cost-effectiveness of each decile was plotted on the cost-effectiveness plane. Patient attribute differences between deciles were decomposed. RESULTS After exclusions and dropout, data were available for 488 patients. The average estimated QALY gain over 7 years was 0.77 (95% confidence interval [CI] 0.70-0.83). Predictors significantly associated with smaller QALY gains were comorbidities (Charlson comorbidity index 3+ coefficient -0.54 CI -0.15 to -0.92), the absence of severe osteoarthritis in the ipsilateral knee (-0.51 CI -0.16 to -0.85), preoperative HrQoL (standardized coefficient -0.34 CI -0.26 to -0.43), the requirement for an interpreter (-0.24 CI -0.05 to -0.44), and age (-0.01 CI -0.01 to -0.02). The largest difference between cost-effective and non-cost-effective deciles was relatively high preoperative HrQoL in the non-cost-effective decile. CONCLUSION TKA is likely to be cost-effective for most patients except those with unusually high preoperative HrQoL or a lack of severe osteoarthritis. The poorer outcomes for those requiring an interpreter requires further research.
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Affiliation(s)
- Chris G Schilling
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria; Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria; Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria
| | - Dennis J Petrie
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria
| | - Philip M Clarke
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria
| | - Peter F Choong
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria; Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria
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Blom AW, Artz N, Beswick AD, Burston A, Dieppe P, Elvers KT, Gooberman-Hill R, Horwood J, Jepson P, Johnson E, Lenguerrand E, Marques E, Noble S, Pyke M, Sackley C, Sands G, Sayers A, Wells V, Wylde V. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BackgroundTotal hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected.ObjectiveTo undertake a programme of research studies to work towards improving patient outcomes after THR and TKR.MethodsWe used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement.ResultsSystematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test.ConclusionsThe RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.Study registrationCurrent Controlled Trials ISRCTN52305381.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil Artz
- School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, UK
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, Birmingham, UK
| | - Emma Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elsa Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Pyke
- North Bristol NHS Trust, Bristol, UK
| | | | - Gina Sands
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Victoria Wells
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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The impact of acute perioperative myocardial infarction on clinical outcomes after total joint replacement. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Moutzouri M, Gleeson N, Billis E, Tsepis E, Gliatis J. Greek Physiotherapists' Perspectives on Rehabilitation Following Total Knee Replacement: a Descriptive Survey. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [PMID: 29027759 DOI: 10.1002/pri.1671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 12/17/2015] [Accepted: 03/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE In Greece, as in many countries, there is a scarcity of evidence in the type of physiotherapy services offered for the rehabilitation of total knee replacement (TKR). Despite the number of TKRs annually performed in Greece (over 10,000), there are no available clinical guidelines as to the content of best physiotherapy practice. The aim of this nationwide survey undertaken by physiotherapists treating TKR patients post-operatively was to record standard practice and services available in Greece. METHODS Design: cross-country survey Ten per cent of all registered physiotherapists working in public/private sectors were recruited. The developed survey comprised of questions regarding therapists' profile, protocols implemented at different stages of rehabilitation and the aims and modalities used. RESULTS A 58.7% response rate was achieved, where 36% (47/132) of respondents were treating patients in the inpatient phase and 64% (85/132) after hospital discharge. Patients in Greece are discharged with a home-based exercise program (56.7%) and, to a lesser extent, are referred to rehabilitation centres (13.3%). Strengthening, range of movement and functionality seemed to be the primary goals especially in the inpatient phase, whereas in the outpatient phase, apart from the larger differences identified, functionality and balance training were more frequently reported. CONCLUSIONS No significant variations in practice were found during inpatient rehabilitation, whilst there seemed to be diversity across outpatient physiotherapy programs. The current survey suggests that patient's general health and psychological and behavioural issues are the criteria by which physiotherapists select the volume of implemented exercise and progression. However, no specific guidelines were followed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Maria Moutzouri
- Department of Physiotherapy, Branch Department of Aigion, Technological Educational Institute (T.E.I.) of Aigion, Aigion, 25100, Greece
| | - Nigel Gleeson
- Exercise and Rehabilitation Sciences, Queen Margaret University, Edinburgh, UK
| | - Evdokia Billis
- Department of Physiotherapy, Technological Educational Institute of Western Greece, Patras, Greece
