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Fawley D, Bernard T, Thomason HC, Zagra L, Ten Broeke RHM, Johnson K. Early functional recovery outcomes and return to work after primary total hip arthroplasty: a novel patient reported outcomes questionnaire. J Orthop Surg Res 2024; 19:434. [PMID: 39061099 DOI: 10.1186/s13018-024-04937-z] [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: 03/12/2024] [Accepted: 07/21/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE Clinical and patient reported outcomes are often collected before and after the procedure to benchmark and study outcomes for patients. These outcomes and scores are useful for tracking patient outcomes after surgery, however, the fact that these commonly used measures typically provide information about a patient's level of pain and function at a single point in time is a limitation. METHODS We present early functional recovery and return to work outcomes after primary THA from a novel questionnaire administered in a global, multi-center, prospective clinical study. RESULTS By 6 and 12 weeks post-op, a large proportion of study subjects were able to perform functional recovery outcomes after their THA: walk without an aid (74%; 94%); drive (76%; 97%); basic activities of daily living (94%; 99%); perform light household duties (91%; 96%); perform moderate-to-heavy household duties (54%; 86%); go up and down a flight of stairs (92%; 99%); put on socks/stockings (77%; 93%); bend down to pick up an object from the floor (87%; 97%); stand up from a chair (96%; 99%); perform leisure recreational activities (54%; 84%); perform primary goal identified pre-THA (69%; 86%). 60% were able to return to work by 12 weeks post-op. These questions showed strong association with the Forgotten Joint Score. CONCLUSION Excellent patient reported early functional recovery outcomes and satisfaction were observed at 6- and 12-weeks post-op in this cohort and is the first reported data using a novel PRO. CLINICAL TRIAL REGISTRATION NCT03189303, registered June 14, 2017.
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Affiliation(s)
- David Fawley
- DePuy Synthes, 700 Orthopaedic Drive, Warsaw, IN, USA.
| | | | | | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - René H M Ten Broeke
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands
| | - Kory Johnson
- Orthopaedic Associates of Michigan, 555 Mid Towne St Suite 105, Grand Rapids, MI, USA
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2
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Kangas P, Soini S, Pamilo K, Kervinen V, Kinnunen ML. Return to Work Following Hip or Knee Arthroplasty: A One-Year Prospective Cohort Study in Participants with Direct Referral from Hospital to Occupational Health Care Services. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10218-7. [PMID: 38896401 DOI: 10.1007/s10926-024-10218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE In a new Finnish Coordinated Return to Work (CRTW) model, patients are referred to occupational health care after hip or knee arthroplasty. This study evaluated the CRTW model's effect on return to work (RTW), activities used in occupational health care and in the workplace, and the patient- and work-related factors affecting early RTW. METHODS 209 participants with occupational health care service underwent primary hip (THA) or total/unicondylar knee (KJA) arthroplasty and completed self-reported questionnaires after arthroplasty and at time of RTW. Factors affecting RTW, and the roles of occupational health care and the workplace in RTW were evaluated. Time to RTW was determined as days between the arthroplasty and RTW. RESULTS Mean time to RTW was 69 days after THA and 87 days after KJA. For easing RTW, work arrangements were made for 56% of the participants. The most utilized adjustments of work were enabling remote work and arranging limitations in work tasks. Participants with earlier RTW had lower physical workload, higher professional status and motivation to work, less pre-arthroplasty sick leave, and more positive personal expectations about the time to RTW compared to participants with later RTW (p < 0.001 for all). The linear regression and dominance analyses showed participants' own expectations and pre-arthroplasty sick leave as the strongest factors affecting time to RTW. CONCLUSIONS The CRTW model seems to shorten time to RTW after THA and KJA. Occupational health care and workplace play important roles in supporting RTW. Patients' own expectations should be noted when giving pre-arthroplasty information.
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Affiliation(s)
- Pauliina Kangas
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Finland.
| | - Satu Soini
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Visa Kervinen
- Terveystalo Ltd, Occupational Health Services, Jyväskylä, Finland
- The Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Marja-Liisa Kinnunen
- The Wellbeing Services County of Central Finland, Jyväskylä, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
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3
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Drużbicki M, Kitrys Ł, Jabłoński J, Filip D, Perenc L, Guzik A. Return to Work after Primary Total Knee Arthroplasty: The First Polish Pilot Retrospective Study. J Clin Med 2024; 13:1902. [PMID: 38610666 PMCID: PMC11012819 DOI: 10.3390/jcm13071902] [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: 01/27/2024] [Revised: 03/02/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Total knee arthroplasty (TKA) performed on working-age patients significantly affects the participation of such patients in social life. A retrospective study was conducted to determine the return to work (RTW) rate after TKA. The goal of this study was to provide reference data for the Polish population and identify the factors impacting patients' decisions to return to or resign from work, relative to their functional performance. (2) Methods: This retrospective study involved 48 patients. An interview related to RTW was carried out to identify the factors impacting a patient's decision to return to or resign from work. Functional performance was assessed using the Knee Outcome Survey-Activities of Daily Living (KOS-ADL) scale. (3) Results: Before TKA, 15 individuals (31.25%) qualified for the study did not work and were receiving welfare benefits. After the surgery, 23 individuals (47.9% of those working prior to TKA) did not return to work. The number of those who did not work after TKA increased to 38 (79.17%), which was a significant change. The mean level of functional performance after TKA assessed using KOS-ADL was 75.89. (4) Conclusions: The findings show that the rate of RTW after TKA in Poland is significantly lower than that in other countries. The reasons for this situation, as shown in the study, may be related to the lack of an occupational rehabilitation system, resulting in a paucity of information about the possibility to return to work and about opportunities for retraining.
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Affiliation(s)
| | | | | | | | | | - Agnieszka Guzik
- Medical College, University of Rzeszów, 35-959 Rzeszów, Poland; (M.D.); (Ł.K.); (J.J.); (L.P.)
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4
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Kamp T, Stevens M, Vlieland TPMV, Nelissen RGHH, Brouwer S, Gademan MGJ. Three out of four working-age patients have fulfilled expectations towards paid employment six months after total hip or knee arthroplasty: a multicentre cohort study. Rheumatol Int 2024; 44:339-347. [PMID: 37642700 PMCID: PMC10796735 DOI: 10.1007/s00296-023-05437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
To investigate factors associated with fulfilment of expectations towards paid employment after total hip/knee arthroplasty (THA/TKA). Cohort study including preoperatively employed patients aged 18-64 scheduled for THA/TKA. Expectations were collected preoperatively, and 6 and 12 months postoperatively with the paid employment item of the Hospital-for-Special-Surgery Expectations Surveys (back-to-normal = 1; large improvement = 2; moderate improvement = 3; slight improvement = 4; not applicable = 5). Patients scoring not applicable were excluded. Fulfilment was calculated by subtracting preoperative from postoperative scores (< 0: unfulfilled; ≥ 0: fulfilled). Multivariable logistic regression analyses were conducted separately for THA/TKA at 6 and 12 months postoperatively. Six months postoperatively, 75% of THA patients (n = 237/n = 316) and 72% of TKA patients (n = 211/n = 294) had fulfilled expectations. Older age (TKA:OR 1.08, 95% CI 1.01-1.15) and better postoperative physical functioning (THA:OR 1.10, 95% CI 1.06-1.14; TKA:OR 1.03, 95% CI 1.01-1.06) increased the likelihood of fulfilment. Physical work tasks (THA:OR 0.12, 95% CI 0.03-0.44), preoperative sick leave (TKA:OR 0.33, 95% CI 0.17-0.65), and difficulties at work (THA:OR 0.10, 95% CI 0.03-0.35; TKA:OR 0.41, 95% CI 0.17-0.98) decreased the likelihood of fulfilment. Twelve months postoperatively similar risk factors were found. Three out of four working-age THA/TKA patients had fulfilled expectations towards paid employment at 6 months postoperatively. Preoperative factors associated with fulfilment were older age, mental work tasks, no sick leave, postoperative factors were better physical functioning, and no perceived difficulties at work.
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Affiliation(s)
- Tamara Kamp
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martin Stevens
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | | | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Prüfer F, Pavlović M, Matko Š, Löfler S, Fischer MJ, Šarabon N, Grote V. Responsiveness of Isokinetic Dynamometry in Patients with Osteoarthritis after Knee and Hip Arthroplasty: A Prospective Repeated-Measures Cohort Study. Healthcare (Basel) 2024; 12:314. [PMID: 38338199 PMCID: PMC10855832 DOI: 10.3390/healthcare12030314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Functional assessments are crucial for the evaluation of rehabilitation after total knee (TKA) and hip (THA) arthroplasty. Muscle strength, a key determinant of physical function (PF), is often measured with isokinetic dynamometry (ID), which is considered the gold standard. However, studies lack evaluations of responsiveness-the ability to detect changes over time. This study aims to determine the responsiveness of ID in measuring PF in TKA and THA rehabilitation-is muscle strength a valid indicator for assessing improvement in rehabilitation processes? The pre- and post-surgery PF of 20 osteoarthritis patients (age 55-82) was assessed, using ID, performance-based and self-reported measures. Responsiveness was evaluated by comparing the observed relationship of changes in ID and PF scores with the a priori defined expected relationship of change scores. While the performance-based and self-reported measures showed significant improvements post-surgery (Cohen's d [0.42, 1.05] p < 0.05), ID showed no significant differences. Moderate correlations were found between changes in some ID parameters and selected functional tests (r ≈|0.5|, p < 0.05). Responsiveness was solely found for the peak torque of knee extension at 180°/s on the operated side. Responsiveness is an often-overlooked psychometric property of outcome measurements. The findings suggest that ID may not be fully responsive to the construct of PF after TKA and THA, raising questions about its role and usefulness in this context and the need for more appropriate assessment methods.
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Affiliation(s)
- Ferdinand Prüfer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Monika Pavlović
- Faculty of Health Sciences, University of Ljubljana, SI-1000 Ljubljana, Slovenia;
| | - Špela Matko
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Vamed Rehabilitation Center Kitzbühel, A-6370 Kitzbühel, Austria
| | - Nejc Šarabon
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Faculty of Health Sciences, University of Primorska, SI-6310 Izola, Slovenia
- Innorenew CoE, SI-6310 Izola, Slovenia
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
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6
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Anzillotti G, Guazzoni E, Conte P, Di Matteo V, Kon E, Grappiolo G, Loppini M. Using Three-Dimensional Printing Technology to Solve Complex Primary Total Hip Arthroplasty Cases: Do We Really Need Custom-Made Guides and Templates? A Critical Systematic Review on the Available Evidence. J Clin Med 2024; 13:474. [PMID: 38256607 PMCID: PMC10816635 DOI: 10.3390/jcm13020474] [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: 12/14/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
The burden of osteoarthritis (OA) is around 300 million people affected worldwide, with the hip representing a commonly affected joint. Total hip arthroplasty (THA) has been used with notable success as a definitive treatment to improve pain and function in hip OA patients. The recent advent of new technologies, such as 3D printing, has pushed the application of these new concepts toward applications for the well-known THA. Currently, the evidence on the use of 3D printing to aid complex primary THA cases is still scarce. METHODS An extensive literature review was conducted to retrieve all articles centered on the use of 3D printing in the setting of primary THA. RESULTS A total of seven studies were included in the present systematic review. Four studies investigated the use of 3D-printed surgical guides to be used during surgery. The remaining three studies investigated the benefit of the use of 3D-printed templates of the pelvis to simulate the surgery. CONCLUSIONS The use of 3D printing could be a promising aid to solve difficult primary total hip arthroplasty cases. However, the general enthusiasm in the field is not supported by high-quality studies, hence preventing us from currently recommending its application in everyday practice.
