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Mannion AF, Mariaux F, Werth PM, Pearson AM, Lurie JD, Fekete TF, Kohler M, Haschtmann D, Kleinstueck FS, Jeszenszky D, Loibl M, Otten P, Norberg M, Porchet F. Evaluation of "appropriate use criteria" for surgical decision-making in lumbar degenerative spondylolisthesis. A controlled, multicentre, prospective observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1773-1785. [PMID: 38416192 DOI: 10.1007/s00586-024-08157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Selecting patients with lumbar degenerative spondylolisthesis (LDS) for surgery is difficult. Appropriate use criteria (AUC) have been developed to clarify the indications for LDS surgery but have not been evaluated in controlled studies. METHODS This prospective, controlled, multicentre study involved 908 patients (561 surgical and 347 non-surgical controls; 69.5 ± 9.7y; 69% female), treated as per normal clinical practice. Their appropriateness for surgery was afterwards determined using the AUC. They completed the Core Outcome Measures Index (COMI) at baseline and 12 months' follow-up. Multiple regression adjusting for confounders evaluated the influence of appropriateness designation and treatment received on the 12-month COMI and achievement of MCIC (≥ 2.2-point-reduction). RESULTS As per convention, appropriate (A) and uncertain (U) groups were combined for comparison with the inappropriate (I) group. For the adjusted 12-month COMI, the benefit of surgery relative to non-surgical care was not significantly greater for the A/U than the I group (p = 0.189). There was, however, a greater treatment effect of surgery for those with higher baseline COMI (p = 0.035). The groups' adjusted probabilities of achieving MCIC were: 83% (A/U, receiving surgery), 71% (I, receiving surgery), 50% (A/U, receiving non-surgical care), and 32% (I, receiving non-surgical care). CONCLUSIONS A/U patients receiving surgery had the highest chances of achieving MCIC, but the AUC were not able to identify which patients had a greater treatment effect of surgery relative to non-surgical care. The identification of other characteristics that predict a greater treatment effect of surgery, in addition to baseline COMI, is required to improve decision-making.
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Affiliation(s)
- Anne F Mannion
- Spine Centre Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Francine Mariaux
- Spine Centre Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Paul M Werth
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Jon D Lurie
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | | | | | | | - Markus Loibl
- Spine Centre, Schulthess Klinik, Zurich, Switzerland
| | | | - Michael Norberg
- Centre Médical de Lavey-les-Bains, Lavey-les-Bains, Switzerland
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Hermus JPS, Stam P, van Kuijk SMJ, Witlox MA, van Rhijn LW, Arts JJC, Poeze M. Does anxiety influence outcome measurements in ankle replacement patients? Foot Ankle Surg 2024; 30:231-238. [PMID: 37996295 DOI: 10.1016/j.fas.2023.11.005] [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: 12/05/2021] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is increasingly used to treat end-stage ankle arthritis to restore ankle functional outcomes and alleviate pain. This treatment outcome may be influenced by pre-morbid patient anxiety. METHODS Twenty-five Infinity TAA implants were prospectively followed post-operatively with a mean follow-up time of 34.18 months. Demographic, clinical, and functional outcomes were assessed. Analysis was performed on the effect of anxiety, reported by the HADS, on patient-perceived postoperative pain, functioning, and quality of life. RESULTS Postoperative the PROMs and Range of Motion (ROM) improved significantly. Linear regression analysis and Pearson correlation showed a significant negative effect of anxiety on the postoperative patient-reported outcome measurements (EQ-5D-5L, VAS, and MOxFQ) at the end of follow-up. CONCLUSION Good functional, clinical, and radiographic results were observed in this prospective cohort study. Anxiety had a negative influence on the outcome of the patient-reported outcome measurements (EQ-5D-5L and MOxFQ) postoperatively. LEVEL OF EVIDENCE Level III, prospective cohort study.
