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Change in patient concerns following total knee arthroplasty described with the International Classification of Functioning, Disability and Health: a repeated measures design.

https://arctichealth.org/en/permalink/ahliterature153700
Source
Health Qual Life Outcomes. 2008;6:112
Publication Type
Article
Date
2008
Author
Ravi Rastogi
Bert M Chesworth
Aileen M Davis
Author Affiliation
Physiotherapist, London Health Sciences Centre, London, Ontario, Canada. ravi.rastogi@lhsc.on.ca
Source
Health Qual Life Outcomes. 2008;6:112
Date
2008
Language
English
Publication Type
Article
Keywords
Aged
Anxiety
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Cross-Sectional Studies
Disability Evaluation
Disabled Persons - classification
Female
Health status
Humans
International Classification of Diseases
Interviews as Topic
Male
Middle Aged
Ontario
Patients - psychology
Postoperative Period
Abstract
There is no published evidence of how patient concerns change during the first six weeks following total knee arthroplasty (TKA). An understanding of the recovery process from the patient's perspective will inform clinicians on how to best educate patients about their post-operative concerns. Our objectives were to (1) quantify the level of importance for each of 32 previously identified concerns pre-operatively, and across the first six weeks following primary TKA and, (2) convey this change in importance post-operatively using the components of the International Classification of Functioning, Disability and Health (ICF).
The objectives were achieved using a repeated measures design. Convenience sampling was used to recruit 54 consecutive patients undergoing primary TKA at a hospital in Ontario, Canada. Pre-operatively and at two, four and six weeks post-operatively subjects rated the level of importance for each of the 32 previously identified patient concerns
The importance rating of patient concerns in all four ICF components changed from before surgery to two weeks after surgery. Patient concerns in the Participation component became increasingly important after the first two weeks following surgery. Post-operatively from week two to week four, changes in importance ratings were also found in the Body Function and Activity components, but not in the Environmental Factors component.
Changes in patient concerns mirror their early recovery from TKA surgery. Consistent with this, Participation restrictions become increasingly important to patients after discharge from acute care suggesting that clinicians should think of managing patient expectations for return to societal roles early in post-operative rehabilitation.
Notes
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PubMed ID
19077246 View in PubMed
Less detail

A cross-sectional look at patient concerns in the first six weeks following primary total knee arthroplasty.

https://arctichealth.org/en/permalink/ahliterature162069
Source
Health Qual Life Outcomes. 2007;5:48
Publication Type
Article
Date
2007
Author
Ravi Rastogi
Aileen M Davis
Bert M Chesworth
Author Affiliation
London Health Sciences Centre, London, Ontario, Canada. ravi.rastogi@lhsc.on.ca
Source
Health Qual Life Outcomes. 2007;5:48
Date
2007
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Canada
Cross-Sectional Studies
Disability Evaluation
Female
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Satisfaction - statistics & numerical data
Patient-Centered Care
Postoperative Period
Prosthesis Fitting
Quality of Life
Questionnaires
Self Concept
Abstract
To date, no researchers have investigated patient concerns in the first six weeks following primary total knee arthroplasty (TKA). An understanding of patient concerns at a time when physical therapists are involved in the treatment of these patients will aid clinicians in providing patient-centered care. Linking of items to the International Classification of Functioning, Disability and Health (ICF) allows for comparison and sharing of data amongst researchers, as the ICF is the accepted framework for evaluating disability in rehabilitation. The objective of this study was to identify patient concerns in the first six weeks following primary TKA and link these concerns to components of the ICF and map them to commonly used outcome measures.
Individual interviews were conducted to identify patient concerns during their recovery following primary TKA. Concerns identified by patients were analysed for content and linked to the components of the ICF using the operational definitions of the ICF components. These concerns were mapped to the WOMAC, KOOS and Oxford Knee Scale.
Thirty patients (18 female) with an average age (SD) of 68.4 (11.1) years completed the study. Patients identified 32 concerns. Twenty-two percent (n = 7) of the concerns linked to Body Function and Structure, 47% (n = 15) to Activity, 13% (n = 4) to Participation, and 13% (n = 4) to the Environmental Factors component of the ICF. Six percent (n = 2) of the concerns did not link to the ICF. Of the 32 concerns identified by patients 14 mapped to the KOOS, 11 to the WOMAC and 4 to the Oxford Knee Scale.
Patient concerns linked to four different components of the ICF indicating that patients are involved in or are thinking of multiple aspects of life even in this early phase of recovery. The KOOS was found to be the most appropriate for use based on the patients' perspective. However, less than half of the concerns identified by patients were covered by the KOOS, WOMAC or Oxford Knee Scale indicating that other existing measures that evaluate the concepts identified as important to patients should be considered when evaluating outcomes during this acute phase of recovery following primary TKA.
Notes
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Cites: Arch Phys Med Rehabil. 2001 Mar;82(3):360-611245759
PubMed ID
17678532 View in PubMed
Less detail

