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Amprachim SE, Vlamis J, Nikolaou VS, Pneumaticos SG. Role of Preoperative Information and Education of Patients Undergoing Total Hip Arthroplasty: A Narrative Review of the Literature. Cureus 2024; 16:e66094. [PMID: 39224727 PMCID: PMC11368389 DOI: 10.7759/cureus.66094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Total hip arthroplasty (THA) is a common and highly effective surgical procedure used to relieve pain and improve function in patients with severe hip arthritis and other hip disorders. While the surgical techniques and implants used in THA have advanced significantly, the importance of preoperative information and education cannot be overstated. The aim of this narrative review is to explore the effect of preoperative information and education on the outcome of THA. Key components of preoperative education and information include detailed information about the operation itself, the preoperative preparation, the postoperative pain management and rehabilitation, the possibility of postoperative complications, psychosocial support, and answers to frequently asked questions. The results of the study have confirmed the contradictory findings found in the literature concerning the impact of preoperative education on THA clinical outcomes, including pain, anxiety, functionality, postoperative rehabilitation, duration of hospitalization, and rate of complications. While, theoretically, preoperative education should have a positive effect on clinical outcomes, a plethora of studies have failed to support this hypothesis. Thus, there is a great need for properly designed, prospective, randomized, and controlled studies that have sufficient power in order to fully elucidate the role of preoperative education and information on THA outcomes.
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Affiliation(s)
- Sara Eleni Amprachim
- 3rd Department of Orthopaedics, National and Kapodistrian University of Athens, KAT Attica General Hospital, Athens, GRC
| | - John Vlamis
- 3rd Department of Orthopaedics, National and Kapodistrian University of Athens, KAT Attica General Hospital, Athens, GRC
| | - Vasileios S Nikolaou
- 2nd Department of Orthopaedics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Spyros G Pneumaticos
- 3rd Department of Orthopaedics, National and Kapodistrian University of Athens, KAT Attica General Hospital, Athens, GRC
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Brossier M, Schwartz-Dillard J, McInerney D, Smith JB, Nguyen J, Murray-Weir M, Edwards D. Preoperative Education Prior to Hip or Knee Arthroplasty Is Associated With Home Discharge but Not Reduced Length of Stay. HSS J 2024; 20:69-74. [PMID: 38356754 PMCID: PMC10863598 DOI: 10.1177/15563316231208423] [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: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 02/16/2024]
Abstract
Background Increasing numbers of patients are undergoing total joint arthroplasty as a treatment for osteoarthritis, which can be an anxiety-provoking experience. Setting expectations through a preoperative physical therapy (pre-op PT) session can alleviate some of these stressors, potentially decrease hospital length of stay (LOS), and promote home discharge. Purpose We sought to determine whether attending a pre-op PT session is associated with decreased hospital LOS and home discharge in total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients. Methods A retrospective cohort study was performed of 20,822 patients who underwent THA or TKA between January 2020 and December 2023. Pre-op PT attendance and covariates, including patient demographics and clinical data, were collected and analyzed for association with LOS and discharge disposition. Results Unadjusted univariate analysis revealed that THA and TKA patients who received pre-op PT had a significantly lower average LOS and were more likely to be discharged home. Our multivariate regression model showed that pre-op PT was not significantly associated with LOS in both groups but was significantly associated with home discharge among THA patients. Conclusions Our retrospective study of the effect of pre-op PT education on LOS and discharge disposition for elective THA and TKA patients found different results in univariate and multivariate analysis. Further study is needed to confirm the association found on multivariate analysis between pre-op PT and home discharge in THA patients.
