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Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty - results from a German prospective cohort study.
Health and Quality of Life Outcomes ( IF 3.6 ) Pub Date : 2019-12-09 , DOI: 10.1186/s12955-019-1237-3
Julia Felix 1 , Christian Becker 1 , Matthias Vogl 1 , Peter Buschner 2 , Werner Plötz 2, 3 , Reiner Leidl 1, 4
Affiliation  

BACKGROUND Evaluation of variations in pre- and postoperative patient reported outcomes (PRO) and the association between preoperative patient characteristics and health and satisfaction outcomes after total knee arthroplasty (TKA) may support shared decision-making in Germany. Since previous research on TKA health outcomes indicated valuation differences in longitudinal data, experienced-based population weights were used for the first time as an external valuation system to measure discrepancies between patient and average population valuation of HRQoL. METHODS Baseline data (n = 203) included sociodemographic and clinical characteristics and PROs, measured by the EQ-5D-3 L and WOMAC. Six-month follow-up data (n = 161) included medical changes since hospital discharge, PROs and satisfaction. A multivariate linear regression analysis was performed to evaluate the relationship between preoperative patient characteristics and PRO scores. Patient acceptable symptom state (PASS) was calculated to provide a satisfaction threshold. Patient-reported health-related quality of life (HRQoL) valuations were compared with average experienced-based population values to detect changes in valuation. RESULTS One hundred thirty-seven subjects met inclusion criteria. All PRO measures improved significantly. Preoperative WOMAC and EQ-5D VAS, housing situation, marital status, age and asthma were found to be predictors of postoperative outcomes. 73% of study participants valued their preoperative HRQoL higher than the general population valuation, indicating response shift. Preoperatively, patient-reported EQ-5D VAS was substantially higher than average experienced-based population values. Postoperatively, this difference declined sharply. Approximately 61% of the patients reported satisfactory postoperative health, being mainly satisfied with results if postoperative WOMAC was ≥82.49 (change ≥20.25) and postoperative EQ-5D VAS was ≥75 (change ≥6). CONCLUSION On average, patients benefited from TKA. Preoperative WOMAC and EQ-5D VAS were predictors of postoperative outcomes after TKA. Particularly patients with high absolute preoperative PRO scores were more likely to remain unsatisfied. Therefore, outcome prediction can contribute to shared-decision making. Using general population valuations as a reference, this study underlined a discrepancy between population and patient valuation of HRQoL before, but not after surgery, thus indicating a potential temporary response shift before surgery.

中文翻译:

患者特征和评估价值的变化会影响全膝关节置换术的生活质量和满意度-这是一项德国前瞻性队列研究的结果。

背景技术评估全膝关节置换术(TKA)前后患者报告的结局(PRO)的变化以及术前患者特征与健康和满意度结局之间的关联可能会支持德国的共同决策。由于先前对TKA健康结果的研究表明纵向数据的估值差异,因此基于经验的人群权重首次用作外部评估系统,以衡量HRQoL患者与平均人群评估之间的差异。方法基线数据(n = 203)包括社会人口统计学和临床​​特征以及PRO,由EQ-5D-3 L和WOMAC测量。六个月的随访数据(n = 161)包括自出院以来的医疗变化,PRO和满意度。进行了多元线性回归分析,以评估术前患者特征与PRO评分之间的关​​系。计算患者可接受的症状状态(PASS)以提供满意度阈值。将患者报告的健康相关生活质量(HRQoL)评估值与基于经验的平均人口值进行比较,以检测评估值的变化。结果137名受试者符合入选标准。所有PRO措施均得到显着改善。术前WOMAC和EQ-5D VAS,住房状况,婚姻状况,年龄和哮喘被认为是术后预后的指标。73%的研究参与者对他们的术前HRQoL的评价高于一般人群的评价,这表明反应有所改变。术前 患者报告的EQ-5D VAS显着高于平均经验水平的人群值。术后,这种差异急剧下降。大约61%的患者报告了满意的术后健康状况,如果术后WOMAC≥82.49(变化≥20.25)并且术后EQ-5D VAS≥75(变化≥6),则主要对结果满意。结论平均而言,患者可从TKA中受益。术前WOMAC和EQ-5D VAS是TKA术后预后的预测指标。特别是,术前PRO绝对绝对值较高的患者更有可能不满意。因此,结果预测可以有助于共享决策的制定。本研究以一般人群的评估为参考,强调了手术前后(而非术后)HRQoL人群与患者评估之间的差异,
更新日期:2019-12-09
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