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Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty.
Clin Orthop Relat Res 2015; 473(8):2688-97CO

Abstract

BACKGROUND

Despite widely reported success associated with hip and knee replacements, some patients remain dissatisfied with their outcomes. Patient activation, an individual's propensity to engage in adaptive health behaviors, has been measured as a potentially important factor contributing to health outcomes, cost, and patient experience of care. However, to our knowledge, it has not been studied in patients undergoing total joint arthroplasties (TJAs).

QUESTIONS/PURPOSES

We wanted to determine whether patients with higher activation scores would experience (1) greater resolution of pain and improved activity, (2) greater improvements in postoperative physical and mental health, and (3) greater patient satisfaction after primary THA or TKA.

METHODS

We approached 174 patients and enrolled 135 who were undergoing primary THA or TKA at one of two hospitals between January 2013 and May 2014. Patient Activation Measure (PAM) scores were obtained preoperatively and patient-reported outcomes were assessed and completed for 125 patients pre- and postoperatively at the 6- or 12-month visit. We assessed pain and activity with the Hip Disability and Osteoarthritis Outcome Score (HOOS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and University of California Los Angeles (UCLA) activity scores. We measured physical and mental health by calculating SF12v2® scores and measured patient satisfaction with the Hip and Knee Satisfaction Scale (HKSS). Linear regression models were used to test the association between baseline PAM and postoperative patient-reported outcomes.

RESULTS

Overall, patients with a higher baseline PAM score experienced better pain relief using the HOOS/KOOS pain scores (R2=0.311, p=0.048) and symptoms using the HOOS/KOOS symptom scores (R2=0.272, p=0.021). In addition, higher PAM scores were associated with better postoperative mental health using the SF12v2® (R2=0.057, p<0.001), but were not associated with higher physical health (R2=0.176, p=0.173). Finally, higher PAM scores were associated with having greater postoperative satisfaction after surgery using the HKSS questionnaire (R2=0.048, p=0.023).

CONCLUSIONS

Higher preoperative patient activation was associated with better pain relief, decreased symptoms, improved mental health, and greater satisfaction after TJA. Future efforts should be aimed at studying if improving patient activation before surgery results in better patient-reported outcomes after elective THA or TKA.

LEVEL OF EVIDENCE

Level II, prognostic study.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

25758378

Citation

Andrawis, John, et al. "Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty." Clinical Orthopaedics and Related Research, vol. 473, no. 8, 2015, pp. 2688-97.
Andrawis J, Akhavan S, Chan V, et al. Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty. Clin Orthop Relat Res. 2015;473(8):2688-97.
Andrawis, J., Akhavan, S., Chan, V., Lehil, M., Pong, D., & Bozic, K. J. (2015). Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty. Clinical Orthopaedics and Related Research, 473(8), pp. 2688-97. doi:10.1007/s11999-015-4247-4.
Andrawis J, et al. Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty. Clin Orthop Relat Res. 2015;473(8):2688-97. PubMed PMID: 25758378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Higher Preoperative Patient Activation Associated With Better Patient-reported Outcomes After Total Joint Arthroplasty. AU - Andrawis,John, AU - Akhavan,Sina, AU - Chan,Vanessa, AU - Lehil,Mandeep, AU - Pong,Dana, AU - Bozic,Kevin J, Y1 - 2015/03/11/ PY - 2014/10/30/received PY - 2015/03/03/accepted PY - 2015/3/12/entrez PY - 2015/3/12/pubmed PY - 2015/12/30/medline SP - 2688 EP - 97 JF - Clinical orthopaedics and related research JO - Clin. Orthop. Relat. Res. VL - 473 IS - 8 N2 - BACKGROUND: Despite widely reported success associated with hip and knee replacements, some patients remain dissatisfied with their outcomes. Patient activation, an individual's propensity to engage in adaptive health behaviors, has been measured as a potentially important factor contributing to health outcomes, cost, and patient experience of care. However, to our knowledge, it has not been studied in patients undergoing total joint arthroplasties (TJAs). QUESTIONS/PURPOSES: We wanted to determine whether patients with higher activation scores would experience (1) greater resolution of pain and improved activity, (2) greater improvements in postoperative physical and mental health, and (3) greater patient satisfaction after primary THA or TKA. METHODS: We approached 174 patients and enrolled 135 who were undergoing primary THA or TKA at one of two hospitals between January 2013 and May 2014. Patient Activation Measure (PAM) scores were obtained preoperatively and patient-reported outcomes were assessed and completed for 125 patients pre- and postoperatively at the 6- or 12-month visit. We assessed pain and activity with the Hip Disability and Osteoarthritis Outcome Score (HOOS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and University of California Los Angeles (UCLA) activity scores. We measured physical and mental health by calculating SF12v2® scores and measured patient satisfaction with the Hip and Knee Satisfaction Scale (HKSS). Linear regression models were used to test the association between baseline PAM and postoperative patient-reported outcomes. RESULTS: Overall, patients with a higher baseline PAM score experienced better pain relief using the HOOS/KOOS pain scores (R2=0.311, p=0.048) and symptoms using the HOOS/KOOS symptom scores (R2=0.272, p=0.021). In addition, higher PAM scores were associated with better postoperative mental health using the SF12v2® (R2=0.057, p<0.001), but were not associated with higher physical health (R2=0.176, p=0.173). Finally, higher PAM scores were associated with having greater postoperative satisfaction after surgery using the HKSS questionnaire (R2=0.048, p=0.023). CONCLUSIONS: Higher preoperative patient activation was associated with better pain relief, decreased symptoms, improved mental health, and greater satisfaction after TJA. Future efforts should be aimed at studying if improving patient activation before surgery results in better patient-reported outcomes after elective THA or TKA. LEVEL OF EVIDENCE: Level II, prognostic study. SN - 1528-1132 UR - https://www.unboundmedicine.com/medline/citation/25758378/Higher_Preoperative_Patient_Activation_Associated_With_Better_Patient_reported_Outcomes_After_Total_Joint_Arthroplasty_ L2 - https://link.springer.com/article/10.1007/s11999-015-4247-4 DB - PRIME DP - Unbound Medicine ER -