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Affiliation(s)
- J P S Hermus
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - P Stam
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - M A Witlox
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - L W van Rhijn
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - J J C Arts
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - M Poeze
- Department of Traumasurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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Zaina F, Mutter U, Donzelli S, Lusini M, Kleinstueck FS, Mannion AF. How well can the clinician appraise the patient's perception of the severity and impact of their back problem? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:39-46. [PMID: 37980278 DOI: 10.1007/s00586-023-08023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/07/2023] [Accepted: 10/24/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE A main concern of patients with back problems is pain and its impact on function and quality of life. These are subjective phenomena, and should be probed during the clinical consultation so that the physician can ascertain the extent of the problem. This study evaluated the agreement between clinicians' and patients' independent ratings of patient status on the Core Outcome Measures Index (COMI). METHODS This was an analysis of the data from 5 spine specialists and 108 patients, in two centres. Prior to the consultation, the patient completed the COMI. After the consultation, the clinician (blind to the patient's version) also completed a COMI. Concordance was assessed by % agreement, Kappa values, Bland-Altman plots, Spearman rank, Intraclass Correlation Coefficients and comparisons of mean values, as appropriate. RESULTS Agreement regarding the "main problem" (back pain, leg/buttock pain, sensory disturbances, other) was 83%, Kappa = 0.70 (95%CI 0.58-0.81). Moderate/strong correlations were found between the doctors' and patients' COMI-item ratings (0.48-0.74; p < 0.0001), although compared with the patients' ratings the doctors systematically underestimated absolute values for leg pain (p = 0.002) and dissatisfaction with symptom state (p = 0.002), and overestimated how much the patient's function was impaired (p = 0.029). CONCLUSION The doctors were able to ascertain the location of the main problem and the multidimensional outcome score with good accuracy, but some individual domains were systematically underestimated (pain, symptom-specific well-being) or overestimated (impairment of function). More detailed/direct questioning on these domains during the consultation might deliver a better appreciation of the impact of the back problem on the patient's daily life.
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Affiliation(s)
- F Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - U Mutter
- Spine Centre, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
| | - S Donzelli
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - M Lusini
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - F S Kleinstueck
- Spine Centre, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
| | - A F Mannion
- Spine Centre, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland.
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Pacheco-Brousseau L, Stacey D, Desmeules F, Ben Amor S, Lambert D, Tanguay E, Hillaby A, Bechiau C, Charette M, Poitras S. Instruments to assess appropriateness of hip and knee arthroplasty: a systematic review. Osteoarthritis Cartilage 2023:S1063-4584(23)00701-X. [PMID: 36898655 DOI: 10.1016/j.joca.2023.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To assess criteria and psychometric properties of instruments for assessing appropriateness of elective joint arthroplasty (JA) for adults with primary hip and knee osteoarthritis (OA). METHODS A systematic review guided by Cochrane methods and PRISMA guidelines. Studies were searched in five databases. Eligible articles include all study designs developing, testing, and/or using an instrument to assess JA appropriateness. Two independent reviewers screened and extracted data. Instruments were compared with Hawker et al. JA consensus criteria. Psychometric properties of instruments were described and appraised guided by Fitzpatrick's and COSMIN approaches. RESULTS Of 55 instruments included, none met all Hawker et al. JA consensus criteria. Criteria the most met were pain (n = 50), function (n = 49), quality of life (n = 33), and radiography (n = 24). Criteria the least met were clinical evidence of OA (n = 18), expectations (n = 15), readiness for surgery (n = 11), conservative treatments (n = 8), and patient/surgeon agree benefits outweigh risks (n = 0). Instrument by Arden et al. met the most criteria (6 of 9). The most tested psychometric properties were appropriateness (n = 55), face/content validity (n = 55), predictive validity (n = 29), construct validity and feasibility (n = 24). The least tested psychometric properties were intra-rater reliability (n = 3), internal consistency (n = 5), and inter-rater reliability (n = 13). Instruments by Gutacker et al. and Osborne et al. met the most psychometric properties (4 of 10). CONCLUSION Most instruments included traditional criteria for assessing JA appropriateness but did not include a trial of conservative treatments or shared decision-making elements. There was limited evidence on psychometric properties.
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Affiliation(s)
- L Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - D Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - F Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Canada.
| | - S Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Canada.
| | - D Lambert
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - E Tanguay
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - A Hillaby
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - C Bechiau
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.
