Patient Relevant Outcomes after total hip replacement. A comparison between different surgical techniques

Objective  

To investigate differences in pre- and postoperative patient-relevant outcome between hybrid total hip replacement (THR) and cemented THR in patients with primary osteoarthritis (OA).     

Cross-cultural adaptation and validation with reliability,validity, and responsiveness of the Italian version of the Oxford Hip Score in patients with hip osteoarthritis

Purpose  

The purpose of this study was to translate the Oxford Hip Score (OHS) into Italian and to evaluate the psychometric properties by testing the feasibility, internal consistency, reproducibility, construct validity, and responsiveness in patients with hip osteoarthritis (OA).     

Importance of patient satisfaction with care in predicting osteoarthritis-specific health-related quality of life one year after total joint arthroplasty

Purpose  

After previous results observed with a generic health-related quality of life (HRQoL) instrument, we aimed to confirm that immediate postoperative patient satisfaction with care predicts self-perceived health 1 year after total hip replacement/total knee replacement (THR/TKR), using an osteoarthritis (OA)-specific HRQoL questionnaire.     

Validity and internal consistency of a Hausa version of the Ibadan knee/hip osteoarthritis outcome measure

Background  

The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) was developed for measuring end results of care in patients with knee or hip OA in Nigeria. The purpose of this study was to validate a Hausa translation of IKHOAM in order to promote its use among the Hausa populations of Nigeria and other West African countries.     

Osteoarthritis Increases the Risk of Cardiovascular Disease: Data from the Osteoarthritis Initiative

Objectives

Although osteoarthritis (OA) is a common condition in older adults, the role of OA in increasing cardiovascular disease (CVD) incidence is still debated. The aim of this study was to investigate the association between OA and the onset of CVD in a large database of American adults.

Design

Longitudinal.

Setting

Community-dwelling.

Participants

People with OA or at high risk of OA.

Measurements

Osteoarthritis was defined as the presence of OA of the hand, knee, hip, back/neck or of other sites. CVD was defined as self-reported presence of heart attack, heart failure, stroke and other cerebral atherosclerotic conditions, and peripheral artery disease.

Results

A total 4,265 persons without CVD (mean age=60.8 years, females=59.2%) at baseline were analyzed (1,775 with OA versus 2,490 without). Over a mean of 8.2 years, according to an adjusted Cox’s regression analysis for 11 potential baseline confounders, study participants with OA of any joint had a significantly higher risk of developing CVD compared to those without OA (Hazard ratio (HR): =1.27; 95% CI: 1.03-1.56). The presence of hand OA was associated with a higher risk of developing CVD (HR=1.31; 95%CI: 1.01-1.68) with respect to those who had no OA. Knee, hip and back/neck OA did not, instead, increase the risk of developing CVD. The association between OA and CVD was significant in the women, but not in the men.

Conclusions

OA, in particular, when it affects the hand and in women, was associated with a higher risk of developing CVD.

     

Comparative validation of the WOMAC osteoarthritis and Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis

Purpose

To comparatively evaluate the reliability and validity of the Western Ontario and McMaster (WOMAC) and the Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis (OA).

Methods

The Greek versions of WOMAC LK 3.1 and Lequesne indices were administered to 97 outpatients with OA. Internal consistency reliability was assessed by Cronbach’s alpha and item–scale correlations. Test–retest reliability was examined with intraclass correlations. Patients were also asked to complete the Short Form 36 (SF-36) and a Visual Analog Scale capturing strength of pain, in order to assess construct validity. Additional demographic and clinical data were also recorded to evaluate further associations.

Results

Cronbach’s alpha values of the WOMAC ranged between 0.92 and 0.98 for hip and 0.89–0.97 for knee OA. The respective values for Lequesne were 0.63–0.74 and 0.74–0.80. Item–scale correlations confirmed the superiority of WOMAC with respect to internal consistency reliability. Intraclass correlations were 0.79–0.97 and 0.57–0.98 for hip and 0.86–0.97 and 0.82–0.97 for knee OA, for WOMAC and Lequesne, respectively. The two indices showed high correlations with comparable subscales of SF-36 and the Visual Analog Scale. Significant relationships were identified for age, body mass index, duration of disease, duration of stiffness and radiographic classification.

