Factors influencing health-related quality of life after total hip replacement - a comparison of data from the Swedish and Danish hip arthroplasty registers (original) (raw)
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Journal of Clinical Medicine
Background: Application of different value sets to health-related quality of life (HRQoL) measured with the EQ-5D-3L may lead to different results due to differences in methods, perspectives, and countries used. Focusing on concordance, this study aimed at understanding the implications of applying EQ-5D-3L value sets from Sweden, Germany, Denmark, and the UK to evaluate HRQoL of patients undergoing total hip replacement (THR) in Sweden before and after surgery. Methods: We performed a longitudinal study of patients in the Swedish Hip Arthroplasty Register from preoperative stage to 1-year follow-up (n = 73,523) using data collected from 2008 to 2016. Eight EQ-5D-3L value sets from the four countries were compared based on a valuation method (visual analogue scale (VAS) or time trade-off (TTO)), perspective (experience-based or hypothetical), and country. Concordance among the value sets with patient-reported EQ VAS score was also assessed. Longitudinal changes in EQ-5D-3L index ove...
BMC Health Services Research, 2019
Background: Health care on equal terms is a cornerstone of the Swedish health care system. Total hip arthroplasty (THA) is considered a success story in Sweden with low frequency of reoperations and restored health-related quality of life (HRQoL). Administratively, health care in Sweden is locally self-governed by 21 counties. In this longitudinal nationwide observational study we assessed the possible geographical variations in 1-year follow-up patient-reported outcomes (PROs): EQ-5D index, EQ VAS, Pain VAS and Satisfaction VAS. Methods: Study population consisted of 36,235 Swedish THA patients, operated during 2008 to 2012 due to hip osteoarthritis. Individual data came from Swedish Hip Arthroplasty Register, Statistics Sweden and National Board of Health and Welfare. We used descriptive statistics together with multivariable regression analysis to analyse the data. Results: We observed county level differences in both preoperative and postoperative PROs. The results showed that the differences observed in preoperative PROs could not fully explain the differences observed in postoperative PROs, even after adjustment for patient demographics (age, sex, BMI, Elixhauser comorbidity index, marital status, educational level and disposable income). This indicates that other factors might influence the outcome after THA. Conclusion: Likely, structural and process differences such as indication for surgery have an influence on PROs after surgery. Standardization of care at hospital levels may decrease geographical variations in postoperative HRQoL. Remaining differences will then possibly be associated to patient demographics.
Clinical Orthopaedics & Related Research
Background Patient-reported outcome measures (PROMs) are the only systematic approach through which the patient’s perspective can be considered by surgeons (in determining a procedure’s efficacy or appropriateness) or healthcare systems (in the context of value-based healthcare). PROMs in registries enable international comparison of patient-centered outcomes after total joint arthroplasty, but the extent to which those scores may vary between different registry populations has not been clearly defined. Questions/purposes (1) To what degree do mean change in general and joint-specific PROM scores vary across arthroplasty registries, and to what degree is the proportion of missing PROM scores in an individual registry associated with differences in the mean reported change scores? (2) Do PROM scores vary with patient BMI across registries? (3) Are comorbidity levels comparable across registries, and are they associated with differences in PROM scores? Methods Thirteen national, regio...
Translation, cross-cultural adaptation and validation of the Danish version of the Oxford hip score
2012
Objectives The Oxford hip score (OHS) is a 12-item questionnaire designed and developed to assess function and pain from the perspective of patients who are undergoing total hip replacement (THR). The OHS has been shown to be consistent, reliable, valid and sensitive to clinical change following THR. It has been translated into different languages, but no adequately translated, adapted and validated Danish language version exists. Methods The OHS was translated and cross-culturally adapted into Danish from the original English version, using methods based on best-practice guidelines. The translation was tested for psychometric quality in patients drawn from a cohort from the Danish Hip Arthroplasty Register (DHR). Results The Danish OHS had a response rate of 87.4%, no floor effect and a 19.9% ceiling effect (as expected in post-operative patients). Only 1.2% of patients had too many items missing to calculate a sum score. Construct validity was adequate and 80% of our predefined hy...