| | - Elias Tsepis
- Physiotherapy Department, Technological Educational Institute of Western Greece, Patras, Greece
| | - John Gliatis
- Orthopaedic Department, University Hospital of Patras, Patras, Greece
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Lenguerrand E, Wylde V, Gooberman-Hill R, Sayers A, Brunton L, Beswick AD, Dieppe P, Blom AW. Trajectories of Pain and Function after Primary Hip and Knee Arthroplasty: The ADAPT Cohort Study. PLoS One 2016; 11:e0149306. [PMID: 26871909 PMCID: PMC4752224 DOI: 10.1371/journal.pone.0149306] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022] Open
Abstract
Background and Purpose Pain and function improve dramatically in the first three months after hip and knee arthroplasty but the trajectory after three months is less well described. It is also unclear how pre-operative pain and function influence short- and long-term recovery. We explored the trajectory of change in function and pain until and beyond 3-months post-operatively and the influence of pre-operative self-reported symptoms. Methods The study was a prospective cohort study of 164 patients undergoing primary hip (n = 80) or knee (n = 84) arthroplasty in the United Kingdom. Self-reported measures of pain and function using the Western Ontario and McMaster Universities Osteoarthritis index were collected pre-operatively and at 3 and 12 months post-operatively. Hip and knee arthroplasties were analysed separately, and patients were split into two groups: those with high or low symptoms pre-operatively. Multilevel regression models were used for each outcome (pain and function), and the trajectories of change were charted (0–3 months and 3–12 months). Results Hip: Most improvement occurred within the first 3 months following hip surgery and patients with worse pre-operative scores had greater changes. The mean changes observed between 3 and twelve months were statistically insignificant. One year after surgery, patients with worse pre-operative scores had post-operative outcomes similar to those observed among patients with less severe pre-operative symptoms. Knee: Most improvement occurred in the first 3 months following knee surgery with no significant change thereafter. Despite greater mean change during the first three months, patients with worse pre-operative scores had not ‘caught-up’ with those with less severe pre-operative symptoms 12 months after their surgery. Conclusion Most symptomatic improvement occurred within the first 3 months after surgery with no significant change between 3–12 months. Further investigations are now required to determine if patients with severe symptoms at the time of their knee arthroplasty have a different pre-surgical history than those with less severe symptoms and if they could benefit from earlier surgical intervention and tailored rehabilitation to achieve better post-operative patient-reported outcomes.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Female
- Hip Joint/physiopathology
- Humans
- Knee Joint/physiopathology
- Male
- Middle Aged
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/complications
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain/complications
- Pain/epidemiology
- Pain Measurement
- Prospective Studies
- Recovery of Function
- Self Report
- Treatment Outcome
- United Kingdom/epidemiology
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Affiliation(s)
- Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Luke Brunton
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew D. Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Ashley W. Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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Dowsey MM, Smith AJ, Choong PFM. Latent Class Growth Analysis predicts long term pain and function trajectories in total knee arthroplasty: a study of 689 patients. Osteoarthritis Cartilage 2015; 23:2141-2149. [PMID: 26187575 DOI: 10.1016/j.joca.2015.07.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize groups of subjects according to their trajectory of knee pain and function over 1 to 5 years post total knee arthroplasty (TKA). METHODS Patients from one centre who underwent primary TKA (N = 689) between 2006 and 2008. The Knee Society Score (KSS) was collected pre-operatively and annually post-operatively. Latent Class Growth Analysis (LCGA) was used to classify groups of subjects according to their trajectory of knee pain and function over 1-5 years post-surgery. RESULTS LCGA identified a class of patients with persistent moderate knee pain (22.0%). Predictors (OR, 95% CI) of moderate pain trajectory class membership were pre-surgery SF12 mental component summary (MCS) per 10 points (0.65, 0.54-0.79) and physical component summary (PCS) per 10 points (0.50, 0.33-0.76), Charlson Comorbidity Index (CCI) one (1.70, 1.07-2.69) and ≥two (2.82, 1.59-4.81) and the absence of computer-navigation (2.26, 1.09-4.68). LCGA also identified a class of patients with poor function (23.0%). Predictors of low function trajectory class membership were, female sex (3.31, 1.95-5.63), advancing age per 10 years (2.27, 1.69-3.02), pre-surgery PCS per 10 points (0.50, 0.33-0.74), obesity (1.69, 1.05-2.72), morbid obesity (3.12, 1.55-6.27) and CCI ≥two (2.50, 1.41-4.42). CONCLUSIONS Modifiable predictors of poor response to TKA included baseline co-morbidity, physical and mental well-being and obesity. This provides useful information for clinicians in terms of informing patients of the expected course of longer term outcomes of TKA and for developing prediction algorithms that identify patients in whom there is a high likelihood of poor surgical response.