| | - M Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - S Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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Atsma F, Molenkamp O, Bouma H, Bolder SB, Groenewoud AS, Westert GP. Uniform criteria for total hip replacement surgery in patients with hip osteoarthritis: a decision tool to guide treatment decisions. Int J Qual Health Care 2021; 33:6146517. [PMID: 33616656 PMCID: PMC7941208 DOI: 10.1093/intqhc/mzab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/15/2021] [Accepted: 02/22/2021] [Indexed: 01/03/2023] Open
Abstract
Background Uniform criteria for performing hip replacement surgery in hip osteoarthritis patients are currently lacking. As a result, variation in surgery and inappropriateness of care may occur. The aim of this study was to develop a consensus-based decision tool to support the decision-making process for hip replacement surgery. Methods Patients with a diagnosis of unilateral or bilateral osteoarthritis were included. Consensus rounds with orthopedic surgeons were organized to blindly reassess medical files and to decide whether surgery is indicated or not, based on all available pre-treatment information. We compared the outcomes obtained from the blind reassessment by the consensus group with the actual treatment. Furthermore, prediction models were fitted on the reassessment outcome to identify which set of clinical parameters would be most predictive and uniformly shared in the decision to operate. Two prediction models were fitted, one model without radiologic outcomes and one model where radiologic outcomes were included. Results In total, 364 medical files of osteoarthritis patients were included and reassessed in the analyses. Key predictors in the prediction model without radiology were age, flexion, internal rotation and the Hip disability and Osteoarthritis Outcome Score–quality of life. The discriminative power was high (Area Under Receiver Operating Curve (AUC) = 0.86). Key predictors in the prediction model with radiology were age, internal rotation and Kellgren and Lawrence severity score (AUC = 0.94). Conclusion The study yielded a decision tool with uniform criteria for hip replacement surgery in osteoarthritis patients. The tool will guide the clinical decision-making process of physicians on whether to perform hip surgery and should be used together with information about patient preferences and social context.
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Affiliation(s)
- Femke Atsma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Geert Grooteplein Noord 21, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | | | - Heinse Bouma
- Department of Orthopedic Surgery, Bergman Clinics, Rijksweg 69, 1411 GE, Naarden, null, The Netherlands
| | - Stefan B Bolder
- Department of Orthopedic Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - A Stef Groenewoud
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Geert Grooteplein Noord 21, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Gert P Westert
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Geert Grooteplein Noord 21, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies. Pain Res Manag 2020; 2020:3873098. [PMID: 32148599 PMCID: PMC7049418 DOI: 10.1155/2020/3873098] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.
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Arendt-Nielsen L, Simonsen O, Laursen M, Roos E, Rathleff M, Rasmussen S, Skou S. Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months. Eur J Pain 2018; 22:1088-1102. [DOI: 10.1002/ejp.1193] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- L. Arendt-Nielsen
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - O. Simonsen
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Orthopedic Surgery Research Unit; Aalborg University Hospital; Denmark
- Department of Clinical Medicine; Aalborg University; Denmark
| | - M.B. Laursen
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Orthopedic Surgery Research Unit; Aalborg University Hospital; Denmark
- Department of Clinical Medicine; Aalborg University; Denmark
| | - E.M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy; Department of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
| | - M.S. Rathleff
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
| | - S. Rasmussen
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Orthopedic Surgery Research Unit; Aalborg University Hospital; Denmark
- Department of Clinical Medicine; Aalborg University; Denmark
| | - S.T. Skou
- SMI, Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Denmark
- Orthopedic Surgery Research Unit; Aalborg University Hospital; Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy; Department of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
- Department of Physiotherapy and Occupational Therapy; Naestved-Slagelse-Ringsted Hospitals, Region Zealand; Slagelse Denmark
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What is the current evidence of the impact on quality of life whilst waiting for management/treatment of orthopaedic/musculoskeletal complaints? A systematic scoping review. Qual Life Res 2018; 27:2227-2242. [PMID: 29611148 DOI: 10.1007/s11136-018-1846-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To describe quality of life (QoL) outcome measures that are reported in the literature in patients waiting for outpatient orthopaedic/musculoskeletal specialist care and how waiting impacts on QoL in these terms. METHODS A subset of studies reporting on QoL outcome measures were extracted from literature identified in a recent scoping search of Medline, Embase, Pubmed, NHS Economic Evaluation Database (Prospero registration CRD42016047332). The systematic scoping search examined impacts on patients waiting for orthopaedic specialist care. Two independent reviewers ranked study design using the National Health and Medical Research Council aetiology evidence hierarchy, and appraised study quality using Critical Appraisal Skills Programme tools. QoL measures were mapped against waiting period timepoints. RESULTS The scoping search yielded 142 articles, of which 18 reported on impact on QoL. These studies reported only on patients waiting for hip and/or knee replacement surgery. The most recent study reported on data collected in 2006/7. The Western Ontario and McMaster Universities Arthritis Index and the SF-36 were the most commonly reported QoL measures. QoL was measured at variable timepoints in the waiting period (from a few weeks to greater than 12 months). The impact of waiting on QoL was inconsistent. CONCLUSION The evidence base was over 10 years old, reported only on patients with hip and knee problems, and on limited QoL outcome measures, and with inconsistent findings. A better understanding of the impact on QoL for patients waiting for specialist care could be gained by using standard timepoints in the waiting period, patients with other orthopaedic conditions, comprehensive QoL measures, as well as expectations, choices and perspectives of patients waiting for specialist care.