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Zhou Y, Shadbolt C, Thuraisingam S, Schilling C, Choong P, Dowsey M. Differences in Outcomes Between Initial Responders and Subsequent Responders to Health Questionnaires for Total Hip and Knee Arthroplasty: An Australian Tertiary Institutional Registry Study. J Arthroplasty 2023; 38:2561-2567. [PMID: 37286051 DOI: 10.1016/j.arth.2023.05.079] [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: 02/01/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Patient-reported outcome measure (PROM) questionnaires in national arthroplasty registries often have low response rates leading to questions about data reliability. In Australia, the SMART (St. Vincent's Melbourne Arthroplasty Outcomes) registry captures all elective total hip (THA) and total knee (TKA) arthroplasty patients with an approximate 98% response rate for preoperative and 12-month PROM scores. This high response rate is due to dedicated registry staff following up patients who do not initially respond (subsequent responders). This study compared initial responders to subsequent responders to find differences in 12-month PROM outcomes for THA and TKA. METHODS All elective THA and TKA patients for osteoarthritis from 2012 to 2021 captured by the SMART registry were included. In total, 1,333 THA and 1,340 TKA patients were included. The PROM scores were assessed using the Veterans-RAND 12 (VR12) and Western Ontario and McMasters Universities Arthritis Index (WOMAC) questionnaires. The primary outcome was differences in mean 12-month PROM scores between initial and subsequent responders. RESULTS Baseline characteristics and PROM scores were similar between initial and subsequent responders. However, 12-month PROM scores varied significantly. The adjusted mean difference showed that for the WOMAC pain score, subsequent responders scored 3.4 points higher in the THA cohort and 7.4 points higher in the TKA cohort compared to initial responders. Significant differences were also found in other WOMAC and VR12 scores for both THA and TKA cohorts at the 12-month timepoint. CONCLUSION This study found that significant differences in PROM outcomes postsurgery occurred in THA and TKA patients based on response to PROM questionnaires, suggesting that loss to follow-up in PROM outcomes should not be treated as missing completely at random (MCAR).
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
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Langenberger B, Steinbeck V, Schöner L, Busse R, Pross C, Kuklinski D. Exploring treatment effect heterogeneity of a PROMs alert intervention in knee and hip arthroplasty patients: A causal forest application. Comput Biol Med 2023; 163:107118. [PMID: 37392619 DOI: 10.1016/j.compbiomed.2023.107118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 07/03/2023]
Abstract
Patient reported outcome measures (PROMs) experience an uptake in use for hip (HA) and knee arthroplasty (KA) patients. As they may be used for patient monitoring interventions, it remains unclear whether their use in HA/KA patients is effective, and which patient groups benefit the most. Nonetheless, knowledge about treatment effect heterogeneity is crucial for decision makers to target interventions towards specific subgroups that benefit to a greater extend. Therefore, we evaluate the treatment effect heterogeneity of a remote PROM monitoring intervention that includes ∼8000 HA/KA patients from a randomized controlled trial conducted in nine German hospitals. The study setting gave us the unique opportunity to apply a causal forest, a recently developed machine learning method, to explore treatment effect heterogeneity of the intervention. We found that among both HA and KA patients, the intervention was especially effective for patients that were female, >65 years of age, had a blood pressure disease, were not working, reported no backpain and were adherent. When transferring the study design into standard care, policy makers should make use of the knowledge obtained in this study and allocate the treatment towards subgroups for which the treatment is especially effective.
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Naylor JM, Harris IA, Joon S, Boland R, Brady B, Ogul S, Mittal R. Preliminary insights into patient preparedness for knee or hip arthroplasty: a descriptive survey study. BMC Res Notes 2023; 16:60. [PMID: 37095535 PMCID: PMC10123575 DOI: 10.1186/s13104-023-06329-8] [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: 01/31/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Knowledge-based preparedness for surgery is achieved through education. It is unclear which of brief or extended education programs prior to knee or hip arthroplasty provides better patient preparedness. Using the Patient Preparedness for Surgery survey, we investigated whether people awaiting arthroplasty attending a hospital that provided education over multiple visits via a pre-surgery management program ('Extended') report superior preparedness compared to those attending a hospital in the same health district that only provides education at the pre-admission clinic assessment ('Brief'). RESULTS A consecutive sample of 128 people (n = 101, 'Extended', n = 27 'Brief') completed the anonymized survey. COVID-19 related service disruptions undermined the sample size, reducing statistical power. The pre-specified superiority of the Extended program (a relative 20% more reporting 'agree'/'strongly agree') was not observed for 'Overall preparedness' [95% (Extended) vs. 89% (Brief), p = 0.36]. Between-group differences exceeding 20% relative superiority were observed for three preparedness sub-domains ['Alternatives explained' (52 vs. 33%, p = 0.09); 'Prepared for home' (85 vs. 57%, p < 0.01); 'Recall of complications' (42 vs 26%, p = 0.14)]. The preliminary findings suggest an extended education program potentially yields better patient-reported preparedness in some preparedness sub-domains, but not all.
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Affiliation(s)
- Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, 2 Campbell St, Liverpool, NSW, 2170, Australia.