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Affiliation(s)
- M M Dowsey
- Department of Orthopaedics and The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Australia.
| | - A J Smith
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Australia.
| | - P F M Choong
- Department of Orthopaedics and The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Australia.
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26
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Association Between Exercise Therapy Dose and Functional Improvements in the Early Postoperative Phase After Hip and Knee Arthroplasty: An Observational Study. PM R 2015; 7:1064-1072. [DOI: 10.1016/j.pmrj.2015.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 04/09/2015] [Accepted: 04/12/2015] [Indexed: 02/03/2023]
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27
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Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2014; 114:551-61. [PMID: 25542191 DOI: 10.1093/bja/aeu441] [Citation(s) in RCA: 357] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Several studies have identified clinical, psychosocial, patient characteristic, and perioperative variables that are associated with persistent postsurgical pain; however, the relative effect of these variables has yet to be quantified. The aim of the study was to provide a systematic review and meta-analysis of predictor variables associated with persistent pain after total knee arthroplasty (TKA). METHODS Included studies were required to measure predictor variables prior to or at the time of surgery, include a pain outcome measure at least 3 months post-TKA, and include a statistical analysis of the effect of the predictor variable(s) on the outcome measure. Counts were undertaken of the number of times each predictor was analysed and the number of times it was found to have a significant relationship with persistent pain. Separate meta-analyses were performed to determine the effect size of each predictor on persistent pain. Outcomes from studies implementing uni- and multivariable statistical models were analysed separately. RESULTS Thirty-two studies involving almost 30 000 patients were included in the review. Preoperative pain was the predictor that most commonly demonstrated a significant relationship with persistent pain across uni- and multivariable analyses. In the meta-analyses of data from univariate models, the largest effect sizes were found for: other pain sites, catastrophizing, and depression. For data from multivariate models, significant effects were evident for: catastrophizing, preoperative pain, mental health, and comorbidities. CONCLUSIONS Catastrophizing, mental health, preoperative knee pain, and pain at other sites are the strongest independent predictors of persistent pain after TKA.
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Affiliation(s)
- G N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - D A Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand Waitemata Pain Services, Waitemata District Health Board, Auckland, New Zealand
| | - P J McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - M Kluger
- Waitemata Pain Services, Waitemata District Health Board, Auckland, New Zealand Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
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28
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Harding P, Holland AE, Delany C, Hinman RS. Do activity levels increase after total hip and knee arthroplasty? Clin Orthop Relat Res 2014; 472:1502-11. [PMID: 24353051 PMCID: PMC3971219 DOI: 10.1007/s11999-013-3427-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/09/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND People with osteoarthritis (OA) often are physically inactive. Surgical treatment including total hip arthroplasty or total knee arthroplasty can substantially improve pain, physical function, and quality of life. However, their impact on physical activity levels is less clear. QUESTIONS/PURPOSES We used accelerometers to measure levels of physical activity pre- and (6 months) postarthroplasty and to examine the proportion of people meeting the American Physical Activity Guidelines. METHODS Sixty-three people with hip or knee OA awaiting arthroplasty were recruited from a major metropolitan hospital. Physical activity was measured using accelerometry before, and 6 months after, surgery. The ActiGraph GT1M (ActiGraph LLC, Fort Walton Beach, FL, USA) was used in this study and is a uniaxial accelerometer contained within a small activity monitor designed to measure human movement through changes in acceleration, which can then be used to estimate physical activity over time. Questionnaires were used to assess patient-reported changes in pain, function, quality of life, and physical activity. Complete data sets (including valid physical activity data) for both time points were obtained for 44 participants (70%). At baseline before arthroplasty, the activity level of patients was, on average, sedentary for 82% of the time over a 24-hour period (based on accelerometry) and self-rated as "sometimes participates in