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Sabesan V, Dawoud M, Al-Mansoori A, Stephens BJ, Lavin AC, Lozano JM, Fomunung CK. Factors influencing physical therapy utilization after shoulder surgery: a retrospective review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:511-518. [PMID: 37928991 PMCID: PMC10625012 DOI: 10.1016/j.xrrt.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Postoperative physical therapy (PT) is a cornerstone to achieve optimal patient outcomes. Access to postoperative PT can be limited by insurance type, coverage, and cost. With copayments (CP) for PT as high as $75 per visit, PT can be costprohibitive for patients. The purpose of this study was to evaluate factors affecting PT utilization among patients that underwent shoulder surgery. Methods A retrospective analysis was performed of 80 shoulder surgery patients with postoperative PT sessions attended at a single institution from 2017 to 2019. Patients were divided based on insurance type: private insurance (PI), and Medicare with or without supplemental insurance (MI), and CP or no copayment. Demographics, CP, total, and postoperative number of PT sessions utilized was collected and analyzed. Results The cohort had 53 females and an average age of 62. There was no significant difference between PI and MI at baseline other than surgery performed (P = .03), older MI group (69 years vs. 56 years: P < .01), and more females in PI group (76% vs. 55%; P = .05). There was no significant difference in the number of PT sessions between groups. The PI group was more likely to have a CP (P < .01). The CP group more often had PI and significantly more total PT visits (P = .05), while the no copayment group more often had Medicare (P < .01). CP was not independently associated with a change in the number of PT visits or total PT visits. Conclusions The utilization of PT after shoulder surgery was found to not be influenced by insurance type or CP as determined by the number of PT sessions attended. Further investigations are necessary to better understand the relationship between CP and different insurance types and develop effective strategies to increase access to PT for postoperative shoulder patients.
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Affiliation(s)
- Vani Sabesan
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - Mirelle Dawoud
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - Ahmed Al-Mansoori
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - B. Joshua Stephens
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL, USA
| | - Alessia C. Lavin
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
| | - Juan Manuel Lozano
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Clyde K. Fomunung
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
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Venishetty N, Sohn G, Nguyen I, Trivedi M, Mounasamy V, Sambandam S. Hospital characteristics and perioperative complications of Hispanic patients following reverse shoulder arthroplasty-a large database study. ARTHROPLASTY 2023; 5:50. [PMID: 37789382 PMCID: PMC10548760 DOI: 10.1186/s42836-023-00206-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/22/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Hispanic patients are the youngest and fastest-growing ethnic group in the USA. Many of these patients are increasingly met with orthopedic issues, often electing to undergo corrective procedures such as reverse shoulder arthroplasty (RSA). This patient population has unique medical needs and has been reported to have higher incidences of perioperative complications following major procedures. Unfortunately, there is a lack of information on the hospitalization data and perioperative complications in Hispanic patients following procedures such as RSA. This project aimed to query the Nationwide Inpatient Sample (NIS) database to assess patient hospitalization information, demographics, and the prevalence of perioperative complications among Hispanic patients who received RSA. METHODS Information from 2016-2019 was queried from the NIS database. Demographic information, incidences of perioperative complications, length of stay, and costs of care among Hispanic patients undergoing RSA were compared to non-Hispanic patients undergoing RSA. A subsequent propensity matching was conducted to consider preoperative comorbidities. RESULTS The query of NIS identified 59,916 patients who underwent RSA. Of this sample, 2,656 patients (4.4%) were identified to be Hispanic, while the remaining 57,260 patients (95.6%) were found to belong to other races (control). After propensity matching, Hispanic patients had a significantly longer LOS (median = 1.4 days) than the patients in the control group (median = 1.0, P < 0.001). The Hispanic patients (89,168.5 USD) had a significantly higher cost of care than those in the control group (67,396.1 USD, P < 0.001). In looking at postoperative complications, Hispanic patients had increased incidences of acute renal failure (Hispanics: 3.1%, control group: 1.1%, P = 0.03) and blood loss anemia (Hispanics: 12.7%, control group: 10.9%, P = 0.03). CONCLUSIONS Hispanic patients had significantly longer lengths of stay, higher costs of care, and higher rates of perioperative complications compared to the control group. For patients who are Hispanic and undergoing RSA, this information will aid doctors in making comprehensive decisions regarding patient care and resource allocation.
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Affiliation(s)
- Nikit Venishetty
- Texas Tech University Health Sciences Center, El Paso, TX, 5001, USA.