- School of Clinical Medicine, South West Sydney Clinical School, Faculty of Medicine and Health, UNSW Medicine & Health, Liverpool Hospital, NSW Sydney, Australia.
- Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool, BC, NSW, 1871, Australia.
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, 2 Campbell St, Liverpool, NSW, 2170, Australia
- School of Clinical Medicine, South West Sydney Clinical School, Faculty of Medicine and Health, UNSW Medicine & Health, Liverpool Hospital, NSW Sydney, Australia
- Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool, BC, NSW, 1871, Australia
| | - Sidhant Joon
- School of Clinical Medicine, South West Sydney Clinical School, Faculty of Medicine and Health, UNSW Medicine & Health, Liverpool Hospital, NSW Sydney, Australia
| | - Robert Boland
- Fairfield Hospital, Cnr Polding St and Prairievale Rd, Prairiewood, NSW, 2176, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Bernadette Brady
- Pain Clinic, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW, 1871, Australia
| | - Shaniya Ogul
- Fairfield Hospital, Cnr Polding St and Prairievale Rd, Prairiewood, NSW, 2176, Australia
| | - Rajat Mittal
- School of Clinical Medicine, South West Sydney Clinical School, Faculty of Medicine and Health, UNSW Medicine & Health, Liverpool Hospital, NSW Sydney, Australia
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Appiah KOB, Khunti K, Kelly BM, Innes AQ, Liao Z, Dymond M, Middleton RG, Wainwright TW, Yates T, Zaccardi F. Patient-rated satisfaction and improvement following hip and knee replacements: Development of prediction models. J Eval Clin Pract 2023; 29:300-311. [PMID: 36172971 DOI: 10.1111/jep.13767] [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: 04/13/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 12/01/2022]
Abstract
RATIONALE Effective preoperative assessments of determinants of health status and function may improve postoperative outcomes. AIMS AND OBJECTIVES We developed risk scores of preoperative patient factors and patient-reported outcome measures (PROMs) as predictors of patient-rated satisfaction and improvement following hip and knee replacements. PATIENTS AND METHODS Prospectively collected National Health Service and independent sector patient data (n = 30,457), including patients' self-reported demographics, comorbidities, PROMs (Oxford Hip/Knee score (OHS/OKS) and European Quality of Life (EQ5D index and health-scale), were analysed. Outcomes were defined as patient-reported satisfaction and improvement following surgery at 7-month follow-up. Univariable and multivariable-adjusted logistic regressions were undertaken to build prediction models; model discrimination was evaluated with the concordance index (c-index) and nomograms were developed to allow the estimation of probabilities. RESULTS Of the 14,651 subjects with responses for satisfaction following hip replacements 564 (3.8%) reported dissatisfaction, and 1433 (9.2%) of the 15,560 following knee replacement reported dissatisfaction. A total of 14,662 had responses for perceived improvement following hip replacement (lack of improvement in 391; 2.7%) and 15,588 following knee replacement (lack of improvements in 1092; 7.0%). Patients reporting poor outcomes had worse preoperative PROMs. Several factors, including age, gender, patient comorbidities and EQ5D, were included in the final prediction models: C-indices of these models were 0.613 and 0.618 for dissatisfaction and lack of improvement, respectively, for hip replacement and 0.614 and 0.598, respectively, for knee replacement. CONCLUSIONS Using easily accessible preoperative patient factors, including PROMs, we developed models which may help predict dissatisfaction and lack of improvement following hip and knee replacements and facilitate risk stratification and decision-making processes.