Conclusions

Our findings, in samples of knee and hip OA patients, indicate that the WOMAC index demonstrates better internal consistency reliability than the Lequesne counterpart, as well as equivalent test–retest reliability and construct validity.     

Healthcare Utilization and Costs of Knee or Hip Replacements versus Pain-Relief Injections

Background

Given the dramatic increase in total knee and hip replacement procedures among the US population aged 45 years and older, there is a need to compare the downstream healthcare utilization and costs between patients who undergo joint replacement and those who receive intraarticular injections as a low-cost alternative.

Objective

To compare changes in osteoarthritis (OA)-related healthcare utilization and costs for Medicare members with OA who underwent knee or hip replacement versus those receiving steroid or viscosupplementation injections.

Methods

Medicare members aged ≥45 years diagnosed with OA were identified for this retrospective longitudinal study. Data were compared for patients who underwent primary knee or hip replacement surgery between July 1, 2007, and June 30, 2012, and those receiving injection of pain-relief medication during the same period. The date of joint replacement surgery was considered the index date. For the comparison cohort, the index date was 180 days postinjection of the first intraarticular injection. Medical and pharmacy claims were examined longitudinally in 90-day increments, from 180 days preindex until 360 days postindex. Difference-in-difference analyses were conducted to compare the change in OA-related healthcare costs, postindex versus preindex, between the study cohorts. Time-to-event analyses were used to measure rates of readmissions and venous thromboembolism (VTE).

Results

The mean age was 70.7 years for patients with knee replacement, 71.7 years for those with hip replacement, and 71.1 years for those receiving pain-relief injection (P <.0001). The RxRisk-V comorbidity index scores were 4.7, 4.4, and 4.8, respectively (P <.0001). Difference-in-difference analyses indicated that decreases in OA-related costs were greater for the joint replacement cohorts (coefficient for knee replacement*time: −0.603; hip replacement*time: −0.438; P <.001 for both) than for the comparison cohort. The VTE rates were 5.6% (knee) and 5.1% (hip) postsurgery versus 1.4% (knee) and 1.3% (hip) presurgery.

Conclusion

The overall difference-in-difference results showed a greater decrease in healthcare utilization and costs for the members with joint replacement than for those receiving injection.     

Impact of clinical osteoarthritis of the hip,knee and hand on self-rated health in six European countries: the European Project on OSteoArthritis

Purpose

Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person’s self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH.

Methods

Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index.

Results

The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function.

Conclusions

Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care.

     

Veaselaircdhation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia

Background  

The aim of this study was to validate a Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ). Pain acceptance is the process of giving up the struggle with pain and learning to live a worthwhile life despite it. The Chronic Pain Acceptance Questionnaire (CPAQ) is the questionnaire most often used to measure pain acceptance in chronic pain populations.     

Occupational kneeling and radiographic tibiofemoral and patellofemoral osteoarthritis

Background  

The objective of our study was to evaluate the association between occupational kneeling and compartment specific radiographic tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA).     

Functional capacity of people with early osteoarthritis: a comparison between subjects from the cohort hip and cohort knee (CHECK) and healthy ageing workers

Objective

The prevalence of osteoarthritis (OA) increases, but the impact of the disorder on peoples’ functional capacity is not known. Therefore, the objective of this study was to compare self-reported health status and functional capacity of subjects with early OA of hip and/or knee to reference data of healthy working subjects and to assess whether this capacity is sufficient to meet physical job demands.

Methods

Self-reported health status and functional capacity of 93 subjects from the Cohort Hip and Cohort Knee (CHECK) were measured using the Short-Form 36 Health Survey and 6 tests of the Work Well Systems Functional Capacity Evaluation. Results were compared with reference data from 275 healthy workers, using t-tests. To compare the functional capacity with job demands, the proportions of subjects with OA performing lower than the p₅ of reference data were calculated.

Results

Compared to healthy workers, the subjects (mean age 56) from CHECK at baseline reported a significantly worse physical health status, whereas the women (n = 78) also reported a worse mental health status. On the FCE female OA subjects performed significantly lower than their healthy working counterparts on all 6 tests. Male OA subjects performed lower than male workers on 3 tests. A substantial proportion of women demonstrated functional capacities that could be considered insufficient to perform jobs with low physical demands.

