Elman Scott A, Dong Yan, Stenquist Derek S, Ghazinouri Roya, Alcantara Luis, Collins Jamie E, Beagan Carolyn, Thornhill Thomas S, Katz Jeffrey N
Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
BMC Musculoskelet Disord. 2014 Jun 16;15:207. doi: 10.1186/1471-2474-15-207.
To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. One outcome of TJR of particular interest is physical activity (PA) since it is strongly linked to general health. This study evaluates the amount of postoperative participation in PA in low-income patients who received total joint replacement in the Dominican Republic and identifies preoperative predictors of postoperative PA level.
We used the Yale Physical Activity Survey (YPAS) to assess participation in postoperative PA 1-4 years following total knee or hip replacement. We compared the amount of aerobic PA reported by postoperative TJR patients with the levels of PA recommended by the CDC and WHO. We also analyzed preoperative determinants of postoperative participation in aerobic PA in bivariate and multivariate analyses.
64 patients out of 170 eligible subjects (52/128 TKR and 14/42 THR) who received TJR between 2009-2012 returned for an annual follow-up visit in 2013, with a mean treatment-to-follow-up time of 2.1 years. 43.3% of respondents met CDC/WHO criteria for sufficient participation in aerobic PA. Multivariate analyses including data from 56 individuals identified that patients who were both younger than 65 and at least two years postoperative had an adjusted mean activity dimensions summary index (ADSI) 22.9 points higher than patients who were 65 or older and one year postoperative. Patients who lived with friends or family had adjusted mean ADSI 17.2 points higher than patients living alone. Patients who had the most optimistic preoperative expectations of outcome had adjusted mean ADSI scores that were 19.8 points higher than those who were less optimistic.
The TJR patients in the Dominican cohort participate in less PA than recommended by the CDC/WHO. Additionally, several associations were identified that potentially affect PA in this population; specifically, participants who are older than 65, recently postoperative, less optimistic about postoperative outcomes and who live alone participate in less PA.
为应对发展中国家日益增长的关节疾病负担以及医疗服务可及性方面的差距，医疗救援组织已开始启动项目，为发展中国家的居民实施全关节置换术（TJR）。TJR一个特别受关注的结果是身体活动（PA），因为它与总体健康密切相关。本研究评估了在多米尼加接受全关节置换术的低收入患者术后参与PA的情况，并确定了术后PA水平的术前预测因素。
我们使用耶鲁身体活动调查问卷（YPAS）来评估全膝关节或髋关节置换术后1至4年的PA参与情况。我们将术后TJR患者报告的有氧PA量与美国疾病控制与预防中心（CDC）和世界卫生组织（WHO）推荐的PA水平进行了比较。我们还在双变量和多变量分析中分析了术后参与有氧PA的术前决定因素。
在2009年至2012年间接受TJR的170名符合条件的受试者中（全膝关节置换术52/128例，全髋关节置换术14/42例），有64例在2013年返回进行年度随访，治疗至随访的平均时间为2.1年。43.3%的受访者达到了CDC/WHO关于充分参与有氧PA的标准。对包括56名个体数据的多变量分析表明，年龄小于65岁且术后至少两年的患者，其调整后的平均活动维度汇总指数（ADSI）比65岁及以上且术后一年的患者高22.9分。与朋友或家人同住的患者调整后的平均ADSI比独居患者高17.2分。术前对结果期望最乐观的患者，其调整后的平均ADSI得分比不太乐观的患者高19.8分。
多米尼加队列中的TJR患者参与的PA少于CDC/WHO推荐的水平。此外，还发现了几个可能影响该人群PA的关联因素；具体而言，年龄大于65岁、近期术后、对术后结果不太乐观以及独居的参与者参与的PA较少。