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Affiliation(s)
- Karen O B Appiah
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Leicester Real World Evidence Unit, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Leicester Real World Evidence Unit, Leicester General Hospital, University of Leicester, Leicester, UK.,NIHR Applied Research Collaboration-East Midlands (ARC-EM), University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | | | | | | | | | - Robert G Middleton
- Nuffield Health, Epsom Gateway, Epsom, UK.,Orthopaedic Research Institute, Bournemouth University, Poole, UK
| | - Thomas W Wainwright
- Nuffield Health, Epsom Gateway, Epsom, UK.,Orthopaedic Research Institute, Bournemouth University, Poole, UK
| | - Thomas Yates
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.,Leicester Real World Evidence Unit, Leicester General Hospital, University of Leicester, Leicester, UK
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Bumberger A, Borst K, Willegger M, Hobusch GM, Windhager R, Waldstein W, Domayer S. Specific knowledge and resilience affect short-term outcome in patients following primary total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:1229-1237. [PMID: 34081194 PMCID: PMC9110532 DOI: 10.1007/s00402-021-03967-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim of the present study was to investigate the potential associations between specific knowledge, resilience and patient-reported outcome measures (PROMS) following primary total hip arthroplasty (THA). METHODS In a cross-sectional prospective study, consecutive patients following primary THA were included at a rehabilitation center. A novel knowledge score and the validated Connor Davidson Resilience Scale (CD-RISC) were utilized to assess patients' specific knowledge and resilience, respectively. Additionally, patients completed a qualitative questionnaire regarding the information they had received. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as the University of California and Los Angeles Score (UCLA) served as primary outcome measures. Stepwise multiple regression analysis was performed to identify potential predictors of outcome. RESULTS A total of 103 patients at a mean age of 67.5 years (SD 10.5, 38-88) were included in the analysis at a median of 55.5 days (IQR 43-81) following primary THA. The mean knowledge and resilience scores were 3.8 (SD 1.6, 0-7) and 69.5 (SD 18.5, 0-100), respectively. Forty-seven percent of patients were afraid of harming their prosthesis and these patients had up to 59% worse WOMAC scores (p < 0.001). WOMAC scores on admission to rehabilitation were predicted by resilience and knowledge scores (R2 = 0.106, p = 0.036). UCLA scores at the time of admission were predicted by knowledge scores (R2 = 0.078, p = 0.007). CONCLUSION The present study demonstrated that patients with a feeling of uncertainty had an inferior short-term functional outcome following primary THA. Moreover, it could be shown that higher specific knowledge and resilience are associated with a better functional outcome according to validated PROMS. While these findings need to be prospectively validated in future studies, specific patient knowledge and resilience may have a direct impact on the outcome of primary THA.
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Affiliation(s)
- Alexander Bumberger
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Katharina Borst
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Madeleine Willegger
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Stephan Domayer
- Sonderkrankenanstalt Zicksee, Otto Pohanka Platz, 7161, Sankt Andrä am Zicksee, Austria
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Kinoshita K, Kimura K, Miyamoto S, Takata Y, Kodama Y, Ieiri A, Ishida K, Inoue M, Abe S, Mikami T, Kanno T. Relationship between Perceived Leg Length Discrepancy at One Month and Preoperative Hip Abductor Muscle Elasticity in Patients after Total Hip Arthroplasty. Phys Ther Res 2022; 24:232-239. [PMID: 35036257 DOI: 10.1298/ptr.e10102] [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: 02/16/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Preoperative factors related to perceived leg length discrepancy (PLLD) after total hip arthroplasty (THA) are not well studied. This study aimed to examine the preoperative factors, including hip abductor modulus, related to PLLD one month after THA. METHODS The study included 73 patients diagnosed with osteoarthritis secondary to developmental dysplasia of the hip and a posterior approach to surgery. Multiple logistic regression analysis was performed using the presence or absence of PLLD as the dependent variable and preoperative hip abductor's modulus of elasticity, pain, hip abduction range of motion, hip abductor muscle strength and pelvic obliquity as the independent variable. Additionally, receiver operating characteristic curves were used for the extracted variables for calculating the cutoffs, sensitivity, specificity and area under the curve (AUC) to determine the presence or absence of PLLD. The significance level was set at p<0.05. RESULTS The hip abductor modulus (odds ratio=1.13; 95% confidence interval=1.06-1.21; p<0.001) was selected as a preoperative factor. The cutoff value to determine the presence or absence of a PLLD was 16.32 kPa. The sensitivity and specificity were 81.8% and 72.5%, respectively, and the AUC was 0.8137. CONCLUSION The hip abductor muscle elastic modulus affected PLLD one month after THA. If the preoperative hip abductor elastic modulus is higher than the cutoff value, it may affect the appearance of PLLD at one month postoperatively.