mild activities such as walking, limited shopping, and housework" according to the UCLA activity scale. RESULTS There was no change in objectively measured physical activity after arthroplasty. The majority of participants were sedentary, both before and after arthroplasty, and did not meet the American Physical Activity Guidelines recommended to promote health. This was despite significant improvements in self-reported measures of pain, function, quality of life, and physical activity after arthroplasty. CONCLUSIONS Despite patient-reported improvements in pain, function, and physical activity after arthroplasty, objectively measured improvements in physical activity may not occur. Clinicians should incorporate strategies for improving physical activity into their management of patients after hip and knee arthroplasty to maximize health status. Future research is needed to explore the factors that impact physical activity levels in people after arthroplasty. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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MESH Headings
- Actigraphy/instrumentation
- Activities of Daily Living
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Knee/adverse effects
- Biomechanical Phenomena
- Equipment Design
- Female
- Health Status
- Hip Joint/physiopathology
- Hip Joint/surgery
- Humans
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Motor Activity
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain, Postoperative/etiology
- Prospective Studies
- Quality of Life
- Recovery of Function
- Sedentary Behavior
- Surveys and Questionnaires
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Paula Harding
- />Department of Physiotherapy, The Alfred, Melbourne, VIC Australia
- />Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010 Australia
| | - Anne E. Holland
- />Department of Physiotherapy, The Alfred, Melbourne, VIC Australia
- />Department of Physiotherapy, La Trobe University, Melbourne, VIC Australia
| | - Clare Delany
- />Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010 Australia
| | - Rana S. Hinman
- />Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010 Australia
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Drexler M, Dwyer T, Chakravertty R, Farno A, Backstein D. Assuring the happy total knee replacement patient. Bone Joint J 2013; 95-B:120-3. [DOI: 10.1302/0301-620x.95b11.32949] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Total knee replacement (TKR) is one of the most common operations in orthopaedic surgery worldwide. Despite its scientific reputation as mainly successful, only 81% to 89% of patients are satisfied with the final result. Our understanding of this discordance between patient and surgeon satisfaction is limited. In our experience, focus on five major factors can improve patient satisfaction rates: correct patient selection, setting of appropriate expectations, avoiding preventable complications, knowledge of the finer points of the operation, and the use of both pre- and post-operative pathways. Awareness of the existence, as well as the identification of predictors of patient–surgeon discordance should potentially help with enhancing patient outcomes. Cite this article: Bone Joint J 2013;95-B, Supple A:120–3.
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Affiliation(s)
- M. Drexler
- Mount Sinai Hospital, 600 University
Avenue, Toronto, Ontario, M5G
1X5, Canada
| | - T. Dwyer
- Women’s College Hospital, University
of Toronto Orthopaedic Sports Medicine, 76
Grenville St, Toronto, Ontario
M5S 1B1, Canada
| | - R. Chakravertty
- Mount Sinai Hospital, 600 University
Avenue, Toronto, Ontario, M5G
1X5, Canada
| | - A. Farno
- Mount Sinai Hospital, 600 University
Avenue, Toronto, Ontario, M5G
1X5, Canada
| | - D. Backstein
- Mount Sinai Hospital, 600 University
Avenue, Toronto, Ontario, M5G
1X5, Canada
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Harris IA, Harris AM, Naylor JM, Adie S, Mittal R, Dao AT. Discordance between patient and surgeon satisfaction after total joint arthroplasty. J Arthroplasty 2013; 28:722-7. [PMID: 23462496 DOI: 10.1016/j.arth.2012.07.044] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 07/02/2012] [Accepted: 07/17/2012] [Indexed: 02/01/2023] Open
Abstract
We surveyed 331 patients undergoing total hip or knee arthroplasty pre-operatively, and patients and surgeons were both surveyed 6 and 12 months post-operatively. We identified variables (demographic factors, operative factors and patient expectations) as possible predictors for discordance in patient-surgeon satisfaction. At 12 months, 94.5% of surgeons and 90.3% of patients recorded satisfaction with the outcome. The discordance between patient and surgeon satisfaction was mainly due to patient dissatisfaction-surgeon satisfaction. In an adjusted analysis, the strongest predictors of discordance in patient-surgeon satisfaction were unmet patient expectations and the presence of complications. Advice to potential joint arthroplasty candidates regarding the decision to proceed with surgery should be informed by patient reported outcomes, rather than the surgeon's opinion of the likelihood of success.