| | - Garrett Sohn
- University of Texas Southwestern, Harry Hines Blvd, Dallas, TX, 5323, USA
| | - Ivy Nguyen
- University of Texas Southwestern, Harry Hines Blvd, Dallas, TX, 5323, USA
| | - Meesha Trivedi
- Texas Tech University Health Sciences Center, El Paso, TX, 5001, USA
| | | | - Senthil Sambandam
- University of Texas Southwestern, Dallas VAMC, Dallas, TX, 4500, USA
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Assessment of Mobile Health Applications for Management of Knee and/or Hip Osteoarthritis Using the Mobile Application Rating Scale. J Clin Rheumatol 2022:00124743-990000000-00058. [PMID: 36256541 DOI: 10.1097/rhu.0000000000001896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mobile health applications (apps) can help individuals with knee and/or hip osteoarthritis (OA) learn about, monitor, and manage their condition. These apps have not been formally evaluated. OBJECTIVE The aim of this study was to evaluate the publicly available mobile health apps for individuals with knee and/or hip OA using a systematic review. METHODS We searched the Apple App Store, Android Google Play, and Amazon Appstore using the terms "arthritis," "osteoarthritis," "hip OA," "knee OA," "hip," "knee," "rehabilitation," "rehab," and "physical therapy" in December of 2021. Applications that met the inclusion/exclusion criteria were reviewed using the Mobile Application Rating Scale (MARS; 29 items across 6 sections, each rated at 1-5). RESULTS Among 1104 identified apps, 94 met the inclusion/exclusion criteria for MARS appraisal. Fourteen apps met the predetermined score thresholds for final summary. Of the 14 apps appraised, the total overall mean app score on the MARS ranged from 3.12 to 4.20 (mean, 3.51 ± 0.37). Although app features varied, common features were symptom tracking, exercise recommendations, education, goal setting, and improving well-being. Many apps allowed for sharing with health care providers and included some measures to protect privacy. Jointfully Osteoarthritis was the top-rated app in both the Apple App Store and Android Google Play. CONCLUSIONS The majority of the apps we identified for knee and/or hip OA did not meet predetermined score thresholds for final summary. Many failed to provide comprehensive education and deliver management plans and lacked scientific testing. Future research should focus on apps that fit the needs of health care providers and patients including quality information, structured exercise programs tailored to individual needs, secure communication methods, and health information protection.
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4
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Gustafsson K, Kvist J, Zhou C, Eriksson M, Rolfson O. Progression to arthroplasty surgery among patients with hip and knee osteoarthritis : a study from the Swedish BOA Register. Bone Joint J 2022; 104-B:792-800. [PMID: 35775173 DOI: 10.1302/0301-620x.104b7.bjj-2021-1766.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to estimate time to arthroplasty among patients with hip and knee osteoarthritis (OA), and to identify factors at enrolment to first-line intervention that are prognostic for progression to surgery. METHODS In this longitudinal register-based observational study, we identified 72,069 patients with hip and knee OA in the Better Management of Patients with Osteoarthritis Register (BOA), who were referred for first-line OA intervention, between May 2008 and December 2016. Patients were followed until the first primary arthroplasty surgery before 31 December 2016, stratified into a hip and a knee OA cohort. Data were analyzed with Kaplan-Meier and multivariable-adjusted Cox regression. RESULTS At five years, Kaplan-Meier estimates showed that 46% (95% confidence interval (CI) 44.6 to 46.9) of those with hip OA, and 20% (95% CI 19.7 to 21.0) of those with knee OA, had progressed to arthroplasty. The strongest prognostic factors were desire for surgery (hazard ratio (HR) hip 3.12 (95% CI 2.95 to 3.31), HR knee 2.72 (95% CI 2.55 to 2.90)), walking difficulties (HR hip 2.20 (95% CI 1.97 to 2.46), HR knee 1.95 (95% CI 1.73 to 2.20)), and frequent pain (HR hip 1.56 (95% CI 1.40 to 1.73), HR knee 1.77 (95% CI 1.58 to 2.00)). In hip OA, the probability of progression to surgery was lower among those with comorbidities (e.g. ≥ four conditions; HR 0.64 (95% CI 0.59 to 0.69)), with no detectable effects in the knee OA cohort. Instead, being overweight or obese increased the probability of OA progress in the knee cohort (HR 1.25 (95% CI 1.15 to 1.37)), but not among those with hip OA. CONCLUSION Patients with hip OA progressed faster and to a greater extent to arthroplasty than patients with knee OA. Progression was strongly influenced by patients' desire for surgery and by factors related to severity of OA symptoms, but factors not directly related to OA symptoms are also of importance. However, a large proportion of patients with OA do not seem to require surgery within five years, especially among those with knee OA. Cite this article: Bone Joint J 2022;104-B(7):792-800.
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Affiliation(s)
- Kristin Gustafsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Caddie Zhou
- Centre of Registries, Västra Götaland, Gothenburg, Sweden
| | - Marit Eriksson
- Futurum - Academy for Health and Care, Jönköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Zaballa E, Ntani G, Harris EC, Lübbeke A, Arden NK, Hannouche D, Cooper C, Walker-Bone K. Feasibility and sustainability of working in different types of jobs after total hip arthroplasty: analysis of longitudinal data from two cohorts. Occup Environ Med 2022; 79:486-493. [PMID: 35027440 DOI: 10.1136/oemed-2021-107970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the rates of return to work and workability among working-age people following total hip arthroplasty (THA). METHODS Participants from the Geneva Arthroplasty Registry and the Clinical Outcomes for Arthroplasty Study aged 18-64 years when they had primary THA and with at least 5 years' follow-up were mailed a questionnaire 2017-2019. Information was collected about preoperative and post-THA employment along with exposure to physically demanding activities at work or in leisure. Patterns of change of job were explored. Survival analyses using Cox proportional hazard models were created to explore risk factors for having to stop work because of difficulties with the replaced hip. RESULTS In total, 825 returned a questionnaire (response 58%), 392 (48%) men, mean age 58 years, median follow-up 7.5 years post-THA. The majority (93%) of those who worked preoperatively returned to work, mostly in the same sector but higher rates of non-return (36%-41%) were seen among process, plant and machine operatives and workers in elementary occupations. 7% reported subsequently leaving work because of their replaced hip and the risk of this was strongly associated with: standing >4 hours/day (HR 3.81, 95% CI 1.62 to 8.96); kneeling/squatting (HR 3.32, 95% CI 1.46 to 7.55) and/or carrying/lifting ≥10 kg (HR 5.43, 95% CI 2.29 to 12.88). CONCLUSIONS It may be more difficult to return to some (particularly physically demanding) jobs post-THA than others. Rehabilitation may need to be targeted to these types of workers or it may be that redeployment or job change counselling are required.