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Mueller AJ, Peffers MJ, Proctor CJ, Clegg PD. Systems approaches in osteoarthritis: Identifying routes to novel diagnostic and therapeutic strategies. J Orthop Res 2017; 35:1573-1588. [PMID: 28318047 PMCID: PMC5574007 DOI: 10.1002/jor.23563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/06/2017] [Indexed: 02/04/2023]
Abstract
Systems orientated research offers the possibility of identifying novel therapeutic targets and relevant diagnostic markers for complex diseases such as osteoarthritis. This review demonstrates that the osteoarthritis research community has been slow to incorporate systems orientated approaches into research studies, although a number of key studies reveal novel insights into the regulatory mechanisms that contribute both to joint tissue homeostasis and its dysfunction. The review introduces both top-down and bottom-up approaches employed in the study of osteoarthritis. A holistic and multiscale approach, where clinical measurements may predict dysregulation and progression of joint degeneration, should be a key objective in future research. The review concludes with suggestions for further research and emerging trends not least of which is the coupled development of diagnostic tests and therapeutics as part of a concerted effort by the osteoarthritis research community to meet clinical needs. © 2017 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 35:1573-1588, 2017.
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Affiliation(s)
- Alan J. Mueller
- Faculty of Health and Life SciencesDepartment of Musculoskeletal BiologyInstitute of Ageing and Chronic DiseaseUniversity of LiverpoolWilliam Henry Duncan Building, 6 West Derby StreetLiverpoolL7 8TXUnited Kingdom
| | - Mandy J. Peffers
- Faculty of Health and Life SciencesDepartment of Musculoskeletal BiologyInstitute of Ageing and Chronic DiseaseUniversity of LiverpoolWilliam Henry Duncan Building, 6 West Derby StreetLiverpoolL7 8TXUnited Kingdom,The MRC‐Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA)LiverpoolUnited Kingdom
| | - Carole J. Proctor
- The MRC‐Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA)LiverpoolUnited Kingdom,Institute of Cellular MedicineNewcastle UniversityFramlington PlaceNewcastle upon TyneNE2 4HHUnited Kingdom
| | - Peter D. Clegg
- Faculty of Health and Life SciencesDepartment of Musculoskeletal BiologyInstitute of Ageing and Chronic DiseaseUniversity of LiverpoolWilliam Henry Duncan Building, 6 West Derby StreetLiverpoolL7 8TXUnited Kingdom,The MRC‐Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA)LiverpoolUnited Kingdom
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Gademan MGJ, Hofstede SN, Vliet Vlieland TPM, Nelissen RGHH, Marang-van de Mheen PJ. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord 2016; 17:463. [PMID: 27829422 PMCID: PMC5103467 DOI: 10.1186/s12891-016-1325-z] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/03/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This systematic review gives an overview of guidelines and original publications as well as the evidence on which the currently proposed indication criteria are based. Until now such a state-of-the-science overview was lacking. METHODS Websites of orthopaedic and arthritis organizations (English/Dutch language) were independently searched by two authors for THA/TKA guidelines for OA. Furthermore, a systematic search strategy in several databases through August 2014 was performed. Quality of the guidelines was assessed with the AGREE II instrument, which consists of 6 domains (maximum summed score of 6 indicating high quality). Also, the level of evidence of all included studies was assessed. RESULTS We found 6 guidelines and 18 papers, out of 3065 references. The quality of the guidelines summed across 6 domains ranged from 0.46 to 4.78. In total, 12 THA, 10 TKA and 2 THA/TKA indication sets were found. Four studies stated that no evidence-based indication criteria are available. Indication criteria concerning THA/TKA consisted of the following domains: pain (in respectively 11 and 10 sets), function (12 and 7 sets), radiological changes (10 and 9 sets), failed conservative therapy (8 and 4 sets) and other indications (6 and 7 sets). Specific cut-off values or ranges were often not stated and the level of evidence was low. CONCLUSION The indication criteria for THA/TKA are based on limited evidence. Empirical research is needed, especially regarding domain specific cut-off values or ranges at which the best postoperative outcomes are achieved for patients, taking into account the limited lifespan of a prosthesis.