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Affiliation(s)
- Ian A Harris
- Whitlam Orthopaedic Research Centre, Liverpool, NSW, Australia
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Mak JCS, Fransen M, Jennings M, March L, Mittal R, Harris IA. Evidence-based review for patients undergoing elective hip and knee replacement. ANZ J Surg 2013; 84:17-24. [PMID: 23496209 DOI: 10.1111/ans.12109] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the evidence for different interventions in the preoperative, perioperative and post-operative care for people undergoing elective total hip (THR) and knee (TKR) replacement surgery. METHOD A multidisciplinary working group comprising consumers, managers and clinicians from the areas of orthopaedics, rheumatology, aged care and rehabilitation evaluated randomized controlled trials (RCTs) and systematic reviews/meta-analyses concerning aspects of preoperative, perioperative and post-operative clinical care periods for THR/TKR through systematic searching of Medline, Embase, CENTRAL and the Cochrane Database of Systematic Reviews from May 2007 to April 2011. Multiple reviewers determined study eligibility and one or more members extracted primary study findings. The body of evidence were assessed and specific recommendations made according to NHMRC guidelines. RESULTS Twenty-five aspects were identified for review. Recommendations for 16 of 25 areas of care were made: impact of waiting, multidisciplinary preparation, preoperative exercise, smoking cessation, interventions for comorbid conditions, predictors of outcome, clinical pathways, implementation of a blood management programme, antibiotic prophylaxis, regional anaesthesia and analgesia, use of a tourniquet in knee replacement, venous thromboembolism prophylaxis, early post-operative cryotherapy, early mobilization and continuous passive motion. In the post-operative period, study heterogeneity across all aspects of care precluded specific recommendations. CONCLUSIONS There was a deficiency in the quality of the evidence supporting key aspects of the continuum of care for primary THR/TKR surgery. Consequently, recommendations were limited. Prioritization and funding for research into areas likely to impact clinical practice and patient outcomes after elective joint replacement surgery are the next important steps.
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Affiliation(s)
- Jenson C S Mak
- Department of Geriatric Medicine, Gosford Hospital, Gosford, New South Wales, Australia; Department of Medicine, Ryde Hospital, Eastwood, New South Wales, Australia
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Heiberg KE, Ekeland A, Bruun-Olsen V, Mengshoel AM. Recovery and prediction of physical functioning outcomes during the first year after total hip arthroplasty. Arch Phys Med Rehabil 2013; 94:1352-9. [PMID: 23385111 DOI: 10.1016/j.apmr.2013.01.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To investigate recovery of physical functioning in patients during the first year after total hip arthroplasty (THA), and to predict postoperative walking distance outcomes from preoperative measures. DESIGN A longitudinal prospective design was used. Data were analyzed by repeated-measures analysis of variance and multivariate regression analyses. SETTING Two hospitals. PARTICIPANTS Patients with hip osteoarthritis were consecutively included and assessed preoperatively (n=88), at 3 months (n=88), and at 12 months (n=64) after THA. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical functioning was assessed by objective measures-the 6-minute walk test (6MWT), stair climbing test, Index of Muscle Function, figure-of-eight, and active hip range of motion-and the subjective measures by Harris Hip Score and Hip dysfunction and Osteoarthritis Outcome Score. RESULTS In objective measures, improvements were found from preoperatively to 3 months in 6MWT (P<.01) and stair climbing test (P<.05) scores, while all measures had improved from 3 to 12 months (P≤.001). In contrast, all the subjective measures showed substantial improvements at 3 months, but small further improvements from 3 to 12 months (P<.001). Age, sex, preoperative 6MWT distance, and hip range of motion predicted 6MWT outcomes at 3 and 12 months (P≤.01). CONCLUSIONS The objective measures of physical functioning improved gradually during the first postoperative year, while the subjective measures showed large early improvements, but little further improvements. Younger age, male sex, and better scores of walking distance and hip flexibility before surgery predicted better score in walking distance at both 3 and 12 months after surgery.