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Affiliation(s)
- Elena Zaballa
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - E Clare Harris
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Anne Lübbeke
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Didier Hannouche
- Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
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6
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Allied health professionals: A promising ally in the work against health inequalities- A rapid review. PUBLIC HEALTH IN PRACTICE 2022; 3:100269. [PMID: 36101762 PMCID: PMC9461647 DOI: 10.1016/j.puhip.2022.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/20/2022] Open
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Gustafsson K, Kvist J, Eriksson M, Dell'Isola A, Zhou C, Dahlberg LE, Rolfson O. Health status of individuals referred to first-line intervention for hip and knee osteoarthritis compared with the general population: an observational register-based study. BMJ Open 2021; 11:e049476. [PMID: 34518262 PMCID: PMC8438840 DOI: 10.1136/bmjopen-2021-049476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To describe the prevalence of comorbidities in a population referred to standardised first-line intervention (patient education and exercise) for hip and knee osteoarthritis (OA), in comparison with the general population. Furthermore, we aimed to evaluate if eventual differences were associated with socioeconomic inequalities. DESIGN Register-based study. SETTING Primary healthcare, Sweden. PARTICIPANTS Individuals with hip and/or knee OA included in the Better Management for Patients with Osteoarthritis Register between 2008 and 2016 and and an age-matched, sex-matched and residence-matched reference cohort (1:3) from the general Swedish population. OUTCOME MEASURES Comorbidities were identified with the RxRisk Index, the Elixhauser Comorbidity Index and the Charlson Comorbidity Index, and presented with descriptive statistics as (1) individual diseases, (2) disease categories and (3) scores for each index. The prevalence of comorbidities in the two populations was tested using logistic regression, with separate analyses for age groups and the most affected joint. We then adjusted the analyses for socioeconomic status. RESULTS In this OA population, 85% had ≥1 comorbidity compared with 78% of the reference cohort (OR; 1.62 (95% CI 1.59 to 1.66)). Cardiovascular/blood diseases were the most common comorbidities in both populations (OA, 59%; reference, 54%), with OR; 1.22 (95% CI 1.20 to 1.24) for the OA population. Younger individuals with OA were more comorbid than their matched references overall, and population differences decreased with age (eg, ≥3 comorbidities, aged ≤45 years OR; 1.74 (95% CI 1.52 to 1.98), ≥81 years OR; 0.95 (95% CI 0.87 to 1.04)). Individuals with knee OA were more comorbid than those with hip OA overall. Adjustment for socioeconomic status did not change the estimates. CONCLUSION Comorbidities were more common among individuals with hip and knee OA than among matched references from the general population. The differences could not be explained by socioeconomic status. TRIAL REGISTRATION NUMBER NCT03438630.
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Affiliation(s)
- Kristin Gustafsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marit Eriksson
- Department of Medical and Health Sciences, Linköping University and Futurum - Academy for Health and Care, Region of Jönköping County, Jönköping, Sweden
| | - Andrea Dell'Isola
- Department of Clinical Sciences Lund, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Caddie Zhou
- Centre of Registries, Västra Götaland, Gothenburg, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ola Rolfson
- Department of Orthopaedicst, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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8
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Teo PL, Bennell KL, Lawford B, Egerton T, Dziedzic K, Hinman RS. Patient experiences with physiotherapy for knee osteoarthritis in Australia-a qualitative study. BMJ Open 2021; 11:e043689. [PMID: 34006028 PMCID: PMC7942256 DOI: 10.1136/bmjopen-2020-043689] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Physiotherapists commonly provide non-surgical care for people with knee osteoarthritis (OA). It is unknown if patients are receiving high-quality physiotherapy care for their knee OA. This study aimed to explore the experiences of people who had recently received physiotherapy care for their knee OA in Australia and how these experiences aligned with the national Clinical Care Standard for knee OA. DESIGN Qualitative study using semistructured individual telephone interviews and thematic analysis, where themes/subthemes were inductively derived. Questions were informed by seven quality statements of the OA of the Knee Clinical Care Standard. Interview data were also deductively analysed according to the Standard. SETTING Participants were recruited from around Australia via Facebook and our research volunteer database. PARTICIPANTS Interviews were conducted with 24 people with recent experience receiving physiotherapy care for their knee OA. They were required to be aged 45 years or above, had activity-related knee pain and any knee-related morning stiffness lasted no longer than 30 min. Participants were excluded if they had self-reported inflammatory arthritis and/or had undergone knee replacement surgery for the affected knee. RESULTS Six themes emerged: (1) presented with a pre-existing OA diagnosis (prior OA care from other health professionals; perception of adequate OA knowledge); (2) wide variation in access and provision of physiotherapy care (referral pathways; funding models; individual vs group sessions); (3) seeking physiotherapy care for pain and functional limitations (knee symptoms; functional problems); (4) physiotherapy management focused on function and exercise (assessment of function; various types of exercises prescribed; surgery, medications and injections are for doctors; adjunctive treatments); (5) professional and personalised care (trust and/or confidence; personalised care) and (6) physiotherapy to postpone or prepare for surgery. CONCLUSION Patients' experiences with receiving physiotherapy care for their knee OA were partly aligned with the standard, particularly regarding comprehensive assessment, self-management, and exercise.