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MESH Headings
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Knee/instrumentation
- Arthroplasty, Replacement, Knee/standards
- Female
- Hip Prosthesis
- Humans
- Knee Prosthesis
- Male
- Middle Aged
- Osteoarthritis, Hip/diagnostic imaging
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/surgery
- Pain Management/methods
- Pain Measurement
- Patient Selection
- Practice Guidelines as Topic
- Radiography
- Reoperation
- Treatment Outcome
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Affiliation(s)
- Maaike G. J. Gademan
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
- Department of Orthopaedics, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Department of Clinical Epidemiology, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Stefanie N. Hofstede
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
| | - Thea P. M. Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
- Rijnlands Rehabilitation Center, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
| | - Perla J. Marang-van de Mheen
- Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
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Dowsey MM, Gunn J, Choong PFM. Selecting those to refer for joint replacement: who will likely benefit and who will not? Best Pract Res Clin Rheumatol 2014; 28:157-71. [PMID: 24792950 DOI: 10.1016/j.berh.2014.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Osteoarthritis (OA) is one of the 10 most disabling diseases in developed countries and worldwide estimates are that 10% of men and 18% of women aged over 60 years have symptomatic OA, including moderate and severe forms. Total joint replacement (TJR) is considered the most effective treatment for end-stage OA in those who have exhausted available conservative interventions. The demand for TJR is continually rising due to the ageing population; in the United States, more than 1 million TJRs were performed in 2010 and the number of procedures is projected to exceed 4 million in the US by 2030. It has been estimated that of all hip and knee replacements performed, approximately one quarter of the patients may be considered inappropriate candidates. Predicting who will benefit from TJR and who will not would seem critical in terms of containing the current and projected expenditure as well as improving satisfaction in TJR recipients. Few formal predictive tools are available to aid referring clinicians to determine those likely to be good or poor responders to surgery and current available tools tend to focus on disease severity alone with little consideration of risk factors that may predict a poor outcome or impede an effective response to surgery. This review examines the tools available to assist with assessing appropriateness for TJR; investigates the modifiable risk factors associated with poor outcome; and identifies areas for future research in selecting those appropriate for joint replacement.
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Affiliation(s)
- Michelle M Dowsey
- The University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, 29 Regent Street, Fitzroy, Victoria, 3065, Australia; St. Vincent's Hospital Melbourne, Department of Orthopaedics, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
| | - Jane Gunn
- The University of Melbourne, Department of General Practice, 200 Berkeley Street, Carlton, Victoria, 3053, Australia.
| | - Peter F M Choong
- The University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, 29 Regent Street, Fitzroy, Victoria, 3065, Australia; St. Vincent's Hospital Melbourne, Department of Orthopaedics, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
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Kuhn L, Page K, Ward J, Worrall-Carter L. The process and utility of classification and regression tree methodology in nursing research. J Adv Nurs 2013; 70:1276-86. [PMID: 24237048 PMCID: PMC4265242 DOI: 10.1111/jan.12288] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 12/01/2022]
Abstract
Aim This paper presents a discussion of classification and regression tree analysis and its utility in nursing research. Background Classification and regression tree analysis is an exploratory research method used to illustrate associations between variables not suited to traditional regression analysis. Complex interactions are demonstrated between covariates and variables of interest in inverted tree diagrams. Design Discussion paper. Data sources English language literature was sourced from eBooks, Medline Complete and CINAHL Plus databases, Google and Google Scholar, hard copy research texts and retrieved reference lists for terms including classification and regression tree* and derivatives and recursive partitioning from 1984–2013. Discussion Classification and regression tree analysis is an important method used to identify previously unknown patterns amongst data. Whilst there are several reasons to embrace this method as a means of exploratory quantitative research, issues regarding quality of data as well as the usefulness and validity of the findings should be considered. Implications for Nursing Research Classification and regression tree analysis is a valuable tool to guide nurses to reduce gaps in the application of evidence to practice. With the ever-expanding availability of data, it is important that nurses understand the utility and limitations of the research method. Conclusion Classification and regression tree analysis is an easily interpreted method for modelling interactions between health-related variables that would otherwise remain obscured. Knowledge is presented graphically, providing insightful understanding of complex and hierarchical relationships in an accessible and useful way to nursing and other health professions.