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Affiliation(s)
| | - Kazushi Kimura
- Graduate School of Rehabilitation Science, Hokkaido Bunkyo University, Japan
| | - Shigenori Miyamoto
- Graduate School of Rehabilitation Science, Hokkaido Bunkyo University, Japan
| | - Yuichi Takata
- Graduate School of Rehabilitation Science, Hokkaido Bunkyo University, Japan
| | - Yuji Kodama
- Department of Rehabilitation, Wajokai Eniwa Hospital, Japan
| | - Akira Ieiri
- Department of Rehabilitation, Wajokai Eniwa Hospital, Japan
| | | | - Masahiro Inoue
- Department of Orthopedic Surgery, Wajokai Eniwa Hospital, Japan
| | - Satomi Abe
- Department of Orthopedic Surgery, Wajokai Eniwa Hospital, Japan
| | - Takashi Mikami
- Department of Orthopedic Surgery, Wajokai Eniwa Hospital, Japan
| | - Taiki Kanno
- Department of Orthopedic Surgery, Wajokai Eniwa Hospital, Japan
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Schatz C, Klein N, Marx A, Buschner P. Preoperative predictors of health-related quality of life changes (EQ-5D and EQ VAS) after total hip and knee replacement: a systematic review. BMC Musculoskelet Disord 2022; 23:58. [PMID: 35039045 PMCID: PMC8764845 DOI: 10.1186/s12891-021-04981-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcomes are of ever-increasing importance in medical decision-making. The EQ-5D is one of the generic instruments measuring health-related quality of life (HRQoL) in arthroplasty. This review aimed to identify possible predictors of HRQoL changes for patients undergoing total knee replacements (TKR) or total hip replacements (THR). METHODS A systematic literature review according to the PRISMA guidelines was conducted, searching several databases. Preoperative to postoperative HRQoL changes were evaluated in patients undergoing THR or TKR, using the EQ-5D visual analog scale (VAS) or the preference-based EQ-5D Index were evaluated. Articles were considered with prospectively or retrospectively collected data, as well as registry data, each with statistical analyses of patient-related factors. RESULTS Eight hundred eighty-two articles were found, of which 21 studies met the inclusion criteria. Predictors were distinguished in alterable and non-alterable ones. The EQ-5D Index indicated a tendency towards beneficial improvements for patients with a high body mass index (BMI) (> 40) and no significant results for the VAS. Additionally, one study found that patient education and preoperative physiotherapy appeared to enhance HRQoL. Some evidence indicated that male gender was negatively associated with changes in the VAS and the EQ-5D Index, but one study reported the opposite. Changes in VAS and EQ-5D Index were lower for older patients, whereas a higher educational level seemed to be advantageous. A high Charnley class led to deteriorating changes in VAS, although a high Kellgren Lawrence classification was positively associated with the EQ-5D Index, in a limited number of studies. For all results, clinical relevance was calculated differently and mainly reported as uncertain or small. CONCLUSIONS The literature on this topic was weak and offers only limited guidance. Results for alterable predictors, such as the BMI, indicated valuable improvements for highly obese patients. Further, high-quality research is required to support medical decision-making. LEVEL OF EVIDENCE Level IV, according to the OCEBM Levels of Evidence Working Group.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany.
| | - Nina Klein
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Antonia Marx
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Marques CJ, Bohlen K, Lampe F. Participation in a Preoperative Patient Education Session Is a Significant Predictor of Better WOMAC Total Index Score and Higher EQ-5D-5L Health Status Index 1 Year After Total Knee and Hip Arthroplasties: A Retrospective Observational Study. Am J Phys Med Rehabil 2021; 100:972-977. [PMID: 33443861 DOI: 10.1097/phm.0000000000001689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate whether patient-specific factors, preoperative patient-reported outcome measures, and participation in a preoperative patient education session significantly predict 1-yr Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) health status index of patients who underwent total hip or knee arthroplasties within an enhanced rehabilitation program. DESIGN This is a retrospective observational cohort study. The inclusion criteria were met by 676 (373 total hip arthroplasties and 303 total knee arthroplasties) patients. Two multiple regression models were carried out to estimate the contributions of nine potential predictors. RESULTS Younger age (P = 0.006), higher preoperative EQ-5D-5L index (P = 0.004), lower patient clinical complexity level (P = 0.001), lower preoperative WOMAC total score (P < 0.001), preoperative patient education session (P = 0.004), and submitting for total hip arthroplasty (P < 0.001) were significant predictors of better 1-yr WOMAC total score. Higher preoperative EQ-5D-5L index (P < 0.001), lower patient clinical complexity level classification (P < 0.001), lower preoperative WOMAC total score (P = 0.009), preoperative patient education session (P = 0.04), and submitting for total hip arthroplasty (P = 0.01) were significant predictors of higher 1-yr EQ-5D-5L health status index. CONCLUSIONS Better baseline patient-reported outcome measure scores, less comorbidities, younger age, submitting for total hip arthroplasty, and attending a preoperative patient education session were significant predictors of better WOMAC total scores and higher EQ-5D-5L health status index 1 yr after total hip or total knee arthroplasties.
