The changes in health-related quality of life and related factors during the process of total hip arthroplasty

Does reverse shoulder arthroplasty improve emotional status and quality of life in patients with rotator cuff insufficiency? Prospective sequential follow-up study

BACKGROUND

The purpose of this study was to investigate sequential changes of emotional status and quality of life after reverse shoulder arthroplasty (RSA) for rotator cuff insufficiency and to determine the predictors that can affect postoperative clinical outcomes. This study was conducted to prove the hypothesis that RSA would improve emotional status and quality of life.

METHODS

Fifty patients undergoing RSA for rotator cuff insufficiency were prospectively included. Evaluation using the visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value, Hospital Anxiety and Depression Scale (HADS), and Abbreviated scale of World Health Organization Quality of Life (WHOQOL-BREF) was performed before surgery and at 1.5, 3, 6, and 12 months after surgery.

RESULTS

The mean visual analog scale pain score, HADS-depression score, and HADS-anxiety score showed a significant decrease from 6.6, 13.3, and 13.9 before surgery to 1.5, 3.9, and 3.7 after 12 months after surgery, respectively (all P < .001). The mean ASES score, WHOQOL-BREF score, and subjective shoulder value showed a significant improvement from 28.5, 32.3, and 23.6% to 81.3, 79.1, and 78.4%, respectively (all P < .001). All outcome measurements showed a significant improvement from 6 weeks after RSA. In multivariate analysis, age was an independent predictor of the final ASES score and WHOQOL-BREF score (P = .037 and .004, respectively).

CONCLUSION

This study showed a sequential improvement of emotional status and quality of life as well as functional recovery with pain relief from 6 weeks after RSA in patients with rotator cuff insufficiency. Especially, younger patients had better postoperative functional ability and quality of life. These findings suggest that RSA for rotator cuff insufficiency provides a rapid improvement of emotional status and quality of life.

Emotions of Orthopaedic Arthroplasty Patients: A European Survey

METHODS

This was a pre/post-observational study examining patients' emotions before and during elective knee or hip replacement surgery for osteoarthritis in seven European Union countries to identify factors related to better emotional status at discharge.

INSTRUMENTS

In addition to demographic data, information was collected on quality of life (EuroQoL five-dimension questionnaire), hospital expectations (Knowledge Expectations of Hospital Patients Scale), symptoms, and experienced emotions.

ANALYSIS

Total negative emotions scores at baseline and discharge were transformed into median values. Multivariate analysis identified the baseline factors related to better emotional status at discharge.

RESULTS

Patients (n = 1,590), mean age 66.7 years (SD = 10.6), had a significant reduction in the frequency of total negative emotions at discharge as compared with baseline. The multivariate model showed better health status (odds ratio [OR] = 1.012; p = .004), better emotional status at baseline (≥24 points), and shorter duration of hospital stay (OR = 0.960; p = .011) as independent factors associated with better emotional status at discharge (OR = 4.297; p = .001).

CONCLUSIONS

Patients undergoing elective knee or hip replacement surgery for osteoarthritis improve their emotional status during hospitalization, with fewer negative emotions at discharge. Good emotional status, feeling of higher health status at baseline, and shorter hospitalization were independently associated with better emotional status at discharge.

Changes in Psychological Status and Health-Related Quality of Life Following Total Shoulder Arthroplasty

BACKGROUND

There has been little documentation of the effects of total shoulder arthroplasty (TSA) on psychological status and health-related quality of life (HRQoL). We investigated changes in psychological status (depression and anxiety) and HRQoL following TSA and assessed the effect of preoperative psychological status on postoperative clinical and functional outcome. We hypothesized that TSA would improve both psychological status and HRQoL.

METHODS

We prospectively enrolled 46 patients undergoing TSA for osteoarthritis. Preoperatively and at 3, 6, and 12 months postoperatively, all of the subjects completed the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons Scale (ASES), the Subjective Shoulder Value (SSV) measure, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF).