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Affiliation(s)
- Lisa Kuhn
- St Vincent's Centre for Nursing Research, Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine (Victoria), Australian Catholic University, Melbourne, Victoria, Australia
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Di Nubila MFDS, Matarazzo CG, Lopes-Albers AD, Gobbi FCM. Self-reported outcomes of patients undergoing total hip replacement surgery assessed by the WOMAC questionnaire. EINSTEIN-SAO PAULO 2011; 9:313-8. [DOI: 10.1590/s1679-45082011ao1982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/27/2011] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To assess pain, stiffness and physical function outcomes among patients undergoing total hip replacement using the Western Ontario and McMaster Universities Osteoarthritis Index. Methods: From January 2009 to July 2010, 64 male and female patients were assessed using the WOMAC questionnaire at baseline, hospital discharge, 3-month follow-up, and 6-month follow-up; one group of patients with primary hip osteoarthritis (n = 42) and another group with hip fracture (n = 22). Results: Changes in the total scores of the osteoarthritis group were statistically significant comparing baseline, hospital discharge, 3-month and 6-month assessments, demonstrating continued improvement over time up to 6-month follow-up. The total scores of the hip fracture group demonstrated a worsening from baseline to discharge, followed by improvement. The differences were statistically significant between baseline and discharge, as well as between discharge and the 6-month assessment. No statistically significant differences were found between baseline values and the 3-month assessment or baseline values and the 6-month assessment, demonstrating that the patients returned to their baseline health status after 3 months and maintained this status up to 6-month follow-up. Conclusion: The Western Ontario and McMaster Universities Osteoarthritis Index questionnaire detected changes in outcome following hip replacement surgery among patients with primary diagnoses of hip osteoarthritis and hip fracture, with differences in the pattern of changes between the two groups.
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Cobos R, Latorre A, Aizpuru F, Guenaga JI, Sarasqueta C, Escobar A, García L, Herrera-Espiñeira C. Variability of indication criteria in knee and hip replacement: an observational study. BMC Musculoskelet Disord 2010; 11:249. [PMID: 20977745 PMCID: PMC2987974 DOI: 10.1186/1471-2474-11-249] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 10/26/2010] [Indexed: 11/10/2022] Open
Abstract
Background Total knee (TKR) and hip (THR) replacement (arthroplasty) are effective surgical procedures that relieve pain, improve patients' quality of life and increase functional capacity. Studies on variations in medical practice usually place the indications for performing these procedures to be highly variable, because surgeons appear to follow different criteria when recommending surgery in patients with different severity levels. We therefore proposed a study to evaluate inter-hospital variability in arthroplasty indication. Methods The pre-surgical condition of 1603 patients included was compared by their personal characteristics, clinical situation and self-perceived health status. Patients were asked to complete two health-related quality of life questionnaires: the generic SF-12 (Short Form) and the specific WOMAC (Western Ontario and Mcmaster Universities) scale. The type of patient undergoing primary arthroplasty was similar in the 15 different hospitals evaluated. The variability in baseline WOMAC score between hospitals in THR and TKR indication was described by range, mean and standard deviation (SD), mean and standard deviation weighted by the number of procedures at each hospital, high/low ratio or extremal quotient (EQ5-95), variation coefficient (CV5-95) and weighted variation coefficient (WCV5-95) for 5-95 percentile range. The variability in subjective and objective signs was evaluated using median, range and WCV5-95. The appropriateness of the procedures performed was calculated using a specific threshold proposed by Quintana et al for assessing pain and functional capacity. Results The variability expressed as WCV5-95 was very low, between 0.05 and 0.11 for all three dimensions on WOMAC scale for both types of procedure in all participating hospitals. The variability in the physical and mental SF-12 components was very low for both types of procedure (0.08 and 0.07 for hip and 0.03 and 0.07 for knee surgery patients). However, a moderate-high variability was detected in subjective-objective signs. Among all the surgeries performed, approximately a quarter of them could be considered to be inappropriate. Conclusions A greater inter-hospital variability was observed for objective than for subjective signs for both procedures, suggesting that the differences in clinical criteria followed by surgeons when indicating arthroplasty are the main responsible factors for the variation in surgery rates.
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Affiliation(s)
- Raquel Cobos
- Health Research Unit of Alava, Basque Health Service, José Achótegui s/n, 01009, Vitoria-Gasteiz, Álava, Spain
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