International Orthopaedics, 2008
The objective of this study was to examine and predict the time trend of health-related quality of life (HRQoL) after total hip replacement (THR). A total of 383 patients receiving primary THR at two medical centers in Taiwan during 1997 to 2000 were enrolled for the study. Face-to-face interviews were conducted by using physicianrated Harris hip score and patient-reported short-form 36item health survey (SF-36) immediately before the surgery and at 3, 6, 12, 24, and 60 months after surgery. Data analysed by piecewise linear regression revealed remarkable improvements in HRQoL dimensions at the third month after surgery and kept improving until the threshold level of from 39 months to 81 months, at which it reached a plateau. Role limitations due to physical and emotional problems and social functioning after surgery saw the most remarkable improvements, which appear to be related to improvements in functioning in many other dimensions of health. Such interdependence of the dimensions should be examined carefully to see if improvements in social roles can help improve the overall HRQoL in a more effective manner. The results should be applicable to other hospitals in Taiwan and in other countries with similar social and cultural practices. Résumé L'objectif de ce travail était d'examiner l'évolution de la qualité de vie après une prothèse totale de hanche par l'étude d'un groupe de 383 patients opérés dans 2 centres de Taiwan entre 1997 et 2000. Des interview ont été menés par des médecins utilisant le score de Harris et le score SF-36 juste après la chirurgie puis à 3, 6, 12, 24 et 60 mois d'évolution. L'analyse en régression linéaire montrait une augmentation notable de la qualité de vie au troisième mois et progressant jusqu'à un plateau atteint entre 39 à 81 mois. Les aspects physique, émotionnel et social étaient les plus améliorés en relation avec l'amélioration d'autres paramètres de santé. Une telle interdépendance doit être examinée soigneusement pour voir si l'amélioration de l'aspect social peut améliorer l'ensemble de la qualité de vie de façon effective. Les résultats peuvent être étendus à d'autres populations de même pratiques culturelles et sociales.
Arthritis and rheumatism, 2006
ObjectiveTo evaluate the psychometric properties of the World Health Organization Quality of Life short version instrument (WHOQOL-BREF), and to determine its responsiveness in assessing early outcome after total hip or knee replacement surgery.To evaluate the psychometric properties of the World Health Organization Quality of Life short version instrument (WHOQOL-BREF), and to determine its responsiveness in assessing early outcome after total hip or knee replacement surgery.MethodsAt baseline (entry to an orthopedic waiting list), 279 participants completed the WHOQOL-BREF instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Assessment of Quality of Life (AQOL) instrument, Kessler Psychological Distress (K10) scale, and the modified Health Assessment Questionnaire (MHAQ). A total of 74 patients completed reassessments 3 months after surgery.At baseline (entry to an orthopedic waiting list), 279 participants completed the WHOQOL-BREF instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Assessment of Quality of Life (AQOL) instrument, Kessler Psychological Distress (K10) scale, and the modified Health Assessment Questionnaire (MHAQ). A total of 74 patients completed reassessments 3 months after surgery.ResultsThe WHOQOL-BREF demonstrated acceptable internal consistency for all domains (Cronbach's α = 0.76–0.84) and moderate concurrent validity for the physical and psychological domains (r = 0.67 for physical versus AQOL; r = −0.71 for psychological versus K10). Minimal ceiling or floor effects were identified at baseline or 3 months, except for the social relationships domain. The disease-specific WOMAC subscales were most responsive to change (relative efficiency [RE] 0.66–1.00). Apart from social relationships, all WHOQOL-BREF scores improved significantly after surgery. The physical domain was more responsive than the AQOL (RE 0.50 versus 0.42) and was similar to the MHAQ (RE 0.55 for MHAQ). The responsiveness of the psychological domain was similar to that of the K10 scale (RE 0.11 versus 0.08).The WHOQOL-BREF demonstrated acceptable internal consistency for all domains (Cronbach's α = 0.76–0.84) and moderate concurrent validity for the physical and psychological domains (r = 0.67 for physical versus AQOL; r = −0.71 for psychological versus K10). Minimal ceiling or floor effects were identified at baseline or 3 months, except for the social relationships domain. The disease-specific WOMAC subscales were most responsive to change (relative efficiency [RE] 0.66–1.00). Apart from social relationships, all WHOQOL-BREF scores improved significantly after surgery. The physical domain was more responsive than the AQOL (RE 0.50 versus 0.42) and was similar to the MHAQ (RE 0.55 for MHAQ). The responsiveness of the psychological domain was similar to that of the K10 scale (RE 0.11 versus 0.08).ConclusionThe WHOQOL-BREF has good psychometric properties for use in persons with severe joint disease, and by providing complementary information, it offers clinicians and researchers an additional tool for comprehensively assessing quality of life in this patient group.The WHOQOL-BREF has good psychometric properties for use in persons with severe joint disease, and by providing complementary information, it offers clinicians and researchers an additional tool for comprehensively assessing quality of life in this patient group.