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Affiliation(s)
- Giuseppe Anzillotti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Edoardo Guazzoni
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
| | - Pietro Conte
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Vincenzo Di Matteo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow 119991, Russia
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.A.); (E.G.); (P.C.); (V.D.M.); (E.K.); (G.G.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università Degli Studi di Genova, 17100 Savona, Italy
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7
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Cheng R, Krell EC, Chiu YF, Stimac JD, Heyse TJ, Abdel MP, Figgie MP, Blevins JL. Survivorship and Clinical Outcomes of Primary Total Knee Arthroplasty Performed in Patients 35 Years of Age and Younger. J Arthroplasty 2023; 38:2316-2323.e1. [PMID: 37286054 DOI: 10.1016/j.arth.2023.05.068] [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: 12/13/2022] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Total knee arthroplasties (TKAs) for patients aged ≤35 years are rare but necessary for patients who have diseases such as juvenile idiopathic arthritis, osteonecrosis, osteoarthritis, and rheumatoid arthritis. Few studies have examined the 10-year and 20-year survivorship and clinical outcomes of TKAs for young patients. METHODS A retrospective registry review identified 185 TKAs in 119 patients aged ≤ 35 years performed between 1985 and 2010 at a single institution. The primary outcome was implant survivorship free of revision. Patient-reported outcomes were assessed at 2 time points: 2011 to 2012 and 2018 to 2019. The average age was 26 years (range, 12 to 35). Mean follow-up was 17 years (range, 8 to 33). RESULTS Survivorship decreased from 84% (95% confidence interval [CI]: 79 to 90) at 5 years to 70% (95% CI: 64 to 77) at 10 years and to 37% (95% CI: 29 to 45) at 20 years. The most common reasons for revision were aseptic loosening (6%) and infection (4%). Risk factors for revision included increasing age at time of surgery (Hazards Ratio [HR] 1.3, P = .01) and use of constrained (HR 1.7, P = .05) or hinged prostheses (HR 4.3, P = .02). There were 86% of patients reporting that their surgery resulted in "a great improvement" or better. CONCLUSION Survivorship of TKAs in young patients is less favorable than expected. However, for the patients who responded to our surveys, TKA demonstrated substantial pain relief and improvement in function at 17-year follow-up. Revision risk increased with older age and higher levels of constraint.
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Affiliation(s)
- Ryan Cheng
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Ethan C Krell
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jeffrey D Stimac
- Department of Orthopedic Surgery, Norton Healthcare, Louisville, Kentucky
| | - Thomas J Heyse
- Medical Faculty, Philipps-University of Marburg, Marburg, Germany; Red Cross Hospital, Frankfurt, Germany
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark P Figgie
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jason L Blevins
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Peters MC, Pronk Y, Brinkman JM. Return to Daily Activities, Work, and Sports at 3 Months After Total Hip Arthroplasty. JB JS Open Access 2023; 8:e23.00048. [PMID: 38058508 PMCID: PMC10697593 DOI: 10.2106/jbjs.oa.23.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Background It is largely unknown if and when patients return to daily activities after undergoing total hip arthroplasty (THA) and which factors might influence this return. This study aimed to assess the percentages of patients who had been able to return to daily activities, work, and sports at 3 months after THA. Furthermore, the time to return and factors influencing the return (patient characteristics, surgical characteristics, and preoperative patient-reported outcomes) were assessed. Methods A retrospective cohort study of patients who underwent THA was performed with use of prospectively collected data. At 3 months postoperatively, patients completed a questionnaire regarding their return to 16 different activities across the categories of daily activities, work, and sports. The percentage of patients who returned to an activity, the time to return, and factors influencing the return were analyzed with use of logistic regression models utilizing backward selection. Results A total of 2,006 patients were studied. Most of the studied activities had been returned to by the majority of patients at 3 months after THA, with the percentage of patients who returned to an activity ranging from 28.8% to 97.9%. The mean or median time to return to an activity ranged from 1 to 56 days after THA. For 13 out of 16 activities, 1 or more of the studied factors influenced the return to the activity. R2 values ranged from 0.057 to 0.273. Conclusions At 3 months after THA, 8 out of 10 patients had returned to daily activities, 7 out of 10 had returned to work, and 5 out of 10 had returned to sports. Factors that clearly influenced the return to daily activities, work, and sports could not be established. These findings might be useful in setting realistic expectations when counselling patients on their return to daily activities, work, and sports after THA. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, The Netherlands
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Kamp T, Gademan MGJ, van Zon SKR, Nelissen RGHH, Vliet Vlieland TPM, Stevens M, Brouwer S. Time to return to work by occupational class after total hip or knee arthroplasty. Bone Joint J 2023; 105-B:977-984. [PMID: 37652455 DOI: 10.1302/0301-620x.105b9.bjj-2023-0190.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims For the increasing number of working-age patients undergoing total hip or total knee arthroplasty (THA/TKA), return to work (RTW) after surgery is crucial. We investigated the association between occupational class and time to RTW after THA or TKA. Methods Data from the prospective multicentre Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study were used. Questionnaires were completed preoperatively and six and 12 months postoperatively. Time to RTW was defined as days from surgery until RTW (full or partial). Occupational class was preoperatively assessed and categorized into four categories according to the International Standard Classification of Occupations 2008 (blue-/white-collar, high-/low-skilled). Cox regression analyses were conducted separately for THA and TKA patients. Low-skilled blue-collar work was used as the reference category. Results A total of 360 THA and 276 TKA patients, preoperatively employed, were included. Patients were mainly high-skilled (THA 57%; TKA 41%) or low-skilled (THA 24%; TKA 38%) white-collar workers. Six months post-THA, RTW rates were 78% of low-skilled blue-collar workers compared to 83% to 86% within other occupational classes, increasing after 12 months to 87% to 90% in all occupational classes. Six months post-TKA, RTW rates were 58% of low-skilled and 64% of high-skilled blue-collar workers compared to 80% to 89% of white-collar workers, and after 12 months 79% of low-skilled blue-collar workers compared to 87% to 92% within other occupational classes. High-skilled white-collar workers (THA: hazard ratio (HR) 2.12 (95% confidence interval (CI) 1.32 to 3.40); TKA: HR 2.31 (95% CI 1.34 to 4.00)) and low-skilled white-collar workers (TKA: HR 1.82 (95% CI 1.04 to 3.18)) had a higher hazard to RTW within six months postoperatively. Conclusion Clear differences existed in time to RTW among both THA and TKA patients in each of the groups studied. These findings may help guide tailored patient-specific information during preoperative consultation and advice postoperatively, as well as to create awareness among workers and their employers.
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Affiliation(s)
- Tamara Kamp
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
- Department of Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Sander K R van Zon
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
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10
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Pasqualini I, Emara AK, Rullan PJ, Pan X, Simmons HL, Klika AK, Murray TG, Piuzzi NS. Return to Sports and Return to Work After Total Hip Arthroplasty: A Systematic Review and Meta-analysis. JBJS Rev 2023; 11:01874474-202308000-00003. [PMID: 37549241 DOI: 10.2106/jbjs.rvw.22.00249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Return to work (RTW) and sports (RTS) are critical gauges to improvement among patients after total hip arthroplasty (THA). This study aimed to determine rates, timelines, and prognostic factors associated with RTW and RTS outcomes after primary THA. METHODS A systematic review was conducted on MEDLINE, EMBASE, and CENTRAL databases with 57 studies meeting inclusion/exclusion criteria. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions and risk of bias in randomized trials (RoB2) tools. Meta-analysis and pooled analysis were conducted, with forest plots to summarize odds ratios and 95% confidence interval (CI). RESULTS The pooled RTW rate across all studies was 70% (95% CI, 68%-80%), with rates varying significantly from 11% to 100%. The mean time to RTW was 11.2 weeks (range 1-27). A time point analysis showed increasing RTW rates with a maximum rate at 2 years of 90%. Increased age (p < 0.001) and preoperative heavy labor (p = 0.005) were associated with lower RTW rates. The RTS rate ranged from 42% to 100%, with a pooled rate of 85% (95% CI, 74%-92%). The mean time to RTS was 16.1 weeks (range 8-26). The RTS ranged from 20% to 80% with a pooled proportion of 56% (95% CI, 42%-70%, I2 = 90%) for high-intensity sports and from 75% to 100% for low-intensity sports with a pooled proportion of 97% (95% CI, 83-99, I2 = 93%). CONCLUSION Most patients RTW and RTS after THA in an increasing manner as time passes with rates more than 85% after 1 year. These rates may be greatly affected by various factors, most notably age, the intensity of the sport, and the type of work performed. In general, young patients, low-demand work or sports can be resumed as soon as 4 to 6 weeks after surgery, but with increased restrictions as the intensity increases. This information should be used by practitioners to manage postoperative expectations and provide appropriate recommendations to patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Pedro J Rullan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Xuankang Pan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hannah L Simmons
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor G Murray
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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11
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Mew L, Heaslip V, Immins T, Wainwright T. What Is Important to the Younger Person (≤50 Years) When Having a Total Hip Arthroplasty: A Systematic Literature Review. Orthop Nurs 2023; 42:213-229. [PMID: 37494902 PMCID: PMC10405792 DOI: 10.1097/nor.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Total hip arthroplasties (THAs) are usually performed in older patients. Despite a growing number of THAs in younger adults, it is unclear whether they have similar priorities in recovery compared with their older counterparts. The purpose of this systematic review was to explore younger patients' priorities when undergoing a THA. Multiple databases were searched in September 2021 prioritizing qualitative data. This review was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of 14,495 articles screened, nine remained for analysis. Four common themes were discovered: improving function and mobility; pain; relationships; and patient expectations and education. However, there was insufficient information to clarify whether these themes could be attributed directly to younger adults undergoing a THA. The absence of research on THA patients younger than 50 years results in the loss of the voices of these patients. Further research is essential to ensure their needs are identified, addressed, and met.
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Affiliation(s)
- Louise Mew
- Correspondence: Louise Mew, BSc, Research and Development Department, Academic Centre, Milton Keynes University Hospital, Standing Way, Milton Keynes, MK6 5LD, United Kingdom ()
| | - Vanessa Heaslip
- Louise Mew, BSc, Milton Keynes University Hospital, Milton Keynes, Buckinghamshire, United Kingdom
- Vanessa Heaslip, PhD, Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom; and Department of Social Work, Stavanger University, Stavanger, Norway
- Tikki Immins, MSc, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
- Thomas Wainwright, PhD, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom; and Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Tikki Immins
- Louise Mew, BSc, Milton Keynes University Hospital, Milton Keynes, Buckinghamshire, United Kingdom
- Vanessa Heaslip, PhD, Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom; and Department of Social Work, Stavanger University, Stavanger, Norway
- Tikki Immins, MSc, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
- Thomas Wainwright, PhD, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom; and Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Thomas Wainwright
- Louise Mew, BSc, Milton Keynes University Hospital, Milton Keynes, Buckinghamshire, United Kingdom
- Vanessa Heaslip, PhD, Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom; and Department of Social Work, Stavanger University, Stavanger, Norway
- Tikki Immins, MSc, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
- Thomas Wainwright, PhD, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom; and Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
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12
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Pasqualini I, Emara AK, Rullan PJ, Pan X, Simmons HL, Molloy RM, Krebs VE, Piuzzi NS. Return to Sports and Return to Work After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2023; 11:01874474-202307000-00008. [PMID: 37499045 DOI: 10.2106/jbjs.rvw.22.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Return to work (RTW) and sports (RTS) are critical gauges to improvement among patients after total knee arthroplasty (TKA). This study aimed to determine rates, timelines, and prognostic factors associated with RTW and RTS outcomes after primary TKA. METHODS A systematic review was conducted on MEDLINE, Embase, and CENTRAL databases, with 44 studies meeting inclusion/exclusion criteria. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool. Meta-analysis and pooled analysis were conducted when possible with forest plots to summarize odds ratios and associated 95% confidence intervals (CIs). RESULTS The pooled RTW rate across all studies was 65% (95% CI, 51%-77%), with rates varying significantly from 10% to 98%. The mean time to RTW was of 12.9 weeks (range, 5-42). A time point analysis showed increasing RTW rates with a maximum rate at 1 year of 90%. Increased age was associated with lower RTW rates (p < 0.001). The RTS rate ranged from 36% to 100%, with a pooled rate of 82% (95% CI, 72%-89%). The mean time to RTS was 20.1 weeks (range, 16-24). A wide range of reported recurrence rates was observed among different sports (subgroup differences, p ≤ 0.001). The RTS ranged from 43% to 98%, with a pooled proportion of 76% (95% CI, 59%-87%, I2 = 91%) for low-intensity sports, and from 0% to 55% for high-intensity sports, with a pooled proportion of 35% (95% CI, 20-52, I2 = 70%). CONCLUSION Most patients successfully return to sports and work after TKA, with rates of RTW increasing to 90% after 1 year. Such outcomes are heavily influenced by nonmodifiable (e.g., age) and modifiable (e.g., intensity of sports/employment) factors. Generally, young adults and patients with low-demand jobs can be reinitiated earlier, albeit with increasing restrictions with rising intensity. Providers should screen patients for desire to RTW and/or RTS after surgery and provide appropriate recommendations as part of necessary preoperative education and postoperative care. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Pedro J Rullan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Xuankang Pan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hannah L Simmons
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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13
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Wijnen A, Seeber GH, Dietz G, Dijkstra B, Dekker JS, Vermeulen KM, Slager GEC, Hessel A, Lazovic D, Bulstra SK, Stevens M. Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty: a comparison of usual care between the Netherlands and Germany. BMC Musculoskelet Disord 2023; 24:525. [PMID: 37370054 DOI: 10.1186/s12891-023-06654-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. METHODS A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. RESULTS 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. CONCLUSIONS German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. TRIAL REGISTRATION The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).