RESULTS

From 3 months after surgery, significant improvement in HADS-depression, HADS-anxiety, and WHOQOL-BREF scores as well as in the other outcome measures of VAS pain score, ASES score, and SSV were observed. The prevalence of depression and anxiety decreased from a rate of 15.2% and 19.5%, respectively, preoperatively to a rate of 6.5% for each at 12 months postoperatively. Preoperative HADS-depression and HADS-anxiety scores did not correlate with any of the clinical and functional outcome measures at 12 months after surgery.

CONCLUSIONS

This study showed significant improvement in psychological status and HRQoL as well as in pain and functional ability from 3 months after TSA in patients with osteoarthritis. Preoperative depression and anxiety did not predict poor postoperative outcome. Our findings suggest that TSA offers an excellent chance of improving psychological status and HRQoL.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Effect of Acetabular Component Positioning on Functional Outcomes in Primary Total Hip Arthroplasty

BACKGROUND

Acetabular component positioning is crucial to a successful total hip arthroplasty (THA). This study evaluated the effect of absolute acetabular component position as well as acetabular position relative to bony anatomy on patient-reported functional outcomes after primary THA.

METHODS

Primary, press fit, hemispherical metal-on-polyethylene THA performed between 2003 and 2011 were analyzed. Western Ontario and McMaster Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), Short Form-12 scores, and radiographs between 2 and 3 years after the index procedure were assessed.

RESULTS

Of the 1241 primary THA included, the mean abduction and anteversion angles were 44.4 ± 6.94 and 21.7 ± 11.9 degrees, respectively. The mean anterior and lateral overhang were 1.9 ± 3.6 and 2.5 ± 3.4 mm, respectively. There was no correlation between functional outcomes and acetabular inclination. A weak positive correlation between anteversion and HHS (P < .001) and WOMAC (P = .02) scores was found. For relative position, anterior overhang of the acetabular component beyond the bone resulted in inferior Short Form-12 physical function (P = .001), HHS (P = .004), and WOMAC (P < .001) scores compared to those with bony coverage. Mean HHS pain score was 41.20 ± 5.69 in patients with lateral overhang and 41.97 ± 5.04 in those who had bony coverage of the lateral edge of the acetabular component (P = .02).

CONCLUSION

The tribology and biomechanics of acetabular component position have been extensively studied without examination of how it affects patient function. Although statistical significance was seen, clinical outcome scores were not sensitive enough to show a clinically significant effect of the absolute or relative position of the acetabular component.

The Knowledge Test Feedback Intervention (KTFI) increases knowledge level of spinal stenosis patients before operation-A randomized controlled follow-up trial

OBJECTIVE

To assess the impact of a preoperative educational intervention on the knowledge level of patients with spinal stenosis.

METHODS

One hundred spinal stenosis patients were randomized into a preoperative educational intervention group (IG, n=50) or a control group (CG, n=50). All the patients received routine preoperative education. In addition, the IG went through an empowering telephone discourse based on a knowledge test performed before admission to hospital. Data on patients' knowledge level were collected at baseline (after the treatment decision), admission to hospital, discharge from hospital and at 3 and 6 months follow-up.

RESULTS

At baseline, there was no difference in the knowledge level of the study groups. At admission, the knowledge level was significantly higher in five of six dimension of empowering knowledge in the IG compared to the CG. During follow-up, the knowledge level within the study groups remained stable.

CONCLUSION

A preoperative KTFI significantly increased the patients' knowledge level in most dimensions of empowering knowledge.

PRACTICE IMPLICATION

KTFI is an effective method of preoperative education in patients with spinal stenosis.

Work disability functional assessment battery: feasibility and psychometric properties

OBJECTIVE

To assess the feasibility and psychometric properties of 8 scales covering 2 domains of the newly developed Work Disability Functional Assessment Battery (WD-FAB): physical function (PF) and behavioral health (BH) function.

DESIGN

Cross-sectional study.

SETTING

Community.

