A prospective study of joint function and the quality of life of patients undergoing total joint replacement

The dynamic impact of Joint Awareness on Quality of Life after Total Knee Arthroplasty: a longitudinal study

BACKGROUND

Joint Awareness is thought to be closely linked to Quality of Life (QoL) for patients undergoing Total Knee Arthroplasty (TKA), yet to date there have been no longitudinal studies to explore how Joint Awareness actually affects QoL. The purpose of this study was therefore to examine the development of Joint Awareness and QoL after TKA as well as the dynamic impact of Joint Awareness on QoL.

METHODS

A total of 342 patients were followed up at 3 months (T1), 6 months (T2), and 12 months (T3) after TKA. Joint Awareness was evaluated using the Forgotten Joint Score-12 (FJS-12), and QoL was measured by SF-36. We used repeated measures analysis of variance to estimate the development of Joint Awareness and QoL and employed a cross-lagged model to examine the dynamic relationship between Joint Awareness and QoL.

RESULTS

Both Joint Awareness and QoL improved with postoperative time (p < 0.001). Importantly, T1 Joint Awareness positively predicted T2 physical QoL (p < 0.001), and T2 Joint Awareness positively predicted T3 physical QoL (p < 0.001). Nevertheless, Joint Awareness had no predictive effect on mental QoL (p = 0.082-0.931).

CONCLUSIONS

In different periods after TKA, Joint Awareness and QoL both increased monotonically, and Joint Awareness positively predicted physical QoL. These findings indicate that focusing on Joint Awareness may be a priority when trying to improve the postoperative life of patients.

Health-Related Quality of Life of Patients Presenting to the Emergency Department with a Musculoskeletal Disorder

Background

Musculoskeletal disorders (MSKDs) are among the most disabling and costly non-fatal health conditions. They may lead to long-term consequences such as chronic pain, physical limitations, and poorer quality of life. They also account for a significant proportion of emergency department visits, representing between 18% and 25% of all visits, depending on country.

Purpose

To assess the health-related quality of life of patients presenting to the emergency department with a MSKD, to convert their answers to utility scores and to explore the association between diverse socio-demographic and clinical variables and patients’ health-related quality of life.

Patients and Methods

This is an analysis of cross-sectional data obtained during the baseline assessment performed as part of a 6-month pragmatic randomized controlled trial conducted in an academic emergency department. We included patients aged 18–80 years with a minor MSKD. The main outcome measures were health-related quality of life (five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and utility scores (−0.148 – worse than death, 0 – dead, 0.949 – perfect health) measured with the EQ-5D-5L. Possible associations were explored by comparing scores across subgroups based on certain socio-demographic (eg, age, gender, triage score) and clinical factors (eg, pain interference on function, pain intensity) and with reference values using descriptive statistics (mean, median), rankFD ANOVAs, and χ² tests.

Results

Sixty-nine participants completed the EQ-5D-5L. Mean and median utility scores were, respectively, 0.536 (95% CI: 0.479–0.594) and 0.531 (IQR: 0.356–0.760). Participants with higher levels of pain (<4/10: 0.741, 95% CI: 0.501–0.980; 4–7/10: 0.572, 0.500–0.644; >7/10: 0.433, 0.347–0.518) or pain interference on function (<4/10: 0.685, 95% CI: 0.605–0.764; 4–7/10: 0.463, 0.394–0.533; >7/10: 0.294, 0.126–0.463) presented significantly lower utility scores. No significant differences were found for other socio-demographic characteristics.

Conclusion

In patients with MSKDs who present to the emergency department, higher levels of pain or pain interference are associated with decreased health-related quality of life. These findings need to be confirmed on a larger scale.

Knee joint function, walking ability and quality of life within 6 weeks after total knee arthroplasty: A prospective cohort study

AIMS AND OBJECTIVES

To track changes in patients' knee function, walking ability and quality of life (QOL) before and after knee arthroplasty surgery and explore factors that influenced these parameters.

BACKGROUND

The number of days as an inpatient for those who undergo joint replacement operations has been greatly reduced in recent years. However, it remains unclear whether shortening the inpatient time has affected patients' recovery or their QOL.

DESIGN

Prospective cohort study.

METHOD

In total, 101 participants who underwent total knee arthroplasty (TKA) were enrolled, with data collected preoperatively and at the 2nd and 6th weeks postoperatively. We followed the STROBE checklist to ensure the rigour of our study.

RESULTS

Forty-nine participants underwent unilateral TKA (UTKA; 48.5%), and 52 underwent simultaneous bilateral TKA (SBTKA; 51.5%). At the 2nd week postoperatively, knee joint function was significantly worse than that preoperatively. However, these patients did not exhibit significant differences in the EQ-5D utility index (EQ-5D UI) compared to their preoperative scores. At the 6th week postoperatively, the knee joint function and EQ-5D UI were significantly better than preoperative values. Participants who underwent UTKA scored higher on the Oxford knee score (OKS) than did SBTKA participants. However, no significant differences were noted between the two groups for the knee flexion angle, the timed up and go (TUG) test, or the EQ-5D UI score.

CONCLUSIONS AND SUGGESTIONS

At the postoperative 6th week, participants exhibited improved knee joint function and QOL, but there was no difference in the walking ability compared to preoperative values. At the 6th week after surgery, patients who underwent SBTKA exhibited poorer joint function than did those who underwent UTKA.

RELEVANCE TO CLINICAL PRACTICE

These results can assist nursing staffs and serve as a reference for providing patient education and nursing intervention to TKA patients.