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Affiliation(s)
- Annet Wijnen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Gesine H Seeber
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Günter Dietz
- Clinic for Orthopedic and Rheumatological Rehabilitation, Reha-Zentrum Am Meer Bad Zwischenahn, Bad Zwischenahn, Germany
- Praxis Für Orthopädie, Bad Zwischenahn, Germany
| | - Baukje Dijkstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Johan S Dekker
- Department of Orthopedics, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geranda E C Slager
- Department of Physical Therapy, School of Health Care Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Aike Hessel
- Deutsche Rentenversicherung Oldenburg, Bremen, Germany
| | - Djordje Lazovic
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Sjoerd K Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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14
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Chen E, Brownell S, DiBrita T, Green A, McPherson L, Ragos R, Jones C, Bonnyman A, Kastrati G, Yoshida K, Smart A. Patient Perspectives on Transitions from Acute to Community-Based Physiotherapy Care Following Total Knee Replacement Surgery Within the Context of a Bundled Care Model. Physiother Can 2023; 75:190-197. [PMID: 37736383 PMCID: PMC10510550 DOI: 10.3138/ptc-2021-0053] [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: 05/05/2021] [Revised: 09/05/2021] [Accepted: 09/20/2021] [Indexed: 09/23/2023]
Abstract
Purpose Research on fiscal implications of the bundled care (BC) model exist; however, patient-perceived experiences are less well known. As BC expands in Ontario, this study aims to examine these experiences with physiotherapy care within the total knee replacement (TKR) BC programme. Methods Qualitative cross-sectional study design. Semi-structured one-on-one telephone interviews were conducted with eight patients four to six weeks post-TKR. Thematic analysis was used. Results This exploratory study identified three themes across the care journey that patients perceived as influencing their physiotherapy experiences: timely access to physiotherapy care, quality of physiotherapy care, and patient outcomes. Communication, clinical support, and social support were sub-themes. Conclusions Patients' overall experiences with BC physiotherapy were positive. Areas for improvement included coordination of postoperative physiotherapy and return-to-work support. Patients valued group settings and were interested in meeting previous TKR patients. Health system planners are advised to consider incorporating patient experiences when evaluating and developing BC programmes to achieve patient-centred outcomes.
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Affiliation(s)
- Emily Chen
- From the:
University of Toronto, Toronto, Ontario, Canada
| | | | - Taylor DiBrita
- From the:
University of Toronto, Toronto, Ontario, Canada
| | - Aden Green
- From the:
University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Karen Yoshida
- From the:
University of Toronto, Toronto, Ontario, Canada
| | - Amanda Smart
- Ontario Physiotherapy Association, Toronto, Ontario, Canada
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15
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Zaballa E, Dennison E, Walker-Bone K. Function and employment after total hip replacement in older adults: A narrative review. Maturitas 2023; 167:8-16. [PMID: 36302339 DOI: 10.1016/j.maturitas.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
The burden of osteoarthritis (OA) has increased steadily due to an aging population, increasing life expectancy, obesity and lifestyle factors. Total hip replacement has become one of the most prevalent and successful operations globally and it is projected that demand will continue to grow as the incidence of OA continues to increase. Patients undergoing the operation expect much-improved function and pain relief but also increasingly need to return to work postoperatively, especially given the growing demand for the procedure and the encouragement of older people to continue working by most governments in the developed world. This review provides an overview of function and employment outcomes after hip arthroplasty. Despite the generally good success rate, some patients do not attain good functional outcomes and it is important that we develop ways to identify these patients preoperatively. We describe the effect of demographic, clinical and other factors on functional outcomes, as well as trajectories of physical function and pain recovery beyond the first few weeks after total hip replacement. Regarding employment outcomes, many people in work preoperatively are likely to resume to work after recovery; however, patients feel that they lack guidance from clinicians about returning to work postoperatively. Our review encompasses factors associated with return to work, timing of return to work, and potential temporary or permanent limitations that people might experience at work depending on type of employment.
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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.
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, 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; Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Australia.
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16
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Van Leemput D, Neirynck J, Berger P, Vandenneucker H. Return to Work after Primary Total Knee Arthroplasty under the Age of 65 Years: A Systematic Review. J Knee Surg 2022; 35:1249-1259. [PMID: 33472262 DOI: 10.1055/s-0040-1722626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A growing number of patients undergoing total knee arthroplasty (TKA) is at working age and need to return to work (RTW) after surgery. The aim of this systematic review is to give an overview of the literature regarding RTW after TKA and beneficial and limiting factors influencing this process. A systematic search in four electronic databases was conducted in November 2019 to identify studies describing RTW after primary TKA in patients aged 65 years or younger. Study characteristics and data on work status before and after surgery were extracted. All studies were assessed for risk of bias. Fourteen studies published between 2009 and 2019 were included in this review, accounting for a total of 3,073 patients. The percentage of patients working after TKA ranged from 36 to 89%, and the fraction of patients working before and returning to work after surgery ranged from 40 to 98%. Mean time of RTW ranged from 7.7 to 16.6 weeks. Most important factors associated with a slower or no RTW were a more physical nature of employment and preoperative absence from work. The majority of patients undergoing TKA returned to work postoperatively. However, comparison between studies is seriously hampered by the wide variation regarding the definition and timeframe used to measure the work status. Therefore, standardized outcome measures for studies investigating RTW after TKA are warranted. We identify this review as level-I evidence (systematic review of level-I and level-II studies).
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Affiliation(s)
- Dries Van Leemput
- Division of Orthopaedics, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Jef Neirynck
- Division of Orthopaedics, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Pieter Berger
- Division of Orthopaedics, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Hilde Vandenneucker
- Division of Orthopaedics, Department of Development and Regeneration-Organ Systems Cluster, KU Leuven, University Hospitals Leuven, Belgium, B-3000 Leuven, Belgium
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17
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ARIMAA A, KNIFSUND J, KESKINEN H, KIVIMÄKI M, AALTO V, OKSANEN T, MÄKELÄ K, VAHTERA J, LANKINEN P. Return to work following anterior cruciate ligament reconstruction. Acta Orthop 2022; 93:554-559. [PMID: 35700049 PMCID: PMC9205185 DOI: 10.2340/17453674.2022.3139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Amongst people of working age, the return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is an important marker of success of surgery. We determined when patients are able to return to work after ACL reconstruction and identified factors that are associated with the timing of RTW. PATIENTS AND METHODS We used logistic regression analyses to examine patient-related factors that may be associated with the length of RTW (above vs. below the median 59 days) after arthroscopic ACLR in a large cohort of patients working in the public sector in Finland (n = 803; n = 334 male, n = 469 female; mean age 41 years [SD 8.6]). RESULTS The mean length of RTW was 65 days (SD 41). Higher odds ratios (OR) were observed for age groups 40-49 and ≥ 50 years compared with ≤ 30 years old (OR 2.0, 95% confidence interval 1.3-3.1 and 2.0, 1.2-3.4, respectively); for lower level non-manual and manual work compared with higher level non-manual work (3.0, 2.0-4.3 and 4.9, 3.4-7.0, respectively); and for those who had been on sick leave > 30 days in the preceding year (2.0, 1.4-2.9). Sex, comorbid conditions, preceding antidepressant treatment and concomitant procedures were not associated with the length of RTW. INTERPRETATION Factors associated with prolonged sick leave beyond the median time of 59 days are higher age, lower occupational status, and preoperative sick leaves.
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Affiliation(s)
- Anssi ARIMAA
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
| | - Jani KNIFSUND
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
| | - Heli KESKINEN
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika KIVIMÄKI
- Finnish Institute of Occupational Health, Helsinki, Finland,Department of Epidemiology and Public Health, University College London, London, UK
| | - Ville AALTO
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuula OKSANEN
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Keijo MÄKELÄ
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi VAHTERA
- Department of Public Health, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University Hospital; Turku, Finland
| | - Petteri LANKINEN
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland,Satasairaala Central Hospital, Pori, Finland
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18
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Kamp T, Brouwer S, Hylkema TH, van Beveren J, Rijk PC, Brouwer RW, Stevens M. Psychosocial Working Conditions Play an Important Role in the Return-to-Work Process After Total Knee and Hip Arthroplasty. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:295-305. [PMID: 34581916 PMCID: PMC9232447 DOI: 10.1007/s10926-021-10006-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 05/26/2023]
Abstract
Purpose Both personal and work-related factors affect return to work (RTW) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Little is known about work-related factors associated with the recovery process. This study aimed to determine which work-related factors are associated with time to RTW for both TKA and THA patients. Methods A prospective multicenter survey study was conducted that included patients aged 18-63, had a paid job and were scheduled to undergo primary TKA/THA. Surveys were completed preoperatively, 6 weeks, and 3, 6, and 12 months postoperatively, and included four domains of work-related factors: work characteristics, physical working conditions, psychosocial working conditions and work adjustments. Control variables included age, sex, education, and comorbidity. Time to RTW was defined as days from surgery until RTW. Multivariate linear regression analyses were conducted separately for TKA/THA patients. Results Enrolled were 246 patients (n = 146 TKA, n = 100 THA, median age 56 years, 57% female). Median time to RTW was 79 days (IQR 52.0-146.0). Mainly physical tasks (TKA: B 58.2, 95%CI 9.5-106.8; THA: B 52.1, 95%CI 14.1-90.2) and a combination of physical and mental tasks (TKA: B 50.2, 95%CI 6.4-94.0; THA B 54.0, 95%CI 24.2-83.7) were associated with longer time to RTW after both TKA and THA. More possibilities for personal job development (B - 12.8, 95%CI - 25.3-0.4) and more work recognition (B - 13.2, 95%CI - 25.5 to - 0.9) were significantly associated with shorter time to RTW after TKA. Higher quality of supervisor leadership (B - 14.1, 95%CI - 22.2 to - 6.0) was significantly associated with shorter time to RTW after THA. Conclusion The findings of this study stress the importance of psychosocial working conditions, besides type of job tasks, in RTW after TKA/THA. Further research on work-related factors is needed, as arthroplasty is being performed on an increasingly younger population of knee and hip OA patients for whom participating in work is of critical importance.
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Affiliation(s)
- Tamara Kamp
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tjerk H Hylkema
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan van Beveren
- Department of Orthopedics, Röpcke-Zweers Hospital Hardenberg, Hardenberg, The Netherlands
| | - Paul C Rijk
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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19
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Kamp T, Stevens M, Van Beveren J, Rijk PC, Brouwer R, Bulstra S, Brouwer S. Influence of social support on return to work after total hip or total knee arthroplasty: a prospective multicentre cohort study. BMJ Open 2022; 12:e059225. [PMID: 35623752 PMCID: PMC9150170 DOI: 10.1136/bmjopen-2021-059225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES There is strong evidence that social support is an important determinant of return to work (RTW). Little is known about the role of social support in RTW after total hip or knee arthroplasty (THA/TKA). Objective was to examine the influence of preoperative and postoperative perceived social support on RTW status 6 months postoperatively. DESIGN A prospective multicentre cohort study was conducted. SETTING Orthopaedic departments of four Dutch medical centres; a tertiary university hospital, two large teaching hospitals and a general hospital. PARTICIPANTS Patients planned to undergo THA/TKA, aged 18-63 and employed preoperatively were included. MAIN OUTCOME MEASURES Questionnaires were filled out preoperatively and 3 and 6 months postoperatively and included questions to assess patients' perceived social support targeting three sources of social support: from home (friends, family), from work (coworkers, supervisors) and from healthcare (occupational physician, general practitioner, other caregivers). Control variables included age, gender, education, type of arthroplasty and comorbidities. RTW was defined as having fully returned to work 6 months postoperatively. Univariate and multivariate logistic regression analyses were conducted. RESULTS Enrolled were 190 patients (n=77 THA, n=113 TKA, median age was 56 years, 56% women). The majority returned to work (64%). Preoperatively, social support from the occupational physician was associated with RTW (OR 2.53, 95% CI 1.15 to 5.54). Postoperatively, social support from the occupational physician (OR 3.04, 95% CI 1.43 to 6.47) and the supervisor (OR 2.56, 95% CI 1.08 to 6.06) was associated with RTW. CONCLUSIONS This study underscores the importance of work-related social support originating from the occupational physician and supervisor in facilitating RTW after primary THA/TKA, both preoperatively and postoperatively. Further research is needed to confirm our results and to understand the facilitating role of social support in RTW, as arthroplasty is being performed on a younger population for whom work participation is critical.