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Affiliation(s)
- Carlos J Marques
- From the Science Office of the Orthopaedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Hamburg, Germany (CJM); Orthopaedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Academic Hospital of the University of Hamburg, Hamburg, Germany (KB, FL); and Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany (FL)
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11
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Saunders R, Seaman K, Emery L, Crompton D, Lynch C, Penjor D, Sagar S. My hip journey: A qualitative study of patients' experiences of an eHealth program for patient preparation and recovery from hip replacement surgery. J Clin Nurs 2021; 31:1580-1587. [PMID: 34427362 DOI: 10.1111/jocn.16011] [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: 04/26/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
AIM AND OBJECTIVE To explore patient experiences, perceived benefits and suggestions of an eHealth program for pre- and post-operative education for total hip arthroplasty. BACKGROUND eHealth programs for surgical patients can facilitate the delivery of information, provide individualised rehabilitation plans and enable communication with health professionals to promote overall patient recovery. DESIGN A qualitative descriptive study was conducted following the COREQ guidelines. A convenience sample of nine patients who had total hip arthroplasty and used the My Hip Journey eHealth program were recruited and participated in individual semi-structured telephone interviews. Interviews were audio recorded, transcribed verbatim and analysed using inductive thematic analysis. RESULTS The participant group were aged between 53 and 70 years. The results are described in three overarching themes and sub-themes: (1) Supported surgical journey-how the My Hip Journey eHealth program supported them in their preparation and recovery from their surgery, and how the program provided information and encouraged engagement; (2) Motivated recovery-how patients found the program motivational, facilitated their self-management and enabled communication with the healthcare team if they had any concern; and (3) Functionality-how the program related to ease of use, its interactivity with the patient and suggestions for future use. CONCLUSIONS The patients reported that using the eHealth program for pre- and post-operative education was helpful to their overall surgical experience and recovery. It was found to engage patients in their care, enabled self-management, encouraged communication with health professionals and motivated them with their recovery. These findings identify the potential for eHealth programs to support patients in the preparation and post-operative stages, and in their post-discharge self-care for other surgical and orthopaedic journeys. RELEVANCE TO CLINICAL PRACTICE Patient experiences of eHealth education can inform nurses of the benefits of eHealth and the development of future eHealth education programs.
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karla Seaman
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Laura Emery
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Debra Crompton
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Chantelle Lynch
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dorji Penjor
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sonali Sagar
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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12
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Tsinaslanidis G, Tsinaslanidis P, Mahajan RH. Perioperative Pain Management in Patients Undergoing Total Hip Arthroplasty: Where Do We Currently Stand? Cureus 2020; 12:e9049. [PMID: 32782868 PMCID: PMC7410504 DOI: 10.7759/cureus.9049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022] Open
Abstract
Total Hip replacement (THR) is a well-discussed topic, and it offers excellent results in patients suffering from end-stage osteoarthritis (OA). However, despite the fact that patients can fully bear weight immediately after the surgery, THR is often associated with a great amount of postoperative pain affecting recovery and rehabilitation. Therefore, the efficient management of pain is of paramount importance. The aim of this review is to examine all the currently available strategies of pain management such as preemptive analgesia (PA), patient-controlled analgesia (PCA), and the various types of anesthesia that are used during the operation. With that objective in mind, we conducted our research by searching through the PubMed database for articles published in 2015 and after. For purely clinical reasons, we have attempted to classify all the best available evidence into three major categories: prior to surgery, during the surgery, and after the surgery. Multimodal analgesia seems to play a major role in the perioperative care of patients undergoing total hip arthroplasty (THA). Therefore, a considerable number of studies have been conducted analyzing all the current strategies that aim to minimize perioperative pain and consequent complications.
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Affiliation(s)
- Georgios Tsinaslanidis
- Trauma and Orthopaedics, George Eliot Hospital National Health Service Trust, Nuneaton, GBR
| | - Prodromos Tsinaslanidis
- Trauma and Orthopaedics, St. George's University Hospitals National Health Service Foundation Trust, London, GBR
| | - Ravindra H Mahajan
- Trauma and Orthopaedics, George Eliot Hospital National Health Service Trust, Nuneaton, GBR
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