PARTICIPANTS

Adults (N=973) unable to work because of a physical (n=497) or a mental (n=476) disability.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Each disability group responded to a survey consisting of the relevant WD-FAB scales and existing measures of established validity. The WD-FAB scales were evaluated with regard to data quality (score distribution, percentage of "I don't know" responses), efficiency of administration (number of items required to achieve reliability criterion, time required to complete the scale) by computerized adaptive testing (CAT), and measurement accuracy as tested by person fit. Construct validity was assessed by examining both convergent and discriminant correlations between the WD-FAB scales and scores on same-domain and cross-domain established measures.

RESULTS

Data quality was good, and CAT efficiency was high across both WD-FAB domains. Measurement accuracy was very good for PF scales; BH scales demonstrated more variability. Construct validity correlations, both convergent and divergent, between all WD-FAB scales and established measures were in the expected direction and range of magnitude.

CONCLUSIONS

The data quality, CAT efficiency, person fit, and construct validity of the WD-FAB scales were well supported and suggest that the WD-FAB could be used to assess PF and BH function related to work disability. Variation in scale performance suggests the need for future work on item replenishment and refinement, particularly with regard to the Self-Efficacy scale.

Factors relating to perioperative experience of older persons undergoing joint replacement surgery: an integrative literature review

PURPOSE

The purpose of this literature review was to examine factors relating to the perioperative experience of older persons undergoing total hip and knee replacement surgery resulting from osteoarthritis.

METHOD

A literature search was undertaken using databases CINAHL, PubMed, Scopus and Web of Science to provide relevant research articles. Articles were included if they examined the factors relating to the HRQOL, QOL and perioperative experience of older persons undergoing joint replacement surgery resulting from osteoarthritis. The use of Joanna Briggs Institute's critical appraisal checklist facilitated a systematic appraisal of studies with regard to the scientific rigor of the studies.

RESULTS

Twenty-two publications were categorized into one main theme: "factors relating to perioperative experience" subcategorized into eight subthemes: "waiting time", "pain and disability", "mental health", "race/ethnicity, age and gender", "body image", "coping and social support", "patient education" and "care continuity".

CONCLUSION

There is a need to conduct further research to examine the perioperative experience of older persons undergoing joint replacement surgery, in particular, the lived perioperative experience of a diverse race, ethnicity and culture in an Asian population. Implications for Rehabilitation Healthcare services should remain focused on reducing waiting time as prolonged waiting time for joint replacement surgery was detrimental to patients' HRQOL. Healthcare professionals need to identify strategies to improve the perioperative pain experience through patient education on pain management and positive social support to support the process of recovery. Patients' expectations of pain and their process of recovery were closely linked to patient education. One model of patient education that was seen to be successful and linked to good post-operative outcomes was care continuity model. Being actively involved in the care continuity results in better post-operative outcomes for the patient and their family.

Total hip replacement: a systematic review and meta-analysis on mid-term quality of life

OBJECTIVE

Total hip replacement (THR) is one of the most successful and frequently performed operations worldwide. Health-related quality of life (HRQOL) is a key outcome measure of surgery. We investigated mid-term HRQOL after THR in patients with osteoarthritis (OA).

DESIGN

A systematic review of clinical studies published after January 2000 was performed using strict eligibility criteria. Quality appraisal and data tabulation were performed using pre-determined forms. Data were synthesised by narrative review and random-effects meta-analysis using standardised response means. Tau(2) and I(2) values and Funnel plots were analysed.

RESULTS

20 studies were included. Mid-term post-operative HRQOL is superior compared to pre-operative status on qualitative and quantitative analysis. Pooled response means of total Harris Hip Score (HHS) (P < 0.00001) and combined pain (P = 0.00001) and physical function (P < 0.00001) domains of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and HHS improved markedly up to 7 years. Medical Outcomes Survey Short Form 36 shows physical functioning (PF) (P < 0.00001), bodily pain (BP) (P < 0.00001), role physical (P = 0.001), role emotional (P = 0.04), and social functioning (SF) (P = 0.03) were improved up to 7 years. General health (GH) (P = 0.29), mental health (MH) (P = 0.43), and vitality (P = 0.17) was similar. HRQOL is at least as good as reference populations in the first few years and subsequently plateaus or declines. Patient satisfaction and functional status was favourable. There was significant heterogeneity amongst all studies, but publication bias was low in pooled analysis.