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Affiliation(s)
- Tamara Kamp
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Van Beveren
- Department of Orthopedics, Röpcke-Zweers Hospital Hardenberg, Hardenberg, The Netherlands
| | - Paul C Rijk
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Reinoud Brouwer
- Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - Sjoerd Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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20
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Freitag J, Wickham J, Shah K, Tenen A. Real-world evidence of mesenchymal stem cell therapy in knee osteoarthritis: a large prospective two-year case series. Regen Med 2022; 17:355-373. [PMID: 35411799 DOI: 10.2217/rme-2022-0002] [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] [Indexed: 12/27/2022] Open
Abstract
Objective: To evaluate the long-term safety and efficacy of adipose-derived mesenchymal stem cell (ADMSC) therapy in the treatment of knee osteoarthritis (OA). Methods: 329 participants with knee OA underwent intra-articular ADMSC therapy. Participants were followed up for 24 months and were separated based on radiological OA grade. Results: Treatment was well tolerated with no related serious adverse events. All participant groups reported clinically and statistically significant pain improvement. Clinical outcome was not influenced by patients' age or BMI. Conclusion: ADMSC therapy is an effective, safe and long-lasting treatment option for knee OA with the potential to delay total joint replacement. In addition to the observed clinical benefits, ADMSC therapy promises to reduce the global economic burden of OA. Trial registration number: ACTRN12617000638336.
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Affiliation(s)
- Julien Freitag
- Charles Sturt University, Orange, NSW, 2800, Australia.,Magellan Stem Cells, Box Hill, Victoria, 3129, Australia.,Melbourne Stem Cell Centre Research, Box Hill, Victoria, 3129, Australia
| | - James Wickham
- Charles Sturt University, Orange, NSW, 2800, Australia
| | - Kiran Shah
- Magellan Stem Cells, Box Hill, Victoria, 3129, Australia.,Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia
| | - Abi Tenen
- Magellan Stem Cells, Box Hill, Victoria, 3129, Australia.,Melbourne Stem Cell Centre Research, Box Hill, Victoria, 3129, Australia.,Monash University, Monash, Victoria, 3800, Australia
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21
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Bender A, Damm P, Hommel H, Duda GN. Overstretching Expectations May Endanger the Success of the “Millennium Surgery”. Front Bioeng Biotechnol 2022; 10:789629. [PMID: 35237570 PMCID: PMC8882767 DOI: 10.3389/fbioe.2022.789629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Total hip arthroplasty (THA) is an extremely successful treatment strategy. Patient expectations, however, have increased; if not properly guided by surgeons, at present, patients expect next to pain-free restoration of the joint and a fast return to work and sports. While the revision rates after THA also increased in younger patients, knowledge on musculoskeletal loads still remains sparse, and the current recommendations on postoperative rehabilitation are based on expert opinions only. The aim of this study was to unravel biomechanical contact conditions in “working age” (<60 years, 53.5 ± 3.0 years) and “retirement age” (>60 years, 67.7 ± 8.6 years) patients during activities recommended post-THA. We hypothesized that working age patients would show substantially increased hip contact loads compared to older patients. The in vivo joint contact force (Fres) and torsion torque (Mtors), reflecting the main contact load situation, experienced during activities of daily living and sports activities were measured in a unique group of 16 patients with instrumented THA. We summarized patient activities and sports recommendations after THA mentioned within the literature using PubMed (without claim of completeness). The measurements showed that younger working age patients experienced significant (p = 0.050) increased Mtors (21.52 ± 9.11 Nm) than older retirement age patients (13.99 ± 7.89 Nm) by walking. Bowling, as a recommended low-impact sport, was associated with Fres of up to 5436 N and Mtors of up to 108 Nm in the working age group, which were higher than the Fres (5276 N) and Mtors (71 Nm) during high-impact soccer. Based on our results, age was proven to be a discriminator in joint loading, with working age patients presenting with increased loads compared to retirement age patients, already during daily activities. The current patient recommendations have led to further increased joint loadings. If THA cannot be delayed in a patient, we propose counselling patients on a carefully considered return to sports, focusing on low-impact activities, as indicated hereby. The findings from this work illustrate the need to provide critical feedback to patient expectations when returning to work and sports activities. Patients returning to more intensive sports activities should be carefully monitored and advised to avoid as much overloading as possible.
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Affiliation(s)
- Alwina Bender
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
- *Correspondence: Philipp Damm,
| | - Hagen Hommel
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
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22
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Return to work after primary total hip or knee arthroplasty. First French study. Retrospective study of 241 cases. Orthop Traumatol Surg Res 2022; 108:103163. [PMID: 34863957 DOI: 10.1016/j.otsr.2021.103163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 04/24/2021] [Accepted: 09/16/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The quality and reliability of the results of primary total hip or knee arthroplasty (THA, TKA) have allowed indications to be extended to younger, working-age patients, raising the issue of return to work. This question has never been specifically addressed in THA and TKA in a French population. We therefore conducted a retrospective study to determine: (1) the rates and intervals of return to work, and (2) factors affecting return to work and reasons for non-return. HYPOTHESIS Rates and intervals of return to work are comparable to those in Western countries as a whole: 1.1-10.5 weeks in THA and 8-12 weeks in TKA. MATERIAL AND METHOD A single-center retrospective study included patients aged under 65 at surgery, between 2009 and 2013. A questionnaire collected population and occupational data. The patients' occupational situation was collected at a minimum 1 year postoperatively. During the study period, 289 TKAs or THAs were performed; 241 patients were recontacted, 144 of whom had been working at the time of surgery: 72 THAs and 72 TKAs. The sex-ratio was well balanced: 69 males, 75 females. Mean age was 55.8±8 years (range, 18.6-65.7 years). The mean time from surgery to data collection was 34.5 months (95% CI, 32.2-36.8 months). RESULTS In all, 86 patients (57.6%) returned to work, at a mean 124 days (range, 15-540 days; 95% CI, 102.8-144.4 days). At 3 months, 55.4% of patients (n=46) had returned to work, and 97.6% (n=81) at 12 months. In most cases, patients returned to the same occupation. CONCLUSION The study hypothesis was not confirmed. French primary THA or TKA patients returned to work later and less frequently than in other Western countries. LEVEL OF EVIDENCE IV, retrospective study without control group.
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23
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Hah JM, Lee E, Shrestha R, Pirrotta L, Huddleston J, Goodman S, Amanatullah DF, Dirbas FM, Carroll IR, Schofield D. Return to work and productivity loss after surgery: A health economic evaluation. Int J Surg 2021; 95:106100. [PMID: 34600123 PMCID: PMC8604782 DOI: 10.1016/j.ijsu.2021.106100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/27/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to identify preoperative psychosocial factors associated with return-to-work (RTW) and the associated cost of productivity loss due to work absenteeism following surgery. Research demonstrates a high economic burden from productivity loss after surgery, but the comparative cost of productivity loss relative to income across different operations has not been examined. MATERIALS AND METHODS A mixed surgical cohort recruited for a randomized controlled trial were prospectively followed for up to two years following surgery with daily phone assessments to three months, weekly assessments thereafter to six months, then monthly assessments thereafter to determine RTW status, opioid use and pain. RESULTS 183 of 207 (88.3%) patients in paid employment prior to surgery, who provided at least one day of follow-up, were included in this analysis. The average cost of productivity loss due to work absenteeism was $13 761 (median $9064). Patients who underwent total knee replacement incurred the highest income loss. Medical claims filed before surgery were significantly associated with relative income loss (AOR 5.09; 95% CI 1.73-14.96; p < 0.01) and delayed postoperative RTW. Elevated preoperative PTSD symptoms were associated with delayed RTW (HR 0.78; 95%CI 0.63-0.96; p-value = 0.02) while male gender (HR 1.63; 95%CI 1.11-2.38; p-value = 0.01) was associated with faster postoperative RTW. CONCLUSION Surgery places a high economic burden on individuals due to postoperative productivity loss. Multidisciplinary approaches, such as pathways, that facilitate the operation and recovery may mitigate the economic consequences for patients, employers, and the healthcare system.
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Affiliation(s)
- Jennifer M Hah
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, NSW, Australia Stanford Systems Neuroscience and Pain Lab, Stanford University, Stanford, CA, USA Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA Department of Orthopaedic Surgery and (by courtesy) Bioengineering, Stanford University, Stanford, CA, USA Department of General Surgery, Stanford University, Stanford, CA, USA
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24
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Hylkema TH, Stevens M, van Beveren J, Rijk PC, Brouwer RW, Bulstra SK, Kuijer PPFM, Brouwer S. Recovery Courses of Patients Who Return to Work by 3, 6 or 12 Months After Total Knee Arthroplasty. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:627-637. [PMID: 33515342 PMCID: PMC8298243 DOI: 10.1007/s10926-021-09959-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 05/26/2023]
Abstract
Purpose This study compared the preoperative levels and postoperative recovery courses of physical and mental impairments, activity limitations and participation restrictions of working-age patients who return to work (RTW) by 3, 6 or 12 months after total knee arthroplasty (TKA). Methods A prospective survey study including TKA patients (aged < 65) (n = 146) who returned to work (RdTW) in the first postoperative year. Three groups were compared: those who returned by 3 (n = 35), 6 (n = 40) or 12 (n = 29) months. Surveys were completed preoperatively and at 6 weeks and 3, 6 and 12 months postoperatively. Outcomes represented domains of the International Classification of Functioning, i.e. physical impairments (pain, stiffness, vitality), mental impairments (mental health and depressive symptoms), activity limitations (physical functioning) and participation restrictions (social and work functioning). Results Preoperative knee-specific pain and physical functioning levels were better among patients who RdTW by 3 months, compared to those who returned by 12 months. Patients who RdTW by 3 months experienced significantly better recovery from physical impairments than those who returned by 6 months (on general pain) or 12 months (on general and knee-specific pain and on stiffness). Patients returning by 3 months experienced significantly better recovery from activity limitations (on knee-specific physical functioning). Conclusions To optimize return to work outcome after TKA surgery, the focus should lie on physical impairments (general and knee-specific pain, stiffness) and activity limitations (knee-specific physical functioning) during recovery.
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Affiliation(s)
- T H Hylkema
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - M Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - J van Beveren
- Department of Orthopedics, Röpcke-Zweers Hospital Hardenberg, Hardenberg, The Netherlands
| | - P C Rijk
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - R W Brouwer
- Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - S K Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - P P F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Brouwer
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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25
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Pahlplatz TMJ, Schafroth MU, Krijger C, Hylkema TH, van Dijk CN, Frings-Dresen MHW, Kuijer PPFM. Beneficial and limiting factors in return to work after primary total knee replacement: Patients' perspective. Work 2021; 69:895-902. [PMID: 34180460 PMCID: PMC8385499 DOI: 10.3233/wor-213522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND: Return to work (RTW) is an important outcome in Total Knee Arthroplasty (TKA). At present, 70–80%of TKA patients return to work within three to six months. OBJECTIVE: What are patients’ perspectives regarding beneficial and limiting factors in RTW after TKA? METHODS: Focus groups were formed in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Three major topics were explored: 1. What was beneficial for RTW after TKA; 2. What was limiting for RTW after TKA; and 3. What additional care would benefit RTW after TKA? RESULTS: Data saturation was reached after four focus groups, comprising 17 participants—nine men and eight women (median age 58, range 52–65). The focus group study identified four main themes that contributed to a successful RTW namely rehabilitation (medical) like post-operative physical therapy, patient characteristics (personal), like motivation to RTW, occupational characteristics (work-related) like build-up in work tasks and medical support (medical) like availability of a walker or crutches. CONCLUSION: According to participants, factors within the following four themes can contribute to a successful return to work: occupational, patient, rehabilitation and medical care. Incorporating these factors into the integrated care pathway for the “young” TKA patients may increase the chances of a successful RTW.
