Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study.
Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study.
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DOI：
10.1186/2052-1847-5-2
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发表时间：
2013-03-28
期刊：
影响因子：
--
通讯作者：
Frémont P
中科院分区：
文献类型：
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作者：
Desmeules F;Dionne CE;Belzile ÉL;Bourbonnais R;Champagne F;Frémont P
全膝关节置换术（TKA）是一种有效的手术。然而，对于一些患者来说，结果并不令人满意。 TKA 决定因素的识别可以帮助更有效地管理这些患者。本研究的目的是确定 TKA 后 6 个月内疼痛、功能限制和健康相关生活质量 (HRQoL) 的术前和围术期决定因素。从加拿大魁北克市的 3 家医院招募了 138 名参与者，并随访至术后 6 个月。数据是通过审查受试者的医疗档案以及全膝关节置换术前和术后 6 个月的结构化电话访谈来收集的。疼痛和功能限制通过西安大略和麦克马斯特骨关节炎指数 (WOMAC) 进行测量，HRQoL 通过 SF-36 健康调查进行测量。自变量包括参与者的人口、社会经济、社会心理、临床和手术特征以及卫生服务利用数据。使用逐步多元回归分析来评估自变量与 WOMAC 和 SF-36 分数之间的关联强度。较高的术前疼痛、十字形保留植入物和并发症的数量与 TKA 后 6 个月的更严重疼痛显着相关 (p<0.05)，并解释了 WOMAC 疼痛评分方差的 11%。较高的术前功能限制、单身、分居、离婚或丧偶、失业或退休以及并发症的数量与 TKA 后 6 个月更差的功能限制显着相关 (p< 0.05)，并解释了 WOMAC 功能评分方差的 16%。较低的术前 HRQoL、对侧膝关节疼痛、较高的心理困扰和合并症与 TKA 后 6 个月较差的 HRQoL 显着相关 (p<0.05)，并解释了 SF-36 身体功能评分的 23% 的方差。研究发现，几个变量与 TKA 术后 6 个月的较差结果显着相关，可能有助于识别有较差结果风险的患者。识别这些决定因素可以帮助更有效地管理患者，并可能帮助针对可能从广泛康复中受益的患者。
Total knee arthroplasty (TKA) is an effective procedure. However, for some patients, the outcomes are not satisfactory. Identification of TKA determinants could help manage these patients more efficiently. The purpose of this study was to identify pre- and perioperative determinants of pain, functional limitations and health-related quality of life (HRQoL) 6 months after TKA. 138 participants were recruited from 3 hospitals in Quebec City, Canada and followed up until 6 months after surgery. Data were collected through review of the subjects’ medical files and structured telephone interviews before and 6 months after TKA. Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Independent variables included demographic, socioeconomic, psychosocial, clinical and surgical characteristics of participants as well as data on health services utilization. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores. Higher preoperative pain, cruciate retaining implants and the number of complications were significantly associated with worse pain 6 months after TKA (p < 0.05) and explained 11% of the variance of the WOMAC pain score. Higher preoperative functional limitations, being single, separated, divorced or widowed, being unemployed or retired and the number of complications were significantly associated (p < 0.05) with worse functional limitations 6 months after TKA and explained 16% of the variance of the WOMAC function score. Lower preoperative HRQoL, contralateral knee pain, higher psychological distress and comorbidities were significantly associated (p < 0.05) with worse HRQoL 6 months after TKA and explained 23% of the variance of the SF-36 physical functioning score. Several variables were found to be significantly associated with worse outcomes 6 months after TKA and may help identify patients at risk of poorer outcome. The identification of these determinants could help manage patients more efficiently and may help target patients who may benefit from extensive rehabilitation.