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A clinical tool to identify patients who are most likely to receive long term improvement in physical function after total hip arthroplasty

A clinical tool to identify patients who are most likely to receive long term improvement in physical function after total hip arthroplasty
A clinical tool to identify patients who are most likely to receive long term improvement in physical function after total hip arthroplasty
Objective: develop a clinical risk prediction tool to identify patients most likely to experiencelong-term clinically meaningful functional improvement following total hip arthroplasty (THA).

Methods: we studied 282 patients from 2 English health districts (Portsmouth and North Staffordshire), age =45 years receiving THA for primary osteoarthritis. Baseline data were collected by interview and examination, on age, sex, comorbidity, body mass index (BMI), functional status (SF-36), and preoperative radiographic severity. The outcome was a clinically significant (30-point) improvement in SF-36 physical function assessed ?8-years after THA. Logistic regression modelling was used to identify predictors of functional improvement.

Results: improvement in physical functioning was less likely in those with better pre-operative functioning[OR 0.73 95%CI (0.60, 0.89)], in older people[0.94 (0.90, 0.98)], women[0.37 (0.19, 0.72)], a previous hip injury[0.14 (0.03, 0.74)], and greater number of painful joint sites[0.61 (0.46, 0.80)]. Patients with worse radiographic grades were most likely to improve[2.15 (1.17, 3.93)]. We found no influence of BMI or patient co-morbidity on functional outcome. Predictors of good outcome were the same as those of bad outcomes, acting in the opposite direction. A clinical risk prediction tool was developed to identify patients who are most likely to receive functional improvement following THA.

Conclusion: this prediction tool has the potential to inform healthcare professionals and patients about functional improvement following THA (as distinct from driving rationing or commissioning decisions on who should have surgery); itrequires introduction into clinical practice under research conditions to investigate its impact on decisions made by patients and clinicians
0004-3591
881-889
Judge, Andy
a7b98e8c-fd10-42be-a35a-ca6359038f95
Javaid, M. Kassim
64155236-2ef0-4065-b684-cf723a888117
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Cushnaghan, Janet
c6b1df54-abc8-48a5-b049-52b2b2655da0
Reading, Isabel
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Croft, Peter
2fddc9f1-8e16-4a53-8a25-7f708b5ea619
Dieppe, Paul A.
ba96f564-f9b8-4012-a124-ea57f038b92d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Judge, Andy
a7b98e8c-fd10-42be-a35a-ca6359038f95
Javaid, M. Kassim
64155236-2ef0-4065-b684-cf723a888117
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Cushnaghan, Janet
c6b1df54-abc8-48a5-b049-52b2b2655da0
Reading, Isabel
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Croft, Peter
2fddc9f1-8e16-4a53-8a25-7f708b5ea619
Dieppe, Paul A.
ba96f564-f9b8-4012-a124-ea57f038b92d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6

Judge, Andy, Javaid, M. Kassim, Arden, Nigel K., Cushnaghan, Janet, Reading, Isabel, Croft, Peter, Dieppe, Paul A. and Cooper, Cyrus (2012) A clinical tool to identify patients who are most likely to receive long term improvement in physical function after total hip arthroplasty. Arthritis & Rheumatism, 64 (6), 881-889. (doi:10.1002/acr.21594). (PMID:22232080)

Record type: Article

Abstract

Objective: develop a clinical risk prediction tool to identify patients most likely to experiencelong-term clinically meaningful functional improvement following total hip arthroplasty (THA).

Methods: we studied 282 patients from 2 English health districts (Portsmouth and North Staffordshire), age =45 years receiving THA for primary osteoarthritis. Baseline data were collected by interview and examination, on age, sex, comorbidity, body mass index (BMI), functional status (SF-36), and preoperative radiographic severity. The outcome was a clinically significant (30-point) improvement in SF-36 physical function assessed ?8-years after THA. Logistic regression modelling was used to identify predictors of functional improvement.

Results: improvement in physical functioning was less likely in those with better pre-operative functioning[OR 0.73 95%CI (0.60, 0.89)], in older people[0.94 (0.90, 0.98)], women[0.37 (0.19, 0.72)], a previous hip injury[0.14 (0.03, 0.74)], and greater number of painful joint sites[0.61 (0.46, 0.80)]. Patients with worse radiographic grades were most likely to improve[2.15 (1.17, 3.93)]. We found no influence of BMI or patient co-morbidity on functional outcome. Predictors of good outcome were the same as those of bad outcomes, acting in the opposite direction. A clinical risk prediction tool was developed to identify patients who are most likely to receive functional improvement following THA.

Conclusion: this prediction tool has the potential to inform healthcare professionals and patients about functional improvement following THA (as distinct from driving rationing or commissioning decisions on who should have surgery); itrequires introduction into clinical practice under research conditions to investigate its impact on decisions made by patients and clinicians

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More information

Published date: 9 January 2012
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 339140
URI: http://eprints.soton.ac.uk/id/eprint/339140
ISSN: 0004-3591
PURE UUID: fca15d3e-2aad-4133-9db8-f6a058081c4d
ORCID for Isabel Reading: ORCID iD orcid.org/0000-0002-1457-6532
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 24 May 2012 10:43
Last modified: 26 Nov 2021 02:41

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Contributors

Author: Andy Judge
Author: M. Kassim Javaid
Author: Nigel K. Arden
Author: Janet Cushnaghan
Author: Isabel Reading ORCID iD
Author: Peter Croft
Author: Paul A. Dieppe
Author: Cyrus Cooper ORCID iD

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