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Affiliation(s)
- T M J Pahlplatz
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.,University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - M U Schafroth
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.,University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - C Krijger
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.,University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - T H Hylkema
- University Medical Center Groningen, Department of Orthopaedic Surgery and Department of Community and Occupational Medicine, Groningen, the Netherlands
| | - C N van Dijk
- Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.,University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - M H W Frings-Dresen
- Amsterdam UMC, University of Amsterdam, Department Public and Occupational Health, Amsterdam Public Health research institute Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - P P F M Kuijer
- Amsterdam UMC, University of Amsterdam, Department Public and Occupational Health, Amsterdam Public Health research institute Amsterdam, Amsterdam Movement Sciences, the Netherlands
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26
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Ng HJH, Loke WJ, James Liang Hao W. Return to work after medial unicompartmental knee arthroplasty: A systematic review. Knee 2021; 30:254-266. [PMID: 33975066 DOI: 10.1016/j.knee.2021.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 03/05/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study aims to evaluate the current literature with regard to the average time to and overall rate of return to work (RTW) following medial unicompartmental knee arthroplasty (UKA). METHODS A systematic search was conducted on MEDLINE (Ovid), Embase, Pubmed, CINAHL, Web of Science, Scopus, and the Cochrane Library to identify studies reporting RTW after UKA. Primary outcomes were the rate and time to RTW after UKA. Secondary outcomes were postoperative changes in work intensity, functional scores, and factors affecting RTW. Methodological quality was evaluated using the the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS Seven studies met inclusion criteria. Results were summarized qualitatively. The overall methodological quality of the studies was moderate based on the MINORS score. These studies included 636 patients with 46.5% male. Mean age was 63.1 years. The average rate of RTW was 81.7%. The average time to RTW was 5.4 ± 3.9 weeks (range 1-32 weeks). 81.8% of patients in one study returned to an equally or more physically demanding job, while 83.5% were able to work the same or longer hours postoperatively in another study. Functional scores improved after surgery (n = 6 studies). Factors affecting RTW were postoperative rehabilitation, retirement, and the effects of surgery. CONCLUSION Limited evidence from the included studies with moderate quality suggests that UKA allows patients to RTW faster, with a high rate of RTW and improved functional outcomes. However, consensus definitions and methods of work status analysis are needed for future studies.
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Affiliation(s)
- Hannah Jia Hui Ng
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
| | - Wei Jie Loke
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
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27
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Hauer G, Smolle M, Zaussinger S, Friesenbichler J, Leithner A, Maurer-Ertl W. Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design. Sci Rep 2021; 11:4968. [PMID: 33654124 PMCID: PMC7925530 DOI: 10.1038/s41598-021-82805-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022] Open
Abstract
Return to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients' RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients' hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7-14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7-14] vs. 11 [7.5-13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.
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Affiliation(s)
- Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Maria Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Sabrina Zaussinger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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28
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Tsang B, McDonald D, McNamara I, Kottam L, Rangan A, Baker P. National survey of occupational advice for lower limb arthroplasty patients. Occup Med (Lond) 2021; 70:123-126. [PMID: 32009175 DOI: 10.1093/occmed/kqaa006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known what advice or support patients are given about return to work (RTW) after hip or knee replacement surgery. AIMS This study aims to understand the delivery, timing and content of 'RTW' advice currently delivered by surgical teams offering hip and knee replacements across the UK. METHODS National online survey exploring five specific areas relating to 'RTW' advice: (i) timings of interactions between hospital orthopaedic teams and patients prior to surgery, (ii) routine delivery of 'RTW' advice, (iii) methods used to deliver 'RTW' advice, (iv) confidence delivering advice and (v) need for an occupational 'RTW' advice intervention. RESULTS A total of 152 participants including surgeons, physiotherapists, occupational therapists and nurses from 59 different public and private health providers responded. Only 20% (n = 30) of respondents reported that working patients were identified as a specific subgroup in need of additional support. Overall, 62% (n = 92) stated that they did not routinely offer 'RTW' advice. When given, 'RTW' advice was almost always verbal, generic advice using blanket timescales and based on the respondent's anecdotal experience rather than the patients individualized needs. Overall, 116 (78%) felt an occupational advice intervention was needed. CONCLUSIONS This national survey demonstrated wide variation in the timing, content and delivery of information and advice for patients in work and intending to RTW after hip and knee replacement surgery. Current RTW advice provided to hip and knee replacement patients is inadequate.
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Affiliation(s)
- B Tsang
- South Tees Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Middlesbrough, UK
| | - D McDonald
- Whole System Patient Flow Programme, Scottish Government, Scotland, UK.,NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - I McNamara
- Norfolk and Norwich NHS Foundation Trust, Department of Trauma & Orthopaedics, Norwich, UK
| | - L Kottam
- South Tees Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Middlesbrough, UK
| | - A Rangan
- South Tees Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Middlesbrough, UK.,University of York, York, UK.,University of Oxford, Oxford, UK
| | - P Baker
- South Tees Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Middlesbrough, UK.,University of York, York, UK
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29
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Coutu MF, Gaudreault N, Major ME, Nastasia I, Dumais R, Deshaies A, Pettigrew S, Labrecque ME, Desmeules F, Maillette P. Return to work following total knee arthroplasty: A multiple case study of stakeholder perspectives. Clin Rehabil 2020; 35:920-934. [PMID: 33371735 DOI: 10.1177/0269215520984319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study's aim was to gain insights into factors influencing sustainable return to work following total knee arthroplasty (TKA). DESIGN A descriptive multiple-case design was used. A case was defined as a worker's following TKA work disability situation. SETTINGS The cases came from public hospitals in urban and semi-urban areas in Quebec (Canada) and involved mostly non-work-related TKAs. SUBJECTS Workers had to be between 6 and 12 months post-TKA, have physical/manual jobs and currently employed. Their rehabilitation professionals and workplace representatives (employer and/or union) were also recruited, based on the work disability paradigm. MAIN MEASURES Semi-structured interviews, questionnaires on pain, physical work demands (workers only), and observation of the work activities of those workers back at work were used. Cases were compared and categorized for worker-perceived levels of difficulty in returning to or staying at work: little or no difficulty (n = 8); some difficulty (n = 5); not back at work due to excessive difficulty with their knee (n = 4). RESULTS A total of 17 cases were constituted. In only one case, the worker benefitted from an interdisciplinary work rehabilitation approach. Results highlight the interplay among these factors: (1) the workers' perceptions of their residual symptoms and ability to manage them, (2) the interaction between work adjustments and tools offered by the employers and the workers' own strategies, and (3) perceptions of the workers' physical capacities. CONCLUSION Workers' who face high levels of work demands/difficulties and who have limited access to work adjustments and tools should be referred for work rehabilitation.
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Affiliation(s)
- Marie-France Coutu
- Université de Sherbrooke, School of Rehabiliation, Sherbrooke, QC, Canada
| | - Nathaly Gaudreault
- Université de Sherbrooke, School of Rehabiliation, Sherbrooke, QC, Canada
| | - Marie-Eve Major
- Université de Sherbrooke, Faculty of Physical Activity Sciences, Sherbrooke, QC, Canada
| | - Iuliana Nastasia
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Research and expertise division, Montreal, QC, Canada
| | - Réjean Dumais
- CIUSSS de l'Estrie-CHUS (Estrie-CHUS University Integrated Health and Social Services Centre), Orthopedics Department, Sherbrooke, QC, Canada
| | - Annie Deshaies
- CIUSSS de l'Estrie-CHUS (Estrie-CHUS University Integrated Health and Social Services Centre), Orthopedics Department, Sherbrooke, QC, Canada
| | - Sara Pettigrew
- Université de Sherbrooke, School of Rehabiliation, Sherbrooke, QC, Canada
| | | | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Centre, Université de Montréal Affiliated Research Centre, Montreal, QC, Canada.,School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Pascale Maillette
- Université de Sherbrooke, School of Rehabiliation, Sherbrooke, QC, Canada
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Martinot P, Dartus J, Putman S, Girard J. Return to work after hip resurfacing. Orthop Traumatol Surg Res 2020; 106:1507-1510. [PMID: 33191171 DOI: 10.1016/j.otsr.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Hip arthroplasty is being performed in ever-younger patients, for whom return to work is a major issue. Type of job, type of implant and comorbidities all affect outcome. Heavy manual work is harder to resume after hip replacement, and reclassification or cessation of activity may ensue. This, however, is little dealt with in the literature, although its consequences are both psychologically and financially critical. The aim of the present study was to perform a retrospective analysis of return to work after hip resurfacing (HR). MATERIAL A retrospective study included patients undergoing Birmingham Hip Resurfacing with at least 6 months' follow-up. Occupational status was assessed, preoperatively and at follow up, as not working, in work or retired, type of work as sedentary, manual, or strenuous, and time to return to work was noted. Clinical assessment, preoperatively and at follow-up, used Postel Merle d'Aubigné, Harris, Devane, UCLA and Oxford scores. RESULTS One hundred and seventeen patients were included (114 male, 3 female) for 121 HRs. Mean age was 52.9 years (range, 29-66 years). Mean follow-up was 14.3 months (range, 6-20 months), with no loss to follow-up. Crutches were abandoned in week 3 on average (range, 1-7 weeks). Four patients had no occupation; analysis focused on the other 113. At follow-up, only one patient had not resumed work, and was reclassified. The other 112 (99.1% of those in work) returned to their previous job at a mean 9.4 weeks (range, 1-22 weeks). Nine patients required therapeutic part-time work for a mean 5.3 weeks (range, 3-8 weeks). Time to return to work was significantly shorter for "sedentary" workers than "physical" (manual/strenuous) workers: 6.4 weeks (range, 1-9 weeks) versus 13.5 weeks (range, 2-22 weeks). DISCUSSION&CONCLUSION Return to work was feasible for almost all these young patients after HR. Sedentary work was resumed very quickly (<7 weeks), while strenuous work required 3 months' sick leave. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Pierre Martinot
- Service d'orthopédie C, Hôpital Salengro, CHRU de Lille, Lille, France
| | - Julien Dartus
- Service d'orthopédie D, Hôpital Salengro, CHRU de Lille, Lille, France
| | - Sophie Putman
- Service d'orthopédie D, Hôpital Salengro, CHRU de Lille, Lille, France
| | - Julien Girard
- Service d'orthopédie C, Hôpital Salengro, CHRU de Lille, Lille, France; University of Lille, University of Artois, University Littoral Côte d'Opale, EA 7369-URePSS-Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000 Lille, France.
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Sveinsdóttir H, Kristiansen K, Skúladóttir H. Health related quality of life in patients having total knee replacement and associations with symptoms, recovery, and patient education: A six month follow up study. Int J Orthop Trauma Nurs 2020; 42:100830. [PMID: 33518438 DOI: 10.1016/j.ijotn.2020.100830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 01/16/2023]
Abstract
AIM To describe the symptoms, recovery, patient education, and health related quality of life (HRQOL) of patients having total knee replacements at three time points and to detect experiences and situations that predict HRQOL six weeks and six months post-surgery. METHOD A prospective exploratory two-site study assessing 123 patients, while in hospital (T1), at six weeks (T2), and at six months (T3) post-discharge. HRQOL was measured using the SF-36v2 and symptoms were measured with the Hospital and Anxiety Scale. Two questions considered pain and two considered movement and tiredness while two questions addressed recovery and patient education. Linear regression models were used to calculate predictors of mental and physical HRQOL at T2 and T3. RESULTS HRQOL improved from T1 to T3. The main predictors of higher physical scores at T2 were; being older, fewer symptoms of depression and little distress related to movement. At T3 the main predictors were; having resumed work, finding patient education very useful, experiencing no pain in the last 24 h and fewer symptoms of depression. The main predictors of higher mental scores at T2 were fewer symptoms of anxiety and depression and little distress related to movement while at T3 these were fewer symptoms of anxiety and depression and experiencing no pain last 24 h. CONCLUSION Apart from pain, function and resumption of activities, the symptoms of anxiety and depression influence HRQOL. These symptoms should be assessed during the hospital stay.