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Adie S, Dao A, Harris IA, Naylor JM, Mittal R. Satisfaction with joint replacement in public versus private hospitals: a cohort study. ANZ J Surg 2012; 82:616-24. [DOI: 10.1111/j.1445-2197.2012.06113.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Naylor JM, Ko V, Rougellis S, Green N, Mittal R, Heard R, Yeo AET, Barnett A, Hackett D, Saliba C, Smith N, Mackey M, Harmer A, Harris IA, Adie S, McEvoy L. Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2. J Eval Clin Pract 2012; 18:652-8. [PMID: 21414108 DOI: 10.1111/j.1365-2753.2011.01656.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Knee range of motion (ROM) at discharge from acute care is used as a clinical indicator following total knee replacement (TKR) surgery. This study aimed to assess the clinical relevance of this indicator by determining whether discharge knee ROM predicts longer-term knee ROM and patient-reported knee pain and function. METHODS A total of 176 TKR recipients were prospectively followed after discharge from acute care. Outcomes assessed included knee ROM and Oxford knee score post rehabilitation and 1 year post surgery. Discharge ROM and other patient factors were identified a priori as potential predictors in multiple linear regression modelling. RESULTS A total of 133 (76%) and 141 (80%) patients were available for follow-up post rehabilitation [mean postoperative week 8.1 (SD 2.7)] and at 1 year [mean postoperative month 12.1 (SD 1.4)], respectively. Greater discharge knee flexion was a significant (P < 0.001) predictor of greater post-rehabilitation flexion but not 1-year knee flexion (P < 0.083). Better discharge knee extension was a significant predictor of better post-rehabilitation (P = 0.001) and 1-year knee extension (P = 0.013). Preoperative Oxford score and post-rehabilitation knee flexion independently predicted post-rehabilitation Oxford score, and gender predicted 1-year Oxford score. Discharge ROM did not significantly predict Oxford score in either model. CONCLUSION The finding that early knee range predicts longer-term range provides clinical evidence favouring the relevance of discharge knee ROM as a clinical indicator. Although longer-term patient-reported knee pain and function were not directly associated with discharge knee ROM, they were associated with ROM when measured concurrently in the sub-acute phase. No causal effect has been demonstrated, but the findings suggest it may be important for physiotherapists to maximize range in the early and sub-acute periods.
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Affiliation(s)
- Justine M Naylor
- South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
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Naylor JM, Ko V. Heart rate response and factors affecting exercise performance during home- or class-based rehabilitation for knee replacement recipients: lessons for clinical practice. J Eval Clin Pract 2012; 18:449-58. [PMID: 21114797 DOI: 10.1111/j.1365-2753.2010.01596.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patients undergoing total knee replacement (TKR) are typically de-conditioned and manifest medical co-morbidities associated with a lack of fitness. Consequently, an argument exists for rehabilitation programmes to target cardiovascular fitness. Doubt exists, however, as to the capacity of TKR recipients to exercise intensely and effectively. This preliminary study aimed to: (1) determine whether patients participating in a home- or class-based exercise programme can exercise in their heart rate (HR) training zone, and (2) identify confounding factors influencing performance. METHODS A mixed method study nested within a randomized trial was undertaken. Forty-two people (mean age 70 years; 23 women) randomized to commence a 6-week group-based (GRP) or monitored home-based programme (MHP) 2 weeks post surgery participated. Assessments were undertaken weeks 5 (GRP and MHP) and 8 (GRP only) post surgery. HR and participant perceived exertion (PE, 0-10 point scale) captured exercise intensity. Qualitative description using triangulation of informant sources identified factors influencing exercise performance. RESULTS For both programmes, attainment of training HR was almost universal (93% or more), average time spent above the training HR exceeded 30 minutes, and PE indicated moderate exertion (5/10). Individual inconsistency in time spent above the training HR was evident between testing weeks in GRP participants. Therapist skill and focus, and patient co-morbidity, knee pain and stiffness and willingness were confounders of performance. CONCLUSION TKR recipients participating in exercise programmes can exercise moderately hard indicating a potential for rehabilitation to improve cardiovascular fitness. Whether individual fitness actually improves likely depends in part on therapist recognition of key modifiable factors. It is recommended that therapists use these observations to inform practice so patients extract the most benefit from their rehabilitation.