Predicting patient dissatisfaction following joint replacement surgery.

https://arctichealth.org/en/permalink/ahliterature154301
Source
J Rheumatol. 2008 Dec;35(12):2415-8
Publication Type
Article
Date
Dec-2008
Author
Rajiv Gandhi
J Roderick Davey
Nizar N Mahomed
Author Affiliation
Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada. rajiv.gandhi@uhn.on.ca
Source
J Rheumatol. 2008 Dec;35(12):2415-8
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - psychology - rehabilitation
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Brief Psychiatric Rating Scale
Female
Follow-Up Studies
Humans
Male
Mental health
Middle Aged
Ontario
Patient satisfaction
Registries
Abstract
The incidence of patient-reported dissatisfaction following total joint arthroplasty can be up to 30%. Our aim was to identify the preoperative patient-level predictors of patient dissatisfaction 1 year after surgery.
We surveyed 1720 patients undergoing primary hip or knee replacement surgery. Relevant covariates including demographic data, body mass index, sex, comorbidities, and education were recorded. Joint functional status and patient quality of life were assessed at baseline and at 1-year followup with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Study Short Form-36 (SF-36) scales, respectively. Patient satisfaction with surgery was determined with 4 survey questions at 1-year followup.
There were no significant differences in demographic data between satisfied (n = 1290) and dissatisfied patients (n = 430). Logistic regression modeling showed that a lower preoperative SF-36 Mental Health score independently predicted patient dissatisfaction with surgery, adjusted for all relevant covariates (p
PubMed ID
19004032 View in PubMed
Less detail

A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery.

https://arctichealth.org/en/permalink/ahliterature104375
Source
Ann R Coll Surg Engl. 2014 Mar;96(2):89-94
Publication Type
Article
Date
Mar-2014
Author
E L Jones
T W Wainwright
J D Foster
J R A Smith
R G Middleton
N K Francis
Author Affiliation
Yeovil District Hospital NHS Foundation Trust, UK.
Source
Ann R Coll Surg Engl. 2014 Mar;96(2):89-94
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip - psychology - rehabilitation
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Denmark
Great Britain
Humans
Length of Stay
Patient Outcome Assessment
Patient satisfaction
Postoperative Care - rehabilitation
Quality of Life
Abstract
Orthopaedic enhanced recovery after surgery (ERAS) providers are encouraged to estimate the actual benefit of ERAS according to the patient's opinion by using patient generated data alongside traditional measures such as length of stay. The aim of this paper was to systemically review the literature on the use of patient generated information in orthopaedic ERAS across the whole perioperative pathway.
Publications were identified using Embase(™), MEDLINE(®), AMED, CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library and the British Nursing Index. Search terms related to experiences, acceptance, satisfaction or perception of ERAS and quality of life (QoL).
Of the 596 abstracts found, 8 papers were identified that met the inclusion criteria. A total of 2,208 patients undergoing elective hip and knee arthroplasty were included. Patient satisfaction was reported in 6 papers. Scores were high in all patients and not adversely affected by length of stay. QoL was reported in 2 papers and showed that QoL scores continued to increase up to 12 months following ERAS. Qualitative methods were used in one study, which highlighted problems with support following discharge. There is a paucity of data reporting on patient experience in orthopaedic ERAS. However, ERAS does not compromise patient satisfaction or QoL after elective hip or knee surgery. The measurement of patient experience should be standardised with further research.
PubMed ID
24780662 View in PubMed
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Traditional assessment of health outcome following total knee arthroplasty was confounded by response shift phenomenon.