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Affiliation(s)
- Herdís Sveinsdóttir
- University of Iceland, Faculty of Nursing, Eirberg, Eiríksgötu 34, 101, Reykjavík, Iceland; Landspitali University Hospital, Surgical Services, 101, Reykjavík, Iceland.
| | | | - Hafdís Skúladóttir
- University of Iceland, Faculty of Nursing, Eirberg, Eiríksgötu 34, 101, Reykjavík, Iceland; University of Akureyri, School of Health Sciences, Iceland
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Fawaz WS, Masri BA. Allowed Activities After Primary Total Knee Arthroplasty and Total Hip Arthroplasty. Orthop Clin North Am 2020; 51:441-452. [PMID: 32950213 DOI: 10.1016/j.ocl.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It is essential for total knee arthroplasty patients to return to their previous level of activity to maintain a healthy lifestyle. This article reviews the current recommendations regarding return to physical activity after total knee arthroplasty and trying to find the balance between levels of activity and prosthetic joint preservation. In general, most total joint replacement patients are able to return to their previous level of activity and to a lesser extent to sports. This article discuss patients' actual levels of activity including their return to work and sport and the factors that influence meeting their expectations for surgery.
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Affiliation(s)
- Wissam S Fawaz
- Department of Orthopaedic Surgery, University of British Columbia, Complex Joint Clinic, Third Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Bassam A Masri
- Department of Orthopaedic Surgery, University of British Columbia, Complex Joint Clinic, Third Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
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Olsen U, Lindberg MF, Denison EML, Rose CJ, Gay CL, Aamodt A, Brox JI, Skare Ø, Furnes O, Lee KA, Lerdal A. Predictors of chronic pain and level of physical function in total knee arthroplasty: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e037674. [PMID: 32912987 PMCID: PMC7485240 DOI: 10.1136/bmjopen-2020-037674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION One in five patients undergoing total knee arthroplasty (TKA) experience unchanged or worse pain and physical function 1 year after surgery. Identifying risk factors for unfavourable outcomes is necessary to develop tailored interventions to minimise risk. There is a need to review more current literature with updated methodology that addresses the limitations of earlier systematic reviews and meta-analyses. We present a Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols compliant protocol for a systematic review and meta-analysis of predictors of chronic pain and impaired function after TKA. METHODS AND ANALYSIS This review will include prospective longitudinal observational studies, or randomised trials (including cluster and crossover designs) that report arm-wise predictors of chronic postsurgical pain or impaired physical function at 3 months, 6 months or 12 months. A comprehensive literature search of studies published between 2000 and 2019 will be performed in Medline, Embase, CINAHL, Cochrane Library and PEDro. Blinded assessment with consensus agreement will be applied for inclusion of studies, data extraction and assessment of bias risk (Quality in Prognosis Studies tool). The co-primary outcomes, pain and impaired function, at 12 months after TKA will be analysed separately. Estimates of association between each outcome and any preoperative or intraoperative factor that may predict chronic pain or impaired physical function will be extracted from the included studies, where possible. For randomised studies, results will only be extracted from TKA arms (or the first period of crossover trials). Estimates of association from the primary evidence will be synthesised narratively, and quantitatively using multivariate meta-analysis to provide 'pooled' estimates of association. Subgroup and sensitivity analyses will be performed. Certainty of evidence for each predictor will be derived from the Grading of Recommendations Assessment, Development and Evaluation framework. ETHICS AND DISSEMINATION No ethical issues are associated with this project. The results from this review will be published in peer-reviewed journals and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42018079069.
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Affiliation(s)
- Unni Olsen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Maren Falch Lindberg
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | | | - Caryl Lynn Gay
- Department of Family and Health Care Nursing, University of California, San Francisco, California, USA
- Department of Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Skare
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Ove Furnes
- Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
- Department of Orthopaedic Surgery, University of Bergen, Bergen, Hordaland, Norway
| | - Kathryn A Lee
- Department of Family and Health Care Nursing, University of California, San Francisco, California, USA
| | - Anners Lerdal
- Department of Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Baker P, Coole C, Drummond A, Khan S, McDaid C, Hewitt C, Kottam L, Ronaldson S, Coleman E, McDonald DA, Nouri F, Narayanasamy M, McNamara I, Fitch J, Thomson L, Richardson G, Rangan A. Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. Health Technol Assess 2020; 24:1-408. [PMID: 32930659 PMCID: PMC7520717 DOI: 10.3310/hta24450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip and knee replacements are regularly carried out for patients who work. There is little evidence about these patients' needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. OBJECTIVES To develop an occupational advice intervention to support early recovery to usual activities including work that is tailored to the requirements of patients undergoing hip or knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks. DESIGN An intervention mapping approach was used to develop the intervention. The research methods employed were rapid evidence synthesis, qualitative interviews with patients and stakeholders, a prospective cohort study, a survey of clinical practice and a modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the intervention mapping process. SETTING Orthopaedic departments in NHS secondary care. PARTICIPANTS Patients who were in work and intending to return to work following primary elective hip or knee replacement surgery, health-care professionals and employers. INTERVENTIONS Occupational advice intervention. MAIN OUTCOME MEASURES Development of an occupational advice intervention, fidelity of the developed intervention when delivered in a clinical setting, patient and clinician perspectives of the intervention and preliminary assessments of intervention effectiveness and cost. RESULTS A cohort study (154 patients), 110 stakeholder interviews, a survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, a personalised return-to-work plan and co-ordination from the health-care team to support the delivery of 13 patient and 20 staff performance objectives. To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created. Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the defined performance objectives was 75% for patient performance objectives and 74% for staff performance objectives. The intervention was generally well received, although the short time frame available for implementation and concurrent research evaluation led to some confusion among patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. LIMITATIONS Implementation and uptake of the intervention was not standardised and was limited by the study time frame. Evaluation of the intervention involved a small number of patients, which limited the ability to assess it. CONCLUSIONS The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention. FUTURE WORK The intervention warrants a randomised controlled trial to assess its clinical effectiveness and cost-effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure that adoption is sustained. STUDY REGISTRATION Current Controlled Trials ISRCTN27426982 and PROSPERO CRD42016045235. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 45. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sayeed Khan
- Make UK, The Manufacturers' Organisation, London, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David A McDonald
- Whole System Patient Flow Programme, Scottish Government, Edinburgh, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Nouri
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iain McNamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Judith Fitch
- British Orthopaedic Association Patient Liaison Group, Royal College of Surgeons of England, London, UK
| | - Louise Thomson
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Rondon AJ, Tan TL, Greenky MR, Kheir MM, Foltz C, Purtill JJ. Return to Work After Total Joint Arthroplasty: A Predictive Model. Orthopedics 2020; 43:e415-e420. [PMID: 32602918 DOI: 10.3928/01477447-20200619-12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/20/2019] [Indexed: 02/03/2023]
Abstract
Returning to work after surgery is a primary concern of patients who are contemplating total joint arthroplasty (TJA). The ability to return to work has enormous influence on the patient's independence, financial well-being, and daily activities. The goal of this study was to determine the independent patient variables that predict return to work as well as to create a predictive model. From June 2017 to December 2017, a total of 391 patients who underwent primary TJA (243 hips, 148 knees) were prospectively enrolled in the study to obtain information on return to work after surgery. Patients were sent a series of questions in a biweekly survey. Information was collected on the physical demands of their occupation, the number of hours spent standing, the limitations to return to work, and the use of assistive devices. Bivariate analysis was performed, and a multiple linear regression model was created. Most (89.6%) patients returned to work within 12 weeks of surgery. Patients who underwent total hip arthroplasty returned to work earlier than those who underwent total knee arthroplasty (5.56 vs 7.79 weeks, respectively). Analysis showed the following independent predictors for faster return to work: self-employment, availability of light-duty work, male sex, and higher income. Predictors for slower return to work included a physically demanding occupation (at least 50% physical duties), knee arthroplasty, longer length of stay, and a job requiring more hours spent standing. This model reported an adjusted R2 of 0.332. The findings provide an objective predictive model of the patient- and procedure-specific characteristics that affect postoperative return to work. Surgeons should consider these factors when counseling patients on their postoperative expectations. [Orthopedics. 2020;43(5):e415-e420.].
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Baker P, Kottam L, Coole C, Drummond A, McDaid C, Rangan A. Development of an occupational advice intervention for patients undergoing elective hip and knee replacement: a Delphi study. BMJ Open 2020; 10:e036191. [PMID: 32636283 PMCID: PMC7342851 DOI: 10.1136/bmjopen-2019-036191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To obtain consensus on the content and delivery of an occupational advice intervention for patients undergoing primary hip and knee replacement surgery. The primary targets for the intervention were (1) patients, carers and employers through the provision of individualised support and information about returning to work and (2) hospital orthopaedic teams through the development of a framework and materials to enable this support and information to be delivered. DESIGN Modified Delphi study as part of a wider intervention development study (The Occupational advice for Patients undergoing Arthroplasty of the Lower limb (OPAL) study: Health Technology Assessment Reference 15/28/02) (ISRCTN27426982). SETTING Five stakeholder groups (patients, employers, orthopaedic surgeons, general practitioners, allied health professionals and nurses) recruited from across the UK. PARTICIPANTS Sixty-six participants. METHODS Statements for the Delphi process were developed relating to the content, format, delivery, timing and measurement of an occupational advice intervention. The statements were based on evidence gathered through the OPAL study that was processed using an intervention mapping framework. Intervention content was examined in round 1 and intervention format, delivery, timing and measurement were examined in round 2. In round 3, the developed intervention was presented to the stakeholder groups for comment. CONSENSUS For rounds 1 and 2, consensus was defined as 70% agreement or disagreement on a 4-point scale. Statements reaching consensus were ranked according to the distribution of responses to create a hierarchy of agreement. Round 3 comments were used to revise the final version of the developed occupational advice intervention. RESULTS Consensus was reached for 36 of 64 round 1 content statements (all agreement). In round 2, 13 questions were carried forward and an additional 81 statements were presented. Of these, 49 reached consensus (44 agreement/5 disagreement). Eleven respondents provided an appraisal of the intervention in round 3. CONCLUSIONS The Delphi process informed the development of an occupational advice intervention as part of a wider intervention development study. Stakeholder agreement was achieved for a large number of intervention elements encompassing the content, format, delivery and timing of the intervention. The effectiveness and cost-effectiveness of the developed intervention will require evaluation in a randomised controlled trial. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982.
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Affiliation(s)
- Paul Baker
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences & Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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37
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Premkumar A, Lebrun DG, Sidharthan S, Penny CL, Dodwell ER, McLawhorn AS, Nwachukwu BU. Bariatric Surgery Prior to Total Hip Arthroplasty Is Cost-Effective in Morbidly Obese Patients. J Arthroplasty 2020; 35:1766-1775.e3. [PMID: 32278487 DOI: 10.1016/j.arth.2020.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/09/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The cost-effectiveness of bariatric surgery to achieve weight loss prior to total hip arthroplasty (THA), and decrease the complications and costs associated with THA in the morbidly obese, is unknown. This study evaluated the cost-effectiveness of bariatric surgery prior to THA for morbidly obese patients with end-stage hip osteoarthritis (OA). METHODS A state-transition Markov model was constructed to compare the cost-utility of 2 treatment protocols for patients with morbid obesity and end-stage hip OA: (1) immediate THA and (2) bariatric surgery 2 years prior to THA (combined protocol). The analysis was performed from both a payer and a societal perspective using direct and indirect costs over a 40-year time horizon. Utilities, associated costs, and probabilities for health state transitions were derived from the literature. One-way, 2-way and probabilistic sensitivity analyses were performed to validate the robustness of the base case results, using the standard willingness-to-pay threshold of $100,000/quality-adjusted life years. RESULTS From the societal perspective, the combined protocol was more effective (13.16 vs 12.26) with less cost ($91,717 vs $92,684) and thus was the dominant strategy over immediate THA. These results were stable across broad ranges for independent model variables. Monte Carlo simulation with 100,000 samples demonstrated that bariatric surgery prior to THA was the preferred cost-effective strategy over 95% of the time from both a societal and payer perspective. CONCLUSION In the morbidly obese patient with end-stage hip OA, bariatric surgery prior to THA is a cost-effective strategy for improving quality of life and decreasing societal and payer costs. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Drake G Lebrun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sreetha Sidharthan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Caitlin L Penny
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Emily R Dodwell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Coole C, Baker P, McDaid C, Drummond A. Using intervention mapping to develop an occupational advice intervention to aid return to work following hip and knee replacement in the United Kingdom. BMC Health Serv Res 2020; 20:523. [PMID: 32517684 PMCID: PMC7285551 DOI: 10.1186/s12913-020-05375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background There are increasing numbers of total hip replacements (THR) and total knee replacements (TKR) being performed in patients of working age. Providing patients undergoing TKR and THR with return to work advice might facilitate return to work. The aim of this paper is to report on the process used to systematically develop an occupational advice intervention to be delivered in hospital for those undergoing arthroplasty. Methods The six-step Intervention Mapping (IM) approach to development, implementation and evaluation of a theory and evidence-based interventions was followed. This paper reports on the development of the intervention covered by steps 1 to 4 of the IM process. Steps 1–3 gathered data on current practice and barriers to change using a mixed methods approach (cohort study of patients undergoing THR or TKR, stakeholder interviews, survey of practice, evidence synthesis) and provided a theoretical framework for intervention development. Step 4 used information from steps 1–3 in combination with a Delphi consensus process to develop the intervention and the associated tools and materials to facilitate its delivery. Results The final intervention identified included a number of core principles including: early patient identification; delivery of key information to patients and their employers; assessment and support by a member of the orthopaedic team; procedures for escalation based on patient need; mechanisms to support communication; and training and support for the clinical teams delivering care. A total of 13 patient and 20 staff performance objectives as delivery requirements, were supported by a range of tools, roles and training resources. The intervention addressed outcomes based at the individual and interpersonal levels of the ecological model. Conclusions Following the IM approach resulted in a structured and justified occupational intervention for delivery in secondary care for patients undergoing total hip and knee replacement. The feasibility of the intervention will subsequently be tested alongside further investigation to establish its effectiveness and cost-effectiveness.