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Affiliation(s)
- Justine M Naylor
- Orthopaedic Department, Liverpool Hospital, Sydney, NSW, Australia.
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Alzahrani K, Gandhi R, Debeer J, Petruccelli D, Mahomed N. Prevalence of clinically significant improvement following total knee replacement. J Rheumatol 2011; 38:753-9. [PMID: 21239743 DOI: 10.3899/jrheum.100233] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although total knee replacement (TKR) has a high reported success rate, the pain relief and functional improvement after surgery vary. The purpose of our retrospective cohort study was to determine the prevalence of patients showing no clinically important improvement 1 year after TKR, and patient factors that may predict this outcome. METHODS We reviewed primary TKR registry data that were collected from 2 academic hospitals: the Toronto Western Hospital and the Hamilton Health Sciences Henderson Hospital in Ontario, Canada. Relevant covariates including demographic data, body mass index, and comorbidity were recorded. Knee joint pain and functional status were assessed at baseline and at 1-year followup with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS) to measure the change using the minimal clinically important difference (MCID). Logistic regression modeling was used to identify the predictors of interest. RESULTS Overall, 11.7% (373/3177) of patients reported no clinically important improvement 1 year after surgery. Logistic regression modeling showed that a greater patient age independently predicted no clinically important improvement on the WOMAC scale 1 year after surgery (p = 0.0003), while being male independently predicted no clinically important improvement on the OKS 1 year after surgery (p = 0.008). CONCLUSION Awareness of the prevalence of patients who may show no clinically important improvement and factors that predict this outcome will help patients and surgeons set realistic expectations of surgery.
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Affiliation(s)
- Khalid Alzahrani
- Division of Orthopedic Surgery, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
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Piano LPAD, Golmia RP, Scheinberg M. Total hip and knee joint replacement: perioperative clinical aspects. EINSTEIN-SAO PAULO 2010; 8:350-3. [DOI: 10.1590/s1679-45082010ao1660] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05). Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.
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Affiliation(s)
| | - Ricardo Prado Golmia
- Santa Casa de Misericórdia de São Paulo – SCMSP, Brazil; Hospital Abreu Sodré da Associação de Assistência à Criança Deficiente – AACD, Brazil
| | - Morton Scheinberg
- Hospital Israelita Albert Einstein – HIAE, Brazil; Hospital Abreu Sodré da Associação de Assistência à Criança Deficiente – AACD, Brazil
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Adie S, Naylor JM, Harris IA. Cryotherapy after total knee arthroplasty a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 2010; 25:709-15. [PMID: 19729279 DOI: 10.1016/j.arth.2009.07.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 07/06/2009] [Indexed: 02/01/2023] Open
Abstract
Cryotherapy has theoretical and practical applications in the reduction of pain, swelling, and blood loss after trauma. We performed a systematic review and meta-analysis of randomized controlled trials on the efficacy of cryotherapy after total knee arthroplasty (TKA). Eleven studies involving 793 TKAs were included. There was considerable clinical and methodological heterogeneity. Cryotherapy resulted in small benefits in blood loss and discharge knee range of motion. There were no benefits in transfusion and analgesia requirements, pain, swelling, length of stay, and gains in knee range of motion after discharge. Despite some early gains, cryotherapy after TKA yields no apparent lasting benefits. Patient-centered outcomes remain underinvestigated. The current evidence does not support the routine use of cryotherapy after TKA.
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Affiliation(s)
- Sam Adie
- South West Sydney Clinical School University of New South Wales Sydney, New South Wales, Australia
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Crosbie J, Naylor J, Harmer A, Russell T. Predictors of functional ambulation and patient perception following total knee replacement and short-term rehabilitation. Disabil Rehabil 2009; 32:1088-98. [DOI: 10.3109/09638280903381014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jack Crosbie
- School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Justine Naylor
- School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
- University of New South Wales, NSW, Australia
- Liverpool Hospital, NSW, Australia
| | - Alison Harmer
- School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Tyson Russell
- School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
- Mona Vale Hospital, NSW, Australia
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