Barlow Tim, Dunbar Mark, Sprowson Andrew, Parsons Nick, Griffin Damian
Warwick Medical School, Clinical Sciences Research Laboratories, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK.
BMC Musculoskelet Disord. 2014 Dec 23;15:451. doi: 10.1186/1471-2474-15-451.
Knee osteoarthritis affects 10% of the UK population over 55 years, resulting in pain and decreased quality of life. Knee replacement surgery has a proven benefit, with over 85,000 performed each year in the UK; however, approximately 17% of people are dissatisfied after surgery. Consequently, some Primary Care Trusts have reduced the funding available for knee replacements.Most previous work has focused on the effect of different prostheses and treatment protocols on patient's outcome. However, this has been unable to account for all the variability and there is growing evidence that patient factors may significantly affect outcome. How to identify these at risk patients has been identified as a research priority by the National Institute of Clinical Excellence, the British Orthopedic Association, and the National Joint Registry.The aim of this study is to develop a clinically appropriate outcome prediction tool based on measurable predictors affecting outcome.
METHODS/DESIGN: We propose a prospective cohort study, designed to develop and validate an outcome prediction tool based on patient factors.Six hundred patients who are scheduled for total knee replacement secondary to primary osteoarthritis will be recruited before surgery from all six hospitals (NHS and private) that provide total knee replacements to the population of Coventry and Warwickshire (UK). Patients will complete a baseline assessment of patient factors before their operation and will be followed up at 6 and 12 months post surgery.
A clinically appropriate outcome prediction tool will allow patients to make a more informed decision regarding surgery. Aligning patient expectations with a realistic prediction of outcome should improve satisfaction. Ultimately, this project is likely to inform national policy making and regional service provision.
膝关节骨关节炎影响着英国55岁以上10%的人口，导致疼痛并降低生活质量。膝关节置换手术已被证明有益，英国每年进行超过85000例；然而，约17%的患者术后不满意。因此，一些初级医疗信托基金减少了膝关节置换手术的可用资金。
此前的大多数研究都集中在不同假体和治疗方案对患者预后的影响上。然而，这无法解释所有的变异性，并且越来越多的证据表明患者因素可能会显著影响预后。如何识别这些高危患者已被英国国家临床优化研究所、英国骨科协会和国家关节注册中心确定为研究重点。
本研究的目的是基于影响预后的可测量预测因素开发一种临床适用的预后预测工具。
方法/设计：我们提议进行一项前瞻性队列研究，旨在基于患者因素开发并验证一种预后预测工具。
将从为考文垂和沃里克郡（英国）人群提供全膝关节置换手术的所有六家医院（国民保健服务体系和私立医院）中，招募600名因原发性骨关节炎计划接受全膝关节置换手术的患者。患者将在手术前完成对患者因素的基线评估，并在术后6个月和12个月进行随访。
一种临床适用的预后预测工具将使患者能够就手术做出更明智的决定。使患者期望与对预后的现实预测相一致应能提高满意度。最终，该项目可能为国家政策制定和地区服务提供提供参考。