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Affiliation(s)
- Carol Coole
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, England.,Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, England
| | - Paul Baker
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BW, England.
| | - Catriona McDaid
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington York, YO10 5DD, England
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, England.,Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, England
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39
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Nouri F, Coole C, Baker P, Drummond A. Return to work advice after total hip and knee replacement. Occup Med (Lond) 2020; 70:113-118. [PMID: 32009167 DOI: 10.1093/occmed/kqaa014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the information and advice on return to work received by patients undergoing total hip and knee replacement. AIMS To investigate patients' views and experiences of work-related advice provided by clinicians, and how this might be improved. METHODS Semi-structured interviews with patients who had undergone total hip and knee replacement, were working prior to surgery and intended to return to work. Data were analysed thematically. RESULTS Forty-five patients from three UK regions were consented. Eight themes were identified including lack of information, lack of an individualized approach and accessibility and acceptability of information dissemination methods. Patients identified their information needs and who they felt was best placed to address them. CONCLUSIONS Patients receive little information and advice on return to work following total hip and knee replacement, although not all patients required this. However, more focus is needed on providing this, and patients should be screened to ensure resources are best targeted with interventions being tailored to the individual.
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Affiliation(s)
- F Nouri
- School of Health Sciences, University of Nottingham, Medical School, Queens Medical Centre, Nottingham, UK
| | - C Coole
- School of Health Sciences, University of Nottingham, Medical School, Queens Medical Centre, Nottingham, UK
| | - P Baker
- James Cook University Hospital, South Tees NHS Hospitals Trust, Middlesbrough, UK
| | - A Drummond
- School of Health Sciences, University of Nottingham, Medical School, Queens Medical Centre, Nottingham, UK
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Hoorntje A, Kuijer PPFM, van Ginneken BT, Koenraadt KLM, van Geenen RCI, Kerkhoffs GMMJ, van Heerwaarden RJ. Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner. Orthop J Sports Med 2020; 7:2325967119890056. [PMID: 31909053 PMCID: PMC6935877 DOI: 10.1177/2325967119890056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Limited evidence exists on patient-relevant outcomes after high tibial osteotomy (HTO), including return to work (RTW). Furthermore, prognostic factors for RTW have never been described. Purpose To investigate the extent and timing of RTW in the largest HTO cohort investigated for RTW to date and to identify prognostic factors for RTW after HTO. Study Design Cohort study; Level of evidence, 3. Methods Consecutive patients who underwent HTO between 2012 and 2015 were included. Patients received a questionnaire at a mean follow-up of 3.6 years. Questions were asked pre- and postoperatively regarding work status, job title, working hours, preoperative sick leave, employment status, and whether patients were their family's breadwinner. The validated Work Rehabilitation Questionnaire (WORQ) was used to assess difficulty with knee-demanding activities. Prognostic factors for RTW were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results We identified 402 consecutive patients who underwent HTO, of whom 349 were included. Preoperatively, 299 patients worked, of whom 284 (95%) achieved RTW and 255 (90%) returned within 6 months. Patients reported significant postoperative improvements in performing knee-demanding activities. Being the family's breadwinner was the strongest predictor of RTW (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.27-6.69). In contrast, preoperative sick leave was associated with lower odds of RTW (OR, 0.20; 95% CI, 0.08-0.46). Conclusion After HTO, 95% of patients were able to RTW, of whom 9 of 10 returned within 6 months. Breadwinners were more likely to RTW, and patients with preoperative sick leave were less likely to RTW within 6 months. These findings may be used to improve preoperative counseling and expectation management and thereby enhance work-related outcomes after HTO.
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Affiliation(s)
- Alexander Hoorntje
- Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Berbke T van Ginneken
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Gino M M J Kerkhoffs
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Ronald J van Heerwaarden
- Department of Orthopaedic Surgery, Maartenskliniek Woerden, Woerden, the Netherlands.,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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van Zaanen Y, van Geenen RCI, Pahlplatz TMJ, Kievit AJ, Hoozemans MJM, Bakker EWP, Blankevoort L, Schafroth MU, Haverkamp D, Vervest TMJS, Das DHPW, van der Weegen W, Scholtes VA, Frings-Dresen MHW, Kuijer PPFM. Three Out of Ten Working Patients Expect No Clinical Improvement of Their Ability to Perform Work-Related Knee-Demanding Activities After Total Knee Arthroplasty: A Multicenter Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:585-594. [PMID: 30539374 PMCID: PMC6675779 DOI: 10.1007/s10926-018-9823-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose Three out of ten patients do not return to work after total knee arthroplasty (TKA). Patient expectations are suggested to play a key role. What are patients' expectations regarding the ability to perform work-related knee-demanding activities 6 months after TKA compared to their preoperative status? Methods A multi-center cross-sectional study was performed among 292 working patients listed for TKA. The Work Osteoarthritis or joint-Replacement Questionnaire (WORQ, range 0-100, minimal important difference 13) was used to assess the preoperatively experienced and expected ability to perform work-related knee-demanding activities 6 months postoperatively. Differences between the preoperative and expected WORQ scores were tested and the most difficult knee-demanding work-related activities were described. Results Two hundred thirty-six working patients (81%) completed the questionnaire. Patients' expected WORQ score (Median = 75, IQR 60-86) was significantly (p < 0.01) higher than their preoperative WORQ score (Median = 44, IQR 35-56). A clinical improvement in ability to perform work-related knee-demanding activities was expected by 72% of the patients, while 28% of the patients expected no clinical improvement or even worse ability to perform work-related knee-demanding activities 6 months after TKA. Of the patients, 34% expected severe difficulty in kneeling, 30% in crouching and 17% in clambering 6 months after TKA. Conclusions Most patients have high expectations, especially regarding activities involving deep knee flexion. Remarkably, three out of ten patients expect no clinical improvement or even a worse ability to perform work-related knee-demanding activities 6 months postoperatively compared to their preoperative status. Therefore, addressing patients expectations seems useful in order to assure realistic expectations regarding work activities.
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Affiliation(s)
- Yvonne van Zaanen
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Thijs M J Pahlplatz
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur J Kievit
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marco J M Hoozemans
- CORAL - Center for Orthopaedic Research Alkmaar, Department of Orthopaedics, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Eric W P Bakker
- Master Evidence Based Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Slotervaart Center of Orthopedic Research and Education (SCORE), MC Slotervaart, Amsterdam, The Netherlands
| | - Ton M J S Vervest
- Department of Orthopaedic Surgery, Tergooi Hospital, Hilversum, The Netherlands
| | - Dirk H P W Das
- Department and Research Center of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Walter van der Weegen
- Department and Research Center of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | | | - Monique H W Frings-Dresen
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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42
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Coole C, Nouri F, Narayanasamy M, Baker P, Drummond A. Total hip and knee replacement and return to work: clinicians' perspectives. Disabil Rehabil 2019; 43:1247-1254. [PMID: 31442079 DOI: 10.1080/09638288.2019.1654000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE An ageing workforce means that our understanding of return to work following total hip and knee replacement is of increasing importance. The purpose of this qualitative study was to explore the views and experiences of clinicians in treating working patients undergoing total hip or knee replacement. MATERIALS AND METHODS We conducted semi-structured interviews in primary and secondary National Health Service care using framework methodology. A total of 40 interviews were conducted. Participants included 12 hospital-based Allied Health Professionals and nurses, 12 orthopedic surgeons, and 16 General Practitioners. Data were analyzed thematically. RESULTS A key theme concerned participants' perceptions and experiences around the process and practice of listing working patients for total hip or knee replacement. Four sub-themes were identified; the perceived likelihood of listing employed patients for surgery, expectations and outcomes of surgery, the impact of work issues, and referral procedures and waiting lists. CONCLUSIONS Decisions around listing working patients for total hip and knee replacement are complex and difficult. Clinicians need to consistently consider patients' work issues, and to be supported in this by appropriate commissioning and service delivery decisions. Further research is indicated to better understand the work-related expectations and anticipated outcomes of both patients and clinicians, and the optimum timing of surgery to maintain and improve patients' work performance.Implications for rehabilitationClinicians need to consistently consider patients' work issues, and current evidence, in their consultations and decisions regarding total hip and knee replacement.Clinical practice should reflect the growing proportion of working patients undergoing total hip and knee replacement, and routinely measure work outcomes.Changes are required at commissioning and service levels to support clinicians in changing their practice with this patient population.
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Affiliation(s)
- Carol Coole
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Nouri
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Paul Baker
- James Cook University Hospital, South Tees NHS Hospitals Trust, Middlesbrough, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Lankinen P, Laasik R, Kivimäki M, Aalto V, Saltychev M, Vahtera J, Mäkelä K. Are patient-related pre-operative factors influencing return to work after total knee arthroplasty. Knee 2019; 26:853-860. [PMID: 31126842 DOI: 10.1016/j.knee.2019.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/08/2019] [Accepted: 04/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritis is one of the leading causes of disability in working-age patients. The total number of working-age patients undergoing total-knee arthroplasty (TKA) is continuously increasing. The purpose of this study was to identify predictive factors related to general health, health risk behaviors and socioeconomic status influencing the rate of return to work after a TKA. METHODS Overall there were 151,901 patients included in the Finnish Public Sector (FPS) study. The response rate varied between 65 and 73% during the study period. We used Cox proportional hazard models to examine patient-related predictive factors that may influence the rate of return to work after TKA in a cohort of patients (n = 452; n = 362 female; mean age 56.4 years). Predictive factors were measured on average 3.6 years before the operation. RESULTS Of the patients, 87% returned to work within one year after TKA at a mean of 116 calendar days. In multivariate analysis, patients at sick-leave ≤30 days during the last year before surgery were 2.2 times (95% confidence interval 1.72-2.92) more likely to return to work compared with those with >30 days of sick-leave. Compared with patients in manual work, those in higher or lower level non-manual work showed a 2.6-fold (1.95-3.52) and 1.5-fold (1.15-1.92) increased probability of returning to work. Age, sex, health risk behaviors, obesity, physical comorbidities, common mental disorders, and other studied health-related factors were not associated with the rate of return to work. CONCLUSIONS Non-manual job, good self-rated general health and preoperative sick leave ≤30 days are associated with a higher rate of return to work.
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Affiliation(s)
- Petteri Lankinen
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland.
| | - Raul Laasik
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK
| | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
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Abstract
Kneeling ability is consistently the poorest patient-rated outcome after total knee replacement (TKR), with 60-80% of patients reporting difficulty kneeling or an inability to kneel.Difficulty kneeling impacts on many activities and areas of life, including activities of daily living, self-care, leisure and social activities, religious activities, employment and getting up after a fall. Given the wide range of activities that involve kneeling, and the expectation that this will be improved with surgery, problems kneeling after TKR are a source of dissatisfaction and disappointment for many patients.Research has found that there is no association between range of motion and self-reported kneeling ability. More research is needed to understand if and how surgical factors contribute to difficulty kneeling after TKR.Discrepancies between patients' self-reported ability to kneel and observed ability suggests that patients can kneel but elect not to. Reasons for this are multifactorial, including knee pain/discomfort, numbness, fear of harming the prosthesis, co-morbidities and recommendations from health professionals. There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation.There has been little research to evaluate the provision of healthcare services and interventions for patients who find kneeling problematic after TKR. Increased clinical awareness of this poor outcome and research to inform the provision of services is needed to improve patient care and allow patients to return to this important activity. Cite this article: EFORT Open Rev 2019;4:460-467. DOI: 10.1302/2058-5241.4.180085.