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Affiliation(s)
- Pek Ling Teo
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Belinda Lawford
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - T Egerton
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Rana S Hinman
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
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Edwards NM, Varnum C, Overgaard S, Pedersen AB. The impact of socioeconomic status on the utilization of total hip arthroplasty during 1995-2017: 104,055 THA cases and 520,275 population controls from national databases in Denmark. Acta Orthop 2021; 92:29-35. [PMID: 33106101 PMCID: PMC7919906 DOI: 10.1080/17453674.2020.1840111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In Denmark, all citizens are guaranteed free access to medical care, which should minimize socioeconomic status (SES) inequalities. We examined the association between SES and the utilization of total hip arthroplasty (THA) by age and over time.Patients and methods - Data on education, income, liquid assets, and occupation on 104,055 THA cases and 520,275 population controls were obtained from Danish health registers. We used logistic regression to estimate adjusted odds ratios (aOR) for THA with 95% confidence intervals (CI).Results - Risk (CI) of THA was higher for 45-55-year-olds with lowest vs. highest education (aOR 1.4 [1.3-1.5]), and for those with lowest vs. highest income (aOR 1.1 [1.0-1.2]). The association between education and income and higher risk of THA decreased with increasing age. The risk of THA was lower for persons with lowest vs. highest liquid assets in all age groups and time periods. The risk of THA was higher for persons with lowest education in 1995-2000 (aOR 1.2 [1.1-1.3]), but diminished in 2013-2017 (aOR 1.0 [1.0-1.0]). For those on lowest income there was a higher risk of THA in 1995-2000 (aOR 1.2 [1.1-1.3]), changing to lower risk in 2013-2017 (aOR 0.8 [0.8-0.9]).Interpretation - In a society where all citizens are guaranteed free access to medical care, we observed a social inequality in regard to the risk of THA with a development over time and in relation to age in most of our SES markers, showing a need for more patient involvement by implementing more focused interventions targeted to the most vulnerable patient groups identified as currently living alone, on low income, and with a low level of liquid assets.
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Affiliation(s)
- Nina M Edwards
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N; ,Correspondence:
| | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle;; ,Department of Regional Health Research, University of Southern Denmark; ,Danish Hip Arthroplasty Register; ,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; ,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Søren Overgaard
- Danish Hip Arthroplasty Register; ,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; ,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N;
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10
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Abstract
This article reviews the literature on racial and socioeconomic disparities in the management of osteoarthritis. Treatments investigated include arthritis education, dietary weight management, exercise/physical therapy, pharmacologic therapy with nonsteroidal antiinflammatory drugs and opioids, intra-articular steroid injections, and total joint replacement. The amount of evidence for each treatment modality varied, with the most evidence available for racial and socioeconomic disparities in total joint arthroplasty. Black patients, Hispanic patients, and patients with low socioeconomic status (SES) are less likely to undergo total joint replacement than white patients or patients with high SES, and generally have worse functional outcomes and more complications.
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Affiliation(s)
- Angel M Reyes
- Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, BWH Orthopaedics, OrACORe Group, 75 Francis Street, BTM Suite 5016, Boston, MA 02115, USA.