CONCLUSION

THR confers significant mid-term HRQOL benefits across a broad range of health domains. Further studies based on consistent guidelines provided in this review are required.

Health-related quality of life after total joint arthroplasty: a scoping review

A scoping review was completed to summarize the change in health status after THA and TKA. Although a recent study has performed a systematic review of functional recovery after THA,(61) we reviewed a broad topic of HRQL changes after total joint arthroplasty. This scoping review was not restricted by study design; however, the majority of studies were prospective single group, observational studies so that change over time could be reported. A variety of HRQL measures were used, including disease-specific, generic, and utility measures. We reported on 33 studies that met our inclusion criteria. Most studies’ primary outcomes were disease-specific measures. Not surprisingly, MCIDs were reported with recovery both short term and long term. These clinically relevant changes were accompanied with large effect sizes for pain and function using disease-specific measures such as the WOMAC. In general, smaller changes were reported with joint stiffness; however, this may also be related to inherent measurement properties of the WOMAC in that it uses two questions to evaluate stiffness. Overall, large effect sizes, in excess of 1.0, were seen not only short term but also long term, that is, more than a year after surgery. The changes may also be reflected in the low rate of complications reported with total joint arthroplasty.(62) The generic health measures showed a smaller magnitude of change, which is to be expected given the construct of these measures evaluate overall health and includes the effect of other health conditions. That being said, the largest changes were seen in those domains that were primary to total joint arthroplasty, pain and physical function. A challenge of evaluating change of health status after total joint arthroplasty is that each measure has individual strengths and limitations. This review introduced the measures and the MCIDs when available to evaluate clinical change. The derived MCIDs should be considered carefully because these values are dependent on a number of features such as the study setting, methodology used to derive the values, baseline scores, and severity of the disease.(63) Change over time was also presented by the effect sizes. The effect size provided another perspective to measuring recovery after total joint arthroplasty in which comparison across measures can be made. Regardless of the type of outcome measure, large effect sizes are seen with total joint arthroplasty both over short-term and long-term outcomes. Because a number of HRQL measures are used to evaluate the outcomes after total joint arthroplasties, comparisons can be challenging. This review summarized published findings to help place the magnitude of change seen with total joint arthroplasty in perspective. Changes seen with HRQL are one aspect of evaluating outcomes from a patient perspective; however, recovery is a complex concept(64) that needs many clinical and research-oriented measures to evaluate the full spectrum of recovery.

[Primary hip replacement: first year results and predictive factors of poor outcome]

OBJECTIVE

To evaluate the results of total hip arthroplasty in patients with osteoarthritis and to identify predictors of poor functional outcome.

MATERIAL AND METHODS

A prospective observational study in patients operated on in 2006 with total hip arthroplasty in 4 hospitals in Guipúzcoa, followed up for 1 year.

OUTCOME VARIABLES

pain, physical function, complications, mortality, quality of life by WOMAC and SF-12 (at 0, 3, 6 and 12 months) and «Poor functional outcome» at one year (last quartile of the WOMAC in function area). Logistic regression was performed to examine predictors of poor functional outcome.

RESULTS

A total of 166 patients were followed up. The incidence of systemic and local complications was 6.3% and 14.5%, respectively, 4.3% readmissions and no deaths related to surgery. Close to 40 points improvement in pain, stiffness and WOMAC functional limitation, mainly in the first 3 months after surgery. A similar trend was seen, but lower in the physical and mental component of the SF12 (12 and 8 points, respectively). The previous score on the WOMAC function area and the physical component of SF-12, and the existence of any complications, are predictors of poor functional recovery.

DISCUSSION

The improvement experienced after the surgery is already very important before the third month. The functional and physical status before surgery and possible complications of surgery are significant determinants of the results.