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Affiliation(s)
- Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - Neil Artz
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Nick Howells
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.,North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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45
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Nouri F, Coole C, Narayanasamy M, Baker P, Khan S, Drummond A. Managing Employees Undergoing Total Hip and Knee Replacement: Experiences of Workplace Representatives. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:451-461. [PMID: 30132175 PMCID: PMC6531398 DOI: 10.1007/s10926-018-9805-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Introduction There is little research on return to work (RTW) from a workplace perspective following hip and knee replacement (THR/TKR) despite employers and other workplace personnel having a key role. Our aim was to explore the experiences of individuals in the workplace in managing employees undergoing THR/TKR. Methods Employers and other workplace representatives from a cross-section of employment sectors and sizes, with experience of managing employees undergoing THR/TKR in the previous 12 months, were recruited. Interviewees included small business owners, line managers, colleagues, human resources managers and occupational health advisers. Semi-structured, qualitative interviews were conducted and data were analysed thematically. Results Twenty-five individuals were interviewed. The main themes identified were accommodating the employee, and barriers and facilitators to RTW. Accommodations included changes to the work environment, amended duties, altered hours, changed roles and colleague support. Perceived barriers and facilitators to RTW included the role of GPs and occupational health, surgical issues, characteristics of the work environment and of employees. Conclusions Employers are motivated to effect supported RTW for employees undergoing THR/TKR but have insufficient guidance. Strategies are required to signpost employers to existing RTW advice, and to develop recommendations specific to lower limb arthroplasty. Communication between medical practitioners and employers should be facilitated in order to enhance the RTW experience of individuals undergoing THR/TKR.
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Affiliation(s)
- Fiona Nouri
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Carol Coole
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Paul Baker
- South Tees NHS Hospitals Trust, James Cook University Hospital, Middlesbrough, TS3 4BW, UK
| | - Sayeed Khan
- The Buckingham Centre, Collingwood Health, 30 Bradford Road, Slough, SL1 4PG, UK
| | - Avril Drummond
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
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46
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Laasik R, Lankinen P, Kivimäki M, Aalto V, Saltychev M, Mäkelä K, Vahtera J. Return to work after primary total hip arthroplasty: a nationwide cohort study. Acta Orthop 2019; 90:209-213. [PMID: 30907679 PMCID: PMC6534229 DOI: 10.1080/17453674.2019.1591081] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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 - While the number of working-age patients undergoing total hip arthroplasty (THA) is increasing, the effect of the surgery on patients' return to work (RTW) is not thoroughly studied. We aimed to identify risk factors of RTW after THA among factors related to demographic variables, general health, health risk behaviors, and socioeconomic status. Patients and methods - We studied 408 employees from the Finnish Public Sector (FPS) cohort (mean age 54 years, 73% women) who underwent THA. Information on demographic and socioeconomic variables, preceding health, and health-risk behaviors was derived from linkage to national health registers and FPS surveys before the operation. The likelihood of return to work was examined using Cox proportional hazard modeling. Results - 94% of the patients returned to work after THA on average after 3 months (10 days to 1 year) of sickness absence. The observed risk factors of successful return to work were: having < 30 sick leave days during the last year (HR 1.8; 95% CI 1.4-2.3); higher occupational position (HR 2.2; CI 1.6-2.9); and BMI < 30 (HR 1.4; CI 1.1-1.7). Age, sex, preceding health status, and health-risk behaviors were not correlated with RTW after the surgery. Interpretation - Most employees return to work after total hip arthroplasty. Obese manual workers with prolonged sick leave before the total hip replacement were at increased risk of not returning to work after the surgery.
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Affiliation(s)
- Raul Laasik
- Department of Orthopaedics and Trauma, Tampere University Hospital, Tampere, Finland; ,Correspondence:
| | - Petteri Lankinen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland;
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland;; ,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland;; ,Department of Epidemiology and Public Health, University College London, London, UK;;
| | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Finland;;
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland;
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland;
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
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Kontio T, Viikari-Juntura E, Solovieva S. Effect of Osteoarthritis on Work Participation and Loss of Working Life-years. J Rheumatol 2019; 47:597-604. [PMID: 31043546 DOI: 10.3899/jrheum.181284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine to what extent disabling osteoarthritis (OA), leading to a prolonged sickness absence (SA), interferes with work participation and shortens working life-years. METHODS A total of 4704 wage earners aged 30 to 59 years, whose SA due to OA started in 2006, were followed until October 31, 2014. Kaplan-Meier analysis was used to plot sustained (at least 28 consecutive days) return-to-work curves. The associations of potential determinants with early exit from paid employment were examined applying Cox proportional hazards regression analysis. Years expected to be spent in different work participation statuses until statutory retirement age were estimated based on daily work participation statuses using adapted Sullivan method. RESULTS Persons with knee OA showed the fastest, and persons with hip OA the slowest, sustained return to work. Although most participants typically were at work during the first year of followup, a considerable proportion was permanently retired. Male sex, older age, low education, long initial SA, and having not returned to work sustainably, as well as receiving vocational rehabilitation, predicted early exit from paid employment during the followup. Overall, only 45-53% of potential working life-years were estimated to be spent at work, being highest for the oldest age group. CONCLUSION Our study showed a considerable effect of OA on work participation and working life duration. Clinicians should avoid prescription of long SA or temporary work disability due to OA without a clear treatment or return-to-work plan.
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Affiliation(s)
- Tea Kontio
- From the University of Helsinki; Finnish Institute of Occupational Health, Helsinki, Finland.,T. Kontio, MD, University of Helsinki; E. Viikari-Juntura, MD, PhD, Finnish Institute of Occupational Health; S. Solovieva, PhD, Finnish Institute of Occupational Health
| | - Eira Viikari-Juntura
- From the University of Helsinki; Finnish Institute of Occupational Health, Helsinki, Finland.,T. Kontio, MD, University of Helsinki; E. Viikari-Juntura, MD, PhD, Finnish Institute of Occupational Health; S. Solovieva, PhD, Finnish Institute of Occupational Health
| | - Svetlana Solovieva
- From the University of Helsinki; Finnish Institute of Occupational Health, Helsinki, Finland. .,T. Kontio, MD, University of Helsinki; E. Viikari-Juntura, MD, PhD, Finnish Institute of Occupational Health; S. Solovieva, PhD, Finnish Institute of Occupational Health.
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48
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Hoorntje A, Janssen KY, Bolder SBT, Koenraadt KLM, Daams JG, Blankevoort L, Kerkhoffs GMMJ, Kuijer PPFM. The Effect of Total Hip Arthroplasty on Sports and Work Participation: A Systematic Review and Meta-Analysis. Sports Med 2019; 48:1695-1726. [PMID: 29691754 PMCID: PMC5999146 DOI: 10.1007/s40279-018-0924-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Total hip arthroplasty (THA) is a successful procedure to treat end-stage hip osteoarthritis. The procedure is increasingly performed in adults of working age, who often wish to return to sports (RTS) and return to work (RTW). However, a systematic overview of the evidence on RTS and RTW after THA is lacking. Objectives Our aim was to systematically review (1) the extent to which patients RTS and RTW after THA, including (2) the time to RTS and RTW. Methods We searched MEDLINE and Embase from inception until October 2017. Two authors screened and extracted the data, including study information, patient demographics, rehabilitation protocols and pre- and postoperative sports and work participation. Methodological quality was assessed using the Newcastle–Ottawa scale. Data on pre- and postoperative sports and work participation were pooled using descriptive statistics. Results A total of 37 studies were included, of which seven were prospective studies and 30 were retrospective studies. Methodological quality was high in 11 studies, moderate in 16 studies, and low in ten studies. RTS was reported in 14 studies. Mean RTS was 104% to the pre-surgery level and 82% to the pre-symptomatic sports level. Time to RTS varied from 16 to 28 weeks. RTW was reported in 23 studies; the mean was 69%. Time to RTW varied from 1 to 17 weeks. Conclusion A great majority of patients RTS and RTW after THA within a timeframe of 28 and 17 weeks, respectively. For the increasingly younger THA population, this is valuable information that can be used in the preoperative shared decision-making process. Electronic supplementary material The online version of this article (10.1007/s40279-018-0924-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands. .,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Kim Y Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Stefan B T Bolder
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Joost G Daams
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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49
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Abstract
Background A substantial proportion of patients undergoing lower limb arthroplasty are of working age. This study aims to identify when patients return to work (RTW) and if they return to normal hours and duties, and to identify which factors influence postoperative RTW. The hypothesis is that there is no difference in time of RTW between the different types of surgery, and no difference in time of RTW based on the physical demands of the job. Materials and methods Consecutive patients aged < 65 years who had undergone unilateral primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or medial unicompartmental knee arthroplasty (UKA) from 2015 to 2017 were sent a questionnaire. Quantitative questions explored timing and nature of RTW, and qualitative questions explored factors influencing timing of RTW. Results There were 116 patients (64 male, 52 female) with an average age of 56 years. Thirty-one patients were self-employed and 85 were employees. Of these patients, 58 had undergone THA, 31 had undergone TKA, and 27 had undergone UKA. One hundred and six (91%) patients returned to work. Patients returned to work after (mean) 6.4 weeks (THA), 7.7 weeks (TKA), and 5.9 weeks (UKA). Time of RTW was not significantly influenced by type of surgery (p = 0.18) (ns). There was a non-significant correlation between physical demands of the work versus time of RTW (p = 0.28) (ns). There was a significantly earlier time of RTW if flexible working conditions were resumed (p = 0.003). Active recovery, motivation, necessity and job flexibility enabled RTW. The physical effects of surgery, medical restrictions and work factors impeded RTW. Conclusion The time of RTW was not significantly influenced by the type of operation or by the physical demands of the job. Patients returned to work 5.9–7.7 weeks after hip/knee arthroplasty. Rehabilitation, desire, and necessity promoted RTW. Pain, fatigue and medical restrictions impeded RTW. Level of evidence 3.
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Devasenapathy N, Maddison R, Malhotra R, Zodepy S, Sharma S, Belavy DL. Preoperative Quadriceps Muscle Strength and Functional Ability Predict Performance-Based Outcomes 6 Months After Total Knee Arthroplasty: A Systematic Review. Phys Ther 2019; 99:46-61. [PMID: 30329137 DOI: 10.1093/ptj/pzy118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/23/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND One-third of individuals report limitations in activities of daily living even 6 months after total knee arthroplasty (TKA). Moderate-quality evidence exists for several sociodemographic and clinical predictors of patient-reported outcome measures of perceived functionality. Objectively measured performance-based measures (PBMs) provide a less subjective approach to informing patient treatment after TKA; however, information about predictors of functionally relevant PBMs is scarce. PURPOSE This systematic review synthesized the available research on preoperative predictors of PBMs after primary TKA for osteoarthritis. DATA SOURCES In June 2016 and January 2017, MEDLINE, EMBASE, and PsycINFO databases were searched. STUDY SELECTION Cohort studies exploring preoperative predictors of stair climbing, walking speed, and gait speed measured ≥6 months after primary TKA were included. Screening of abstracts and selection of full texts were undertaken by 2 independent reviewers. DATA EXTRACTION Information on study design, patient characteristics, analysis, and results was extracted using pilot-tested forms. Two independent reviewers assessed risk of bias using modified Quality in Prognostic Studies criteria. DATA SYNTHESIS Of the eligible 12 studies involving 6 prospective cohorts, 10 studies reported information on baseline predictors. Meta-analysis of predictors was not possible because of missing information on effect size or standard errors. Narrative synthesis of evidence of predictors was therefore performed. LIMITATIONS The quality of evidence was low because of the risk of bias and heterogeneity of included studies as well as nonreporting of measures of effect. CONCLUSIONS Low-quality evidence exists for an association of preoperative functional ability and quadriceps muscle strength with functionality at 6 months after TKA. Improved reporting of predictor analyses is needed to enable evidence generation for clinical management.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot 47, Sec 44, Institutional Area, Gurgaon-122002, Haryana, India; and School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Ralph Maddison
- Physical Activity and Disease Prevention, School of Exercise and Nutrition Sciences, Deakin University
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Zodepy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India
| | | | - Daniel L Belavy
- Exercise and Musculoskeletal Health, School of Exercise and Nutrition Sciences, Deakin University
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