| | - Jeffrey N Katz
- Department of Orthopaedic Surgery, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, BWH Orthopaedics, OrACORe Group, 75 Francis Street, BTM Suite 5016, Boston, MA 02115, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Munugoda IP, Brennan-Olsen SL, Wills K, Cai G, Graves SE, Lorimer M, Cicuttini FM, Callisaya ML, Aitken D, Jones G. The association between socioeconomic status and joint replacement of the hip and knee: A population-based cohort study of older adults in Tasmania. Intern Med J 2020; 52:265-271. [PMID: 32975868 DOI: 10.1111/imj.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 08/26/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A socioeconomic gradient exists in the utilisation of total hip replacements (THR) and total knee replacements (TKR) for osteoarthritis. However, the relations between socioeconomic status (SES) and time to THR or TKR is unknown. AIM To describe the association between SES and time to THR and TKR. METHODS 1072 older-adults residing in Tasmania, Australia were studied. Incident primary THR and TKR were determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. At baseline, each participant's area-level SES was determined by the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD), from the Australian Bureau of Statistics' 2001 census data. IRSAD was analysed in two ways; 1) categorised into quartiles, whereby quartile 1 represented the most socioeconomically disadvantaged group, 2) the cohort dichotomised at the quartile 1 cut-point. RESULTS The mean age was 63.0 (±7.5) years, and 51% were women. Over the median follow-up of 12.9 (Interquartile range: 12.2-13.9) years, 56 (5%) participants had a THR, and 79 (7%) had a TKR. Compared to the most disadvantaged quartile, less disadvantaged participants were less likely to have a THR (i.e. less disadvantaged participants had a longer time to THR) (HR: 0.56, 95% CI 0.32, 1.00) but not TKR (HR: 0.90, 95% CI 0.53, 1.54). However, the former became non-significant after adjustment for pain and radiographic osteoarthritis, suggesting that the associations may be mediated by these factors. CONCLUSIONS This study suggests that time to joint replacement was determined according to the symptoms/need of the participants rather than their SES. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ishanka P Munugoda
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Guoqi Cai
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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12
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Gustafsson K, Kvist J, Eriksson M, Dahlberg LE, Rolfson O. Socioeconomic status of patients in a Swedish national self-management program for osteoarthritis compared with the general population-a descriptive observational study. BMC Musculoskelet Disord 2020; 21:10. [PMID: 31906904 PMCID: PMC6945568 DOI: 10.1186/s12891-019-3016-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND First-line treatment for hip and knee osteoarthritis (OA) including education and supervised exercises, delivered as a self-management program, is considered one of the mainstays in OA treatment. However, the socioeconomic profile of the population that utilizes first-line treatment for hip and knee OA is unclear. The aim of this study was to describe the socioeconomic status (SES) of a population referred to a self-management program for OA, in comparison with that of the general Swedish population. METHODS This is a cross-sectional study including 72,069 patients with hip or knee OA enrolled in the National Quality Register for Better management of patients with Osteoarthritis (BOA) between 2008 and 2016, and registered before participation in a structured OA self-management program. A reference cohort (n = 216,207) was selected from the general Swedish population by one-to-three matching by year of birth, sex and residence. Residential municipality, country of birth, marital status, family type, educational level, employment, occupation, disposable income and sick leave were analyzed. RESULTS The BOA population had higher educational level than the reference group, both regarding patients with hip OA (77.5% vs 70% with ≥10 years of education), and with knee OA (77% vs 72% with ≥10 years of education). Their average disposable income was higher (median [IQR] in Euro (€), for hip €17,442 [10,478] vs €15,998 [10,659], for knee €17,794 [10,574] vs €16,578 [11,221]). Of those who worked, 46% of patients with hip OA and 45% of the reference group had a blue-collar occupation. The corresponding numbers for knee OA were 51 and 44% respectively. Sick leave was higher among those with hip and knee OA (26%) than those in the reference groups (13% vs 12%). CONCLUSIONS The consistently higher SES in the BOA population compared with the general population indicates that this self-management program for OA may not reach the more socioeconomically disadvantaged groups, who are often those with a higher disease burden.
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Affiliation(s)
- Kristin Gustafsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. .,Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marit Eriksson
- Department of Medical and Health Sciences, Linköping University and Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Allen KD, Arbeeva L, Callahan LF, Golightly YM, Goode AP, Heiderscheit BC, Huffman KM, Severson HH, Schwartz TA. Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial. Osteoarthritis Cartilage 2018; 26:383-396. [PMID: 29307722 PMCID: PMC6021028 DOI: 10.1016/j.joca.2017.12.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/04/2017] [Accepted: 12/16/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the effectiveness of physical therapy (PT, evidence-based approach) and internet-based exercise training (IBET), each vs a wait list (WL) control, among individuals with knee osteoarthritis (OA). DESIGN Randomized controlled trial of 350 participants with symptomatic knee OA, allocated to standard PT, IBET and WL control in a 2:2:1 ratio, respectively. The PT group received up to eight individual visits within 4 months. The IBET program provided tailored exercises, video demonstrations, and guidance on progression. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, range 0 [no problems]-96 [extreme problems]), assessed at baseline, 4 months (primary time point) and 12 months. General linear mixed effects modeling compared changes in WOMAC among study groups, with superiority hypotheses testing differences between each intervention group and WL and non-inferiority hypotheses comparing IBET with PT. RESULTS At 4-months, improvements in WOMAC score did not differ significantly for either the IBET or PT group compared with WL (IBET: -2.70, 95% Confidence Interval (CI) = -6.24, 0.85, P = 0.14; PT: -3.36, 95% (CI) = -6.84, 0.12, P = 0.06). Similarly, at 12-months mean differences compared to WL were not statistically significant for either group (IBET: -2.63, 95% CI = -6.37, 1.11, P = 0.17; PT: -1.59, 95% CI = -5.26, 2.08, P = 0.39). IBET was non-inferior to PT at both time points. CONCLUSIONS Improvements in WOMAC score following IBET and PT did not differ significantly from the WL group. Additional research is needed to examine strategies for maximizing benefits of exercise-based interventions for patients with knee OA. TRIAL REGISTRATION NCT02312713.