https://arctichealth.org/en/permalink/ahliterature153586
Source
J Clin Epidemiol. 2009 Jan;62(1):91-6
Publication Type
Article
Date
Jan-2009
Author
Helen Razmjou
Carolyn E Schwartz
Albert Yee
Joel A Finkelstein
Author Affiliation
Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room MG301, Toronto, ON, Canada.
Source
J Clin Epidemiol. 2009 Jan;62(1):91-6
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Aged
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Bias (epidemiology)
Female
Health status
Humans
Male
Middle Aged
Ontario
Outcome Assessment (Health Care) - standards
Postoperative Period
Quality of Life - psychology
Questionnaires
Statistics, nonparametric
Treatment Outcome
Abstract
To examine the existence, direction, and effect of response shift as measured by the total score of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and SF-36 physical and mental component score domains at 6 months and 1 year after primary total knee arthroplasty (TKA).
Consecutive candidates participated in the study. In line with the Then-test design, two sets of questionnaires were completed at 6 months and 1 year postoperatively. Patients were divided into three groups on the basis of minimal clinically important differences (MCIDs). Parametric and nonparametric statistics and generalized mixed effects models were used.
Two hundred and thirty-six patients completed the study. The magnitude of response shift increased over time for SF-36 physical and mental component scores. The traditional unadjusted presurgical and 1-year postsurgical assessment failed to reveal any mental health improvement, whereas the adjusted treatment effect demonstrated statistically significant changes.
Response shift phenomenon increases with time in patients undergoing orthopedic interventions. The traditional pre- and post-assessment of joint replacement surgery may be confounded by a change in perspective and in internal standards of measurement in patients undergoing surgery. Response shift has substantial impact on measuring recovery in this population.
PubMed ID
19095168 View in PubMed
Less detail

Willingness to go through surgery again validated the WOMAC clinically important difference from THR/TKR surgery.

https://arctichealth.org/en/permalink/ahliterature155786
Source
J Clin Epidemiol. 2008 Sep;61(9):907-18
Publication Type
Article
Date
Sep-2008
Author
Bert M Chesworth
Nizar N Mahomed
Robert B Bourne
Aileen M Davis
Author Affiliation
School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Elborn College, 1201 Western Road, London, Ontario, Canada. bcheswor@uwo.ca
Source
J Clin Epidemiol. 2008 Sep;61(9):907-18
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Aged
Arthroplasty, Replacement, Hip - psychology - rehabilitation
Arthroplasty, Replacement, Knee - psychology - rehabilitation
Female
Health status
Health Status Indicators
Humans
Male
Ontario - epidemiology
Osteoarthritis - epidemiology - psychology - rehabilitation
Pain Measurement - methods
Pain, Postoperative - psychology
Patient satisfaction
Probability
Quality of Life - psychology
Questionnaires
Reoperation - psychology
Severity of Illness Index
Abstract
The objective was to determine the clinically important difference (CID) from primary total hip replacement (THR) and total knee replacement (TKR) surgeries using the Western Ontario McMaster University (WOMAC) osteoarthritis index.
WOMAC scores were collected at decision for and 1 year after surgery (n=2,709). Transition ratings (15-point scale) were obtained at 1 year for pain and function, as well as a global assessment of willingness to go through surgery again. A "good deal better" defined the positive CID. WOMAC change scores for transition ratings and willingness to go through surgery again were evaluated using receiver operating characteristic curves. Patient characteristics within transition rating categories were examined.
For THR, the positive CIDs were 41 of 100 for pain and 34 of 100 for function. The negative CIDs were 35 and 33, respectively. For TKR, the positive CIDs were 36 for pain and 33 for function. The negative CIDs were 30 and 25, respectively. Change scores for willingness to go through surgery again validated CID values. Postoperative complications decreased the likelihood of a positive CID.
Improvement that is "a good deal better" is an appropriate threshold for the THR/TKR positive CID. Attaining a positive CID is negatively related to postoperative complications.
PubMed ID
18687289 View in PubMed
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6 records – page 1 of 1.