Conclusions

Functional capacity and self-reported health of subjects with early OA of the hips and knees were worse compared to healthy ageing workers. A substantial proportion of female subjects did not meet physical job demands.     

High levels of fat and (<Emphasis Type="Italic">n</Emphasis>-6) fatty acids in cancellous bone in osteoarthritis

Background  

Osteoarthritis (OA) is strongly linked with obesity and patients with osteoporosis (OP) have a low body mass index. Anecdotal evidence, clinical and laboratory, suggests that OA bone contains more fat. However, conversion of osteoblasts to adipocytes is reported in OP and this would suggest that the more porous OP cancellous bone would have a high fat content.     

Subjective impact of osteoarthritis flare-ups on patients' quality of life

Background  

Clinical trials on osteoarthritis (OA) flare-ups treatment usually focus only on objective measures of health status, albeit recent literature suggestions on the importance of patients' subjectivity. Aim of the study was to evaluate the effects of OA and of its different types of medical treatment(s) on Health Related Quality of Life (HRQoL) in terms of both subjective satisfaction and functional status.     

The <Emphasis Type="Italic">Work Instability Scale for Rheumatoid Arthritis</Emphasis> (RA-WIS): Does it work in osteoarthritis?

Purpose  

To validate the 23-item Work Instability Scale for Rheumatoid Arthritis (RA-WIS) for use in osteoarthritis (OA) using both classical test theory and item response theory approaches.     

Health service utilization patterns of primary care patients with osteoarthritis

Background  

To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA).     

The effect of patient characteristics on variability in pain and function over two years in early knee osteoarthritis

Background  

Large variations in pain and function are seen over time in subjects at risk for and with radiographic knee osteoarthritis (OA). We hypothesized that this variation may be related not only to knee OA but also to patient characteristics. The objective of this study was to investigate the influence of age, gender, and body mass index (BMI) on clinically relevant change in pain and function over two years in subjects at high risk for or with knee OA.     

Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability,validity and responsiveness

Purpose

To study the psychometric properties, including reliability, validity and responsiveness, of the Spanish EQ-5D-5L questionnaire for patients with hip or knee osteoarthritis (OA).

Methods

We included 758 patients with hip or knee OA who completed the EQ-5D-5L and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, of whom 644 also did 6 months later. The EQ-5D-5L contains five questions from which a utility index is derived. The WOMAC covers three dimensions: pain, stiffness and physical function. Floor and ceiling effects were calculated. Reliability was assessed using Cronbach’s alpha. Convergent validity was tested using the Spearman correlation coefficient between EQ-5D-5L and WOMAC. We examined known-groups validity by comparing the EQ-5D-5L between subgroups defined by WOMAC scores using ANOVA or the Kruskal–Wallis test. Effect sizes were calculated to assess responsiveness, and minimal clinically important difference (MCID) was estimated.

Results

The EQ-5D-5L showed minimal floor and ceiling effects (<?3%). Cronbach’s alpha was 0.86. The EQ-5D-5L index was strongly correlated with WOMAC pain and function scores (??0.688 and ??0.782). Patients with higher WOMAC scores had significantly (p?<?0.0001) lower EQ-5D-5L index. The 20.19% had hip or knee replacement during the follow-up. Effect sizes were small among non-surgical patients, but >?0.80 among “improved” surgical patients, being the MCID for improvement 0.32 points.

Conclusions

The results support the reliability, validity and responsiveness of the EQ-5D-5L, overcoming the limitations of the EQ-5D-3L in these patients. Therefore, the EQ-5D-5L could be very useful as an outcome measure, at least in patients with hip or knee OA.

     

The role of cumulative physical work load in symptomatic knee osteoarthritis – a case-control study in Germany

Objectives  

To examine the dose-response relationship between cumulative exposure to kneeling and squatting as well as to lifting and carrying of loads and symptomatic knee osteoarthritis (OA) in a population-based case-control study.     

Effects of kinesio taping in a physical therapist with acute low back pain due to patient handling: A case report

Objectives  

The paper describes the case of a physical therapist with acute Low Back Pain (LBP) due to patient handling and the efficacy of Kinesio Taping (KT) around the trunk in the treatment of this occupational LBP. Materials and