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Affiliation(s)
- K D Allen
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA; Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
| | - L Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA.
| | - L F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA.
| | - Y M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - A P Goode
- Duke Clinical Research Institute, Durham, NC, USA; Department of Orthopedic Surgery, Division of Physical Therapy, Duke University Medical Center, USA.
| | - B C Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
| | - K M Huffman
- Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA; Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, NC, USA.
| | | | - T A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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14
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Lawford BJ, Bennell KL, Kasza J, Hinman RS. Physical Therapists' Perceptions of Telephone- and Internet Video-Mediated Service Models for Exercise Management of People With Osteoarthritis. Arthritis Care Res (Hoboken) 2017; 70:398-408. [PMID: 28437566 DOI: 10.1002/acr.23260] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/18/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate physical therapists' perceptions of, and willingness to use, telephone- and internet-mediated service models for exercise therapy for people with knee and/or hip osteoarthritis. METHODS This study used an internet-based survey of Australian physical therapists, comprising 3 sections: 1 on demographic information and 2 with 16 positively framed perception statements about delivering exercise via telephone and video over the internet, for people with hip and/or knee osteoarthritis. Levels of agreement with each statement were evaluated. Logistic regression models were used to determine therapist characteristics influencing interest in delivering telerehabilitation. RESULTS A total of 217 therapists spanning metropolitan, regional, rural, and remote Australia completed the survey. For telephone-delivered care, there was consensus agreement that it would not violate patient privacy (81% agreed/strongly agreed) and would save patient's time (76%), but there was less than majority agreement for 10 statements. There was consensus agreement that video-delivered care would save a patient's time (82%), be convenient for patients (80%), and not violate patient privacy (75%). Most agreed with all other perception statements about video-delivered care, except for liking no physical contact (14%). Low confidence using internet video technologies, and inexperience with telerehabilitation, were significantly associated with reduced interest in delivering telephone and/or video-based services. CONCLUSION Physical therapists agree that telerehabilitation offers time-saving and privacy advantages for people with osteoarthritis and perceive video-delivered care more favorably than telephone-delivered services. However, most do not like the lack of physical contact with either service model. These findings may inform the implementation of telerehabilitation osteoarthritis services and the training needs of clinicians involved in delivering care.
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Affiliation(s)
| | - Kim L Bennell
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Rana S Hinman
- University of Melbourne, Melbourne, Victoria, Australia
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15
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Lawford BJ, Bennell KL, Hinman RS. Consumer Perceptions of and Willingness to Use Remotely Delivered Service Models For Exercise Management of Knee and Hip Osteoarthritis: A Cross-Sectional Survey. Arthritis Care Res (Hoboken) 2017; 69:667-676. [PMID: 27813360 DOI: 10.1002/acr.23122] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/21/2016] [Accepted: 10/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the perceptions of people with hip and/or knee osteoarthritis (OA) about the remote delivery of exercise therapy by a physical therapist. METHODS A survey of people age ≥45 years with a clinical diagnosis of hip and/or knee OA was conducted. The survey comprised 3 sections, including 1) demographic information, 2) statements about receiving exercise via the telephone, and 3) statements about receiving exercise via video over the internet. Data were analyzed by calculating response proportions and evaluating levels of agreement with each statement. Exploratory binomial regression analyses were performed to determine whether participant characteristics influenced perceptions of tele-rehabilitation. RESULTS A total of 330 people spanning metropolitan, regional, and rural Australia completed the survey. Respondents were in majority (≥50%) agreement with 13 of 17 statements, with most agreement about tele-rehabilitation saving time (telephone versus video: 78% versus 81%), being easy to use (79% versus 78%), and maintaining privacy (86% versus 82%). There was no consensus agreement with liking the lack of physical contact (telephone versus video: 20% agreement versus 22%), willingness to pay (32% versus 46%), belief that telephone-delivered exercise would be effective (45%), and belief that a physical therapist could adequately monitor OA over the telephone (42%). CONCLUSION People with knee and/or hip OA hold mostly positive perceptions about tele-rehabilitation, delivered via the telephone or by video over the internet, for provision of physical therapist-prescribed exercise services. There was concern about the lack of physical contact with the therapist when using tele-rehabilitation.
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Affiliation(s)
- Belinda J Lawford
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA:D™): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord 2017; 18:72. [PMID: 28173795 PMCID: PMC5297181 DOI: 10.1186/s12891-017-1439-y] [Citation(s) in RCA: 240] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/31/2017] [Indexed: 02/04/2023] Open
Abstract
Background The uptake of evidence-based guidelines in clinical practice is suboptimal in osteoarthritis (OA) and other chronic diseases. Good Life with osteoArthritis in Denmark (GLA:D) was launched in 2013 with the aim of implementing guidelines for the treatment of knee and hip OA in clinical care nationwide. The purpose of this report was to evaluate the effects of the GLA:D intervention from 2013 to 2015, using data from the national GLA:D registry. Methods Patients undergo education and supervised exercise delivered by trained physiotherapists. Outcomes evaluated at baseline, 3 and 12 months are pain intensity (0 to 100, best to worst), objective physical function (30-s chair-stand test and 40-m fast-paced walk test), physical activity (number of days per week being physically active for at least 30 min), quality of life (Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) quality of life subscale, 0–100, worst to best), number of patients on painkillers and sick leave, and access to care according to guidelines. Results Data from 9,825 participants from the GLA:D registry were utilised in the analyses. It was demonstrated that GLA:D improved pain intensity and quality of life by 12.4 points and 5.4 points at 3 months, and 13.7 points and 9.4 points at 12 months, respectively. Furthermore, physical function and physical activity improved (only at 3 months), fewer patients took painkillers following the treatment, and fewer patients were on sick leave at 12 months following GLA:D compared with the year prior to GLA:D. GLA:D is offered in all five health care regions in Denmark via 286 active GLA:D units, but the uptake in the Danish municipalities is still low with only 20% of the municipalities offering GLA:D. Conclusion Three years after its inception, GLA:D has been rolled out nationwide and has a significant impact not only on patient symptoms and physical function, but also on intake of painkillers and sick leave. The lifestyle changes introduced by education and supervised exercise were largely maintained at 1 year and may have the potential to also improve general health and reduce societal costs.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, DK-5230, Odense M, Denmark. .,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, 4200, Slagelse, Region Zealand, Denmark.
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 55 Campusvej, DK-5230, Odense M, Denmark
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Wetterholm M, Turkiewicz A, Stigmar K, Hubertsson J, Englund M. The rate of joint replacement in osteoarthritis depends on the patient's socioeconomic status. Acta Orthop 2016; 87:245-51. [PMID: 26982799 PMCID: PMC4900082 DOI: 10.3109/17453674.2016.1161451] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Assessment of potential disparities in access to care is a vital part of achieving equity in health and healthcare. We have therefore studied the effect of socioeconomic status (SES) on the rates of knee and hip replacement due to osteoarthritis. Methods - This was a cohort study in Skåne, Sweden. We included all residents aged ≥ 35 years with consultations between 2004 and 2013 for hip or knee osteoarthritis. We retrieved individual information on income, education, and occupation and evaluated the rates of knee and hip replacement according to SES, with adjustment for age and sex. Professionals, legislators, senior officials, and managers, and individuals with the longest education, served as the reference group. Results - We followed 50,498 knee osteoarthritis patients (59% women) and 20,882 hip osteoarthritis patients (58% women). The mutually adjusted rate of knee replacement was lower in those with an elementary occupation (hazard ratio (HR) = 0.81, 95% CI: 0.72-0.92), in craft workers and those with related trades (HR = 0.88, CI: 0.79-0.98), and in skilled agricultural/fishery workers (HR = 0.83, CI: 0.72-0.96), but higher in the 2 least educated groups (HR = 1.2 in both). The rate of hip replacement was lower in those with an elementary occupation (HR = 0.77, 95% CI: 0.68-0.87), in plant and machine operators/assemblers (HR = 0.83, CI: 0.75-0.93), and service workers/shop assistants (HR = 0.88, CI: 0.80-0.96). The rate of hip replacement was higher in the highest income group (HR = 1.1, 95% CI: 1.0-1.2). Interpretation - There was a lower rate of joint replacement in osteoarthritis patients working in professions often associated with lower socioeconomic status, suggesting inequity in access to care. However, the results are not unanimous, as the rate of knee replacement was higher in the least educated groups.
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Affiliation(s)
- Malin Wetterholm
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University,,Correspondence:
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University,
| | | | - Jenny Hubertsson
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University,
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University,,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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Abstract
BACKGROUND Despite increasing demand for joint replacement surgery and other health services for hip and knee osteoarthritis (OA), barriers and enablers to individual access to care are not well understood. A comprehensive understanding of drivers at all levels is needed to inform efforts for improving access. OBJECTIVE The aim of this study was to explore perceived barriers and enablers to receiving conservative (nonsurgical) and surgical treatment for hip and knee OA. DESIGN This was a qualitative study using directed content analysis. METHODS Semistructured telephone interviews were conducted, with 33 participants randomly sampled from an Australian population-based survey of hip and knee OA. Each interview covered factors contributing to receiving treatment for OA and perceived barriers to accessing care. Interview transcripts were coded and organized into themes. RESULTS Key barriers to accessing care for OA included medical opinions about saving surgery for later and the appropriate age for joint replacement. Other common barriers included difficulty obtaining referrals or appointments, long waiting times, work-related issues, and limited availability of primary and specialist care in some areas. Several participants perceived a lack of effective treatment for OA. Private health insurance was the most frequently cited enabler and was perceived to support the costs of surgical and conservative treatments, including physical therapy, while facilitating faster access to surgery. Close proximity to services and assistance from medical professionals in arranging care also were considered enablers. CONCLUSIONS People with hip or knee OA experience substantial challenges in accessing treatment, and these challenges relate predominantly to health professionals, health systems, and financial factors. Private health insurance was the strongest perceived enabler to accessing care for OA.
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19
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Socio-economic status and the risk of developing hand, hip or knee osteoarthritis: a region-wide ecological study. Osteoarthritis Cartilage 2015; 23:1323-9. [PMID: 25819582 DOI: 10.1016/j.joca.2015.03.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/25/2015] [Accepted: 03/15/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis (OA) at a population level. DESIGN Retrospective ecological study using the System for the Development of Research in Primary Care (SIDIAP) database (primary care anonymized records for >5 million people in Catalonia (Spain)). Urban residents >15 years old (2009-2012) were eligible. OUTCOMES Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee OA (2009-2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes. RESULTS Compared to the least deprived, the most deprived areas were younger (43.29 (17.59) vs 46.83 (18.49), years (Mean SD), had fewer women (49.1% vs 54.8%), a higher percentage of obese (16.2% vs 8.4%), smokers (16.9% vs 11.9%) and high-risk alcohol consumption subjects (1.5% vs 1.3%). Compared to the least deprived, the most deprived areas had an excess risk of OA: age-sex-adjusted Incidence Rate Ratio (IRR) 1.26 (1.11-1.42) for hand, 1.23 (1.17-1.29) hip, and 1.51 (1.45-1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93-1.20), 1.04 (0.99-1.09), and 1.23 (1.19-1.28) respectively. CONCLUSIONS Deprived areas have higher rates OA (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee OA observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities.
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20
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Verstappen SMM, Cobb J, Foster HE, Fu B, Baildam E, Wedderburn LR, Davidson JE, Ioannou J, Chieng A, Hyrich KL, Thomson W. The association between low socioeconomic status with high physical limitations and low illness self-perception in patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study. Arthritis Care Res (Hoboken) 2015; 67:382-9. [PMID: 25187470 PMCID: PMC4737227 DOI: 10.1002/acr.22466] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 08/26/2014] [Indexed: 11/07/2022]
Abstract
Objective To examine the association between socioeconomic status (SES) and delay to a pediatric rheumatology clinic, disease severity, and illness perception in patients with juvenile idiopathic arthritis in England. Methods Using the Index of Multiple Deprivation, 923 consecutive children from the Childhood Arthritis Prospective Study were assigned to SES groups: high‐SES (19.1%), middle‐SES (44.5%), or low‐SES (36.4%). At baseline, disease activity was assessed, and the Childhood Health Assessment Questionnaire (C‐HAQ), the Illness Perception Questionnaire, and the Child Health Questionnaire, version Parent Form 50, were completed. Linear median regression analyses or zero‐inflated negative binominal (ZINB) regression analyses were used. Results Delay to first pediatric rheumatology consultation was the same between the 3 SES groups. Although disease activity scores assessed by the pediatric rheumatologist did not differ between the 3 SES groups, persons in the low‐SES group recorded higher C‐HAQ scores compared to the high‐SES group (zero‐inflated part of ZINB odds ratio 0.28 [95% confidence interval (95% CI) 0.14, 0.55], count part of ZINB β 0.26 [95% CI 0.05, 0.48]). Parents with low SES also reported more often that their children's school work or activities with friends had been limited. Furthermore, the low‐SES group had a worse perception about the consequences of the disease and the effect of treatment than those in the high‐SES group. Conclusion Patients from a low‐SES background report more problems with daily activities and have a lower perception of the consequences of the disease than patients from a high‐SES background, warranting special attention from a multidisciplinary team.
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Affiliation(s)
- Suzanne M M Verstappen
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Bohensky M, Ackerman I, de Steiger R, Gorelik A, Brand C. Lifetime Risk of Total Hip Replacement Surgery and Temporal Trends in Utilization: A Population-Based Analysis. Arthritis Care Res (Hoboken) 2014; 66:1213-9. [DOI: 10.1002/acr.22279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/31/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Megan Bohensky
- Melbourne EpiCentre, Royal Melbourne Hospital, and University of Melbourne; Melbourne, Victoria Australia
| | - Ilana Ackerman
- Melbourne EpiCentre, Royal Melbourne Hospital, and University of Melbourne; Melbourne, Victoria Australia
| | | | - Alexandra Gorelik
- Melbourne EpiCentre and Royal Melbourne Hospital; Melbourne, Victoria Australia
| | - Caroline Brand
- Melbourne EpiCentre, Royal Melbourne Hospital, University of Melbourne, and Monash University; Melbourne, Victoria Australia
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22
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Bohensky MA, Ackerman I, DeSteiger R, Gorelik A, Brand CA. Lifetime Risk of Total Knee Replacement and Temporal Trends in Incidence by Health Care Setting, Socioeconomic Status, and Geographic Location. Arthritis Care Res (Hoboken) 2014; 66:424-31. [DOI: 10.1002/acr.22122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 08/08/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Megan A. Bohensky
- Melbourne EpiCentre, Royal Melbourne Hospital, and The University of Melbourne; Parkville, Victoria Australia
| | - Ilana Ackerman
- Melbourne EpiCentre, Royal Melbourne Hospital, and The University of Melbourne; Parkville, Victoria Australia
| | | | - Alexandra Gorelik
- Melbourne EpiCentre, Royal Melbourne Hospital; Parkville, Victoria Australia
| | - Caroline A. Brand
- Melbourne EpiCentre, Royal Melbourne Hospital, and The University of Melbourne; Parkville